New IRS Rules For Employers Regarding Health Insurance

Within the past year, the IRS posed a question to themselves to consider imposing more specific rules and guidelines to employers. These rules were in regard to the effect of employers’ decisions to contribute to employees choosing alternate healthcare coverage.

What are the consequences to the employer if the employer does not establish a health insurance plan for its own employees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health plan in the marketplace or outside the marketplace)?

Employer Payment Plans

In order to be set apart from health reimbursement accounts (HRA’s) and healthcare flexible spending accounts (FSA’s), the IRA designated the new arrangement of specific guidelines to be known as “employer payment plans”.

Because employer payment plans are considered to be group health plans, as such they are subject to the provisions and rules of the Affordable Care Act (ACA). This includes the prohibition of an annual limit for essential health benefits, along with the requirement for full coverage on preventive health services. Unfortunately, these provisions also mean that employees cannot purchase separate coverage for these particular benefits, because according to the IRS, employer payment plans “cannot be integrated with individual policies to satisfy the market reforms”.

The IRS has mandated that because employer payment plans do not satisfy the market reforms, employers would be required to pay an excise tax of up to $100 per day per employee. That totals up to $36,500 per year for just one single employee, let alone 50 or 100 or more employees.

While the IRS and Department of Labor have decided that HRAs and healthcare FSAs are acceptable plans for helping employees pay for certain benefits including vision, dental, accidents, long-term care, and automobile medical payment coverage, it has been determined that employer payment plans cannot be integrated with either one.

Wraparound Coverage

Fortunately, there is an alternate form of health coverage available that is not actually subject to ACA requirements. Called “wraparound coverage”, it was established in 2015 and determines that employers can help employees buy basic health insurance without being penalized. This insurance must be supplementary to a standard health plan that does meet ACA requirements, and coverage cannot cost more than 15% of the standard health plan cost offered to the rest of the employees.

For employers still pursuing other healthcare options, the penalties for an employer payment plan can be avoided by giving employees a pay raise that will sufficiently cover their health benefits.

However, if this is the route you choose as an employer, remember that pay raises equal increased payroll taxes. Ultimately, because all income is taxed, the amount your employees will have left available to cover the cost of health premiums will be less than intended. Additionally, employees may soon forget why they actually received the raise, and can quickly become resentful that a standard health plan is not offered to them as valued employees.

Lastly, it is important to note that even if you provide a salary raise to your employees to avoid employer payment plan penalties, you will still be subject to the penalty required for not providing a health coverage plan to your employees.

Sincerely,
Your Team at Phoenix Health Insurance