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Simple Cafeteria Plans – A GIFT for small employers.
SIMPLE Cafeteria Plans Provide a “Safe Harbor” from Non-discrimination Testing.
The good news is that the new SIMPLE cafeteria plan regulations provide for a “safe harbor” from non-discrimination testing requirements for small employers that allow employees to contribute to health insurance premiums on a pre-tax basis.
Eligible Employers
Employers with an average of 100 or fewer employees on business days during either of the two preceding years are eligible for the simple cafeteria plan.
- An employer that was previously eligible will remain so for each subsequent year until they exceed an average of 200 or more employees for the prior year.
- For new businesses, eligibility is based on the number of employees the business reasonably expects to employ for the current year.
Employee Eligibility
All employees who worked at least 1,000 hours during the prior plan year must be eligible to participate in the plan and be able to elect any benefit available under the cafeteria plan the same terms and conditions.
An employer can exclude the following from the eligibility requirement:
- Employees under age twenty-one prior to the end of the plan year
- Employees with less than one year of service
- Employees covered under a collective bargaining agreement
- Non-resident aliens
Employer Contribution Requirements
Regardless of whether a qualified employee makes any salary reduction contribution, the employer must make a contribution under the plan on behalf of each qualified employee in an amount equal to:
- a uniform percentage (not less than 2 percent) of the employee’s compensation for the plan year, or
- an amount that is not less than the lesser of:
– 6 percent of the employee’s compensation for the plan year, or
– twice the amount of the salary reduction contributions of each qualified employee (the rate of matching contribution for HCE or key employees cannot be greater than the rate for NHCEs).
New York may enact mandatory 132 Transit Benefit Program
New York State is considering similar legislation for employers with fifty or more employees to establish a qualified transportation fringe benefit program consistent with section 132 of the internal revenue code (IRS).
Three years ago the City and County of San Francisco passed groundbreaking legislation that mandates companies with 20 or more employees to offer transit benefits to their employees. The most striking aspect of this mandate was that it had the support of the business community. Business groups like the San Francisco Chamber of Commerce, the Golden Gate Restaurant Association and the Building Owners and Managers Association (BOMA) saw the inherent benefit for their members to participate in a program that saves payroll taxes, income tax for their employees, reduces traffic congestion, and lessens air pollution.
Now New York State is considering similar legislation for employers with fifty or more employees to establish a qualified transportation fringe benefit program consistent with section 132 of the internal revenue code (IRS). According to the content of the bill they believe that by “requiring large employers to offer this program, this bill will encourage the use of mass transit. For those employees who already commute to work using mass transit, it will offer significant tax savings. Participating employers will also reduce their tax burden.”
With the bill passed by the State Assembly and it is now up to the hands of the Senate. The bill has been put on the calendar for a floor vote #767. However, even though it is on the calendar there is no guarantee that it will pass through the Senate.
If you are a New York state employer, it is important to let your State Senator be made aware of your interest in seeing this legislation pass. If every larger employer in the State of New York offers the same transit benefit program that you currently offer, the results will be visible: Higher transit usages, less roadway congestion, and cleaner air. Saving employees on income tax could not be more timely in these tight economic times. With all the discouraging environmental news we receive, this is a chance for you to promote a beneficial solution.
SIGIS Releases Significant Updates to IIAS Eligible Products List
In response to new IRS guidance issued on Friday, September 3, 2010, the organization that manages the IIAS standard, SIGIS, is making significant changes to its Eligible Products List ©. The guidance, issued by the IRS in Notice 2010-59 in response to changes made by the Affordable Care Act, requires a doctor’s prescription for the reimbursement of over-the-counter (OTC) drug and medicines from health plans and tax-advantaged health care accounts. Based on this IRS guidance, the SIGIS Eligible Products List committee completed a thorough review of The List and determined that just over 15,000 items are impacted and will need to be removed. Even after this significant reduction, over 27,000 OTC items remain on the list for purchase without a prescription and through a Health Care Debit Card at SIGIS-certified merchants without the need for further substantiation.Items that continue to be eligible without a prescription include insulin, medical devices (crutches, blood sugar monitors, etc.), bandages, contact lens solution, and denture bond, as examples.
Though the IRS rule goes into effect on January 1, 2011, SIGIS is releasing a summary of the edits today to help SIGIS members begin to prepare for this significant change. The detailed SIGIS Eligible Products List (ELP) will be published on December 15, 2010.
Important Note: In the guidance, the IRS granted transitional relief for IIAS merchants. IIAS merchants have until January 15, 2011 to update their systems to be compliant with the new guidance. This means that some merchants may have the update completed sooner than others. It is important to prepare participants for this time period to minimize confusion and complaints.
Categories to be Deleted
The following categories have been removed from the Eligible Products List to prevent them from being purchased at an IIAS merchant without a prescription.
Categories no longer eligible without a prescription
- Acid Controllers
- Antibiotics
- Anti-Gas Products
- Anti-Parasitic Treatments
- Cold Sore Remedies
- Digestive Aids
- Hemorrhoidal Preps
- Motion Sickness
- Respiratory Treatments
- Stomach Remedies
- Allergy & Sinus medicine
- Anti-Diarrheals
- Anti-Itch & Insect Bite
- Baby Rash Ointments/Creams
- Cough, Cold & Flu
- Feminine Anti-Fungal/Anti-Itch
- Laxatives
- Pain Relievers
- Sleep Aids & Sedatives
Note: Controlled Drugs and Medicines that require a prescription as defined by state law remain eligible for purchase with an FSA/HRA card using IIAS.
Methodology
In addition to products that clearly meet the definition of a drug or medicine, the SIGIS Eligible Products List Committee also evaluated the items’ primary purpose. For example, band aids with an antibiotic remain eligible, as the primary use is as a band aid even though the antibiotic has a medicinal component. The basis of this methodology was vetted in informal conversations with the IRS about how to treat these items.
As we receive more information from SIGIS we will communicate it. If you have any questions or need additional information, please contact us at 800-499-3539
IRS Issues New Guidance on PPACA Changes to OTC Medical Expenses
The Internal Revenue Service issued guidance last Friday, September 3, 2010, in the form of Notice 2010-59 that reflects statutory changes regarding the use of health flexible spending arrangements (health FSAs) and health reimbursement arrangements (HRAs) to pay for over-the-counter medicines and drugs. A copy of the IRS Notice is attached for your convenience. This guidance is reproduced below at the end of this email and is scheduled to be published on September 27, 2010.
PPACA revised the definition of medical expenses for employer-provided accident and health plans, including health FSAs and HRAs. PPACA also revised the definition of qualified medical expenses for Health Savings Accounts (HSAs) and Archer Medical Savings Accounts (Archer MSAs). Beginning after December 31, 2010, expenses incurred for medicines or drugs may be paid or reimbursed by an employer-provided plan, including a health FSA or HRA, only if
- the medicine or drug requires a prescription,
- is available without a prescription (an over-the-counter medicine or drug) and the individual obtains a prescription, or
- is insulin.
A “prescription” means a written or electronic requirements of a prescription in the state in which the medical expense is incurred and that is issued by an individual who is legally authorized to issue a prescription in that state. Expenses incurred for over-the-counter medicines or drugs purchased without a prescription before January 1, 2011 may be reimbursed tax-free at any time, pursuant to the terms of the employer’s plan.
There are special rules for FSAs or HRAs using a debit card. The Notice indicates that current debit card systems are not capable of substantiating compliance with the revised definition of medical expense with respect to over-the-counter medicines or drugs because the systems are incapable of recognizing and substantiating that the medicines or drugs were prescribed. Therefore, for medical expenses incurred on and after January 1, 2011, health FSA and HRA debit cards may not be used to purchase over-the-counter medicines or drugs.
In order to facilitate the significant changes to existing systems necessary to reflect the statutory change, the IRS will not challenge the use of health FSA and HRA debit cards for expenses incurred through January 15, 2011. However, the plan must ensure that the card is reprogrammed no later than January 15, 2011 so that the card can no longer be used to purchase over-the-counter medicines or drugs.
Some health FSAs include a provision for a grace period, so that if all of the money in the health FSA is not spent by December 31 in a given year, the amount left in the health FSA can still be used at the end of the year to reimburse expenses incurred during the first 2 1/2 months of the following year. The IRS Notice makes it clear that the new OTC rules apply to purchases made on or after January 1, 2011. Thus, even if the FSA plan includes a 2 1/2 month grace period provision, the cost of OTC medicines and drugs purchased without a prescription during the first 2 1/2 months of 2011 will not be eligible to be reimbursed by a health FSA.
Finally, cafeteria plans may need to be amended to conform to the new OTC requirements. Notwithstanding the rule against retroactive amendments, Notice 2010-59 permits an amendment to conform a cafeteria plan to the requirements set forth in the Notice that is adopted no later than June 30, 2011. The amendment may be made effective retroactively for expenses incurred after December 31, 2010 (or after January 15, 2011 for health FSA and HRA debit card purchases).
Please contact me if you have any questions.
Richard A. Szczebak, Esq. | Of Counsel | Parker Brown & Macaulay, P.C.
4 Faneuil Hall Marketplace, Boston MA 02109 | 617-399-0441 | Fax 617-350-7744
rszczebak@parkerbrown.com | www.parkerbrown.com
Treasury Regulations (Circular 230) require us to disclose the following in connection with the correspondence: Subject to the exclusions specified in Circular 230, any advice included in this email and its attachments regarding federal tax matters was not intended or written to be used, and it cannot be used by the taxpayer, for the purpose of avoiding penalties that may be imposed on the taxpayer.
3 comments >Cafeteria Plans, HSA and HRAs are now allowed to offer coverage to Adult Children to age 27 Retro to 3-30-10
The IRS has released a notice which allows Cafeteria Plans to offer coverage to adult children to age 27, even if those children are not tax qualified dependents of the employee. The coverage is retroactive to March 30th 2010. In order to adopt this provision, employers must amend their Section 125 plan documents to reflect the offering to adult children to age 27.
The IRS released this notice http://www.irs.gov/pub/irs-irbs/irb10-20.pdf which has details of the program.
1. A cafeteria plan (POP, FSA, DCAP etc) may allow for adult children to have coverage under an FSA or POP plan. in
2. The IRS is making changes to the “change in status rules” to allow employees to revoke a election and make new elections only in limited circumstances.
See Treas.Reg. § 1.125–4(c). A change in status event includes changes in the number of an employee’s dependents. The regulations under § 1.125–4(c) currently do not permit election changes for children under age 27 who are not the employee’s dependents.
IRS and Treasury intend to amend the regulations under § 1.125–4, effective retroactively to March 30, 2010, to include change in status events affecting nondependent children under age 27, including becoming newly eligible for coverage or eligible for coverage beyond the date on which the child otherwise would have lost coverage. In general, a health reimbursement arrangement (HRA) is an arrangement that is paid for solely by an employer (and not through a § 125 cafeteria plan) which reimburses an employee for medical care expenses up to a maximum dollar amount for a coverage period. Notice 2002–45, 2002–2 C.B. 93. The same rules that apply to an employee’s child under age 27 for purposes of §§ 106 and 105(b) apply to an HRA.
In order to implement this dependent coverage eligibility change employers should amend their plan documents and SPD to include eligibility of adult children of the employee up to age 27. American Benefits Group will prepare the necessary amendments for employer clients to adopt this new coverage provision.
Over The Counter Changes for Flex Debit Card Coming for 2011
Debit Card Entity Clarifies Over-the-Counter Changes for 2011
Within Section 9003 of the PPACA health reform law, IRS Code was amended so that over-the-counter (OTC) drugs will no longer be reimbursable unless they are prescribed by a physician as of Jan. 1, 2011. This prohibition affects health Flexible Spending Accounts (FSAs), Health Reimbursement Arrangements (HRAs), Health Savings Accounts (HSAs) and Archer Medical Savings Accounts (MSAs). Many plans currently allow participants to use electronic payment cards or debit cards when purchasing OTC items. When electronic payment is permitted, existing substantiation rules allow for automatic reimbursement at the point of sale if a merchant uses the Inventory Information Approval System (IIAS).
The entity in charge of the IIAS (Special Interest Group for IIAS Standards, or SIGIS) issued a news release on how it will address the OTC drug prohibition. It indicated that, effective Jan. 1, 2011, OTC drugs will be reclassified, changing from “Eligible” to “Dual Purpose.” This means that these items can no longer be auto-substantiated. Beginning Jan. 1, 2011, participants will be able to submit OTC drug purchases for reimbursement if they obtain a letter of medical necessity or prescription from their physician. The press release included a sample of OTC drugs, including acid controllers, allergy/sinus/cold/flu medicines, laxatives, pain relief medicines, sleep aids and sedatives and stomach remedies.
Click here to view the press release.
2 comments >Health Care Reform – The Good, the Bad and the Ugly… a Video Tour
My good friend Dave Cleary (the Video Benefits Guy), has produced a nice overview of the massive Health Care Reform Legislation. He reviews and highlights the landmark changes to benefits and the very substantial new taxes on individuals and employers that you need to know about NOW .
Dave reviews the Good, the Bad and the UGLY in chronological order as these huge changes phase in from 2010 to 2018. Take a look at Parts 1 and 2 – Dave also offers personalized branded versions of his videos for employee benefits brokers, consultants and employers. Thanks Dave!!
http://videobenefitsguy.com/HealthcareReformVideo.aspx
no comments >IRS Clarifies Rules Regarding Adult Dependents
IRS Clarifies Rules Regarding Adult Dependents
On April 27, 2010, the IRS issued Notice 2010-38, relating to the tax exclusion for medical care reimbursement of adult children. These changes are a result of the two health care reform laws passed in March: the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA).
The Notice collectively refers to these laws as the Affordable Care Act. Two major changes resulted for adult children of covered employees. First, group health plans must begin to cover adult children up to age 26 for plan years starting after September 23, 2010. Second, the definition of a “dependent” includes adult children up to age 27 for medical care reimbursements under Sec. 105(b) of the Internal Revenue Code. Notice 2010-38 is concerned with the second change.
The IRS clarified that the expansion of the tax exclusion went into effect when HCERA became law on March 30, 2010. This has an immediate effect on plans that define eligibility based on Sec. 105(b), including Health FSAs and health reimbursement arrangements (HRAs).
The Notice makes several important points:
- The tax exclusion applies for medical care reimbursements of individuals who are not age 27 or older at any time during the calendar year. For example, if an adult child turns 27 in any month of 2010, a Health FSA/HRA cannot reimburse any 2010 expenses for that adult child. However, expenses for adult children who are 26 or younger as of the end of the calendar year may be reimbursed if incurred on or after March 30, 2010.
- Employers may rely on an employee’s representation as to the birthdate of the adult child.
- An adult child is defined by reference to Sec. 152(f)(1): son/daughter, stepson/stepdaughter, adopted child or eligible foster child. The other qualifying child requirements in Sec. 152 no longer apply for establishing dependent status. These other requirements include residency and amount of support provided. The amount of the dependent�s income does not matter.
- This expansion applies to married and unmarried adult children. It does not apply to the spouse or children of those adult children.
- Current Sec. 1.125-4 rules allow election changes for change in status events. A change in status includes the addition of a dependent under Sec. 152. The IRS indicated that it will change (retroactive to March 30, 2010) this rule to include adult children under age 27. What this means is that participants who add an adult child dependent can increase their current year Health FSA election.
- The IRS will permit a onetime exception to the rule that all plan changes must be prospective. Employers may amend their cafeteria plans retroactively to allow pre-tax salary reductions for adult children as long as they execute the amendment by December 31, 2010. Infinisource’s plan documents currently refer to Sec. 105(b), so they include the expansive definition of an adult child already.
- The IRS will amend its Sec. 106 Regulations (relating to accident and health insurance) to match the changes to Sec. 105, even though the Affordable Care Act did not specifically address Sec. 106.
- This expansion also applies to health care accounts in pension plans (Sec. 401(h)), voluntary employee benefit associations, or VEBAs (Sec. 501(c)(9)), and the self-employed medical tax deduction (Sec. 162).
- This expansion does not appear to apply to Health Savings Accounts.
The following is a summary of the two provisions relating to adult children:
| Plan Coverage Mandate | Tax Deductibility of Medical Care Coverage and Claims | |
|---|---|---|
| Brief description | Plans that cover dependent children must provide for coverage of adult children until they turn age 26. | Medical care coverage and claims for adult children are tax deductible until the year in which an adult child turns age 27. |
| Application to spouse/children of adult child | Not applicable. | Not applicable. |
| Additional effect | Grandfathered plans can prohibit adult children who are eligible for other group coverage. | Election changes are permitted for adding a new dependent. |
| Effective date | Plan years starting after September 23, 2010. | March 30, 2010. |
| Health Care Reform law provision | Sec. 1001 of PPACA and Sec. 2301 of HCERA. | Sec. 1004 of HCERA. |
| Applies to existing law | Sec. 2714 of the Public Health Service Act. | Sec. 105(b) of the Internal Revenue Code. |
Several major insurance carriers (e.g., CIGNA, UnitedHealth Group and Humana) have already announced they are adding eligible adult children ahead of September 23, 2010, unless plan sponsors object. Some self-funded employers are doing likewise.
Recall that prior to the Affordable Care Act, tax-free coverage was available for dependent children up to age 19, or age 24 if enrolled as a student. Dependent status was based on satisfying one of two tests as either a qualifying child or a qualifying relative under Sec. 152(c) and (d), respectively. For purposes of providing tax-free medical coverage, the Affordable Care Act has now made it much easier for adult children to qualify.
5 comments >FSAs will get a two year honeymoon
The final health reform bill allows a two-year reprieve for flexible spending accounts and a $2,500 cap on annual contributions in the Senate bill that was scheduled to take effect December 31 of this year. FSAs will now see their contributions limited starting on January 1, 2013 and the cap will be indexed to inflation starting in 2014. The final bill contains no other changes in CDH plans and never mentions HSAs.
The change in FSA deadlines was a victory for a group of employers, health plans and administrators led by the Employers Council on Flexible Compensation and board chair/UMB Bank leader Dennis Triplett. Others involved were Joe Jackson from Wageworks, Bob Patricelli from Evolution Benefits, Bob Natt from PayFlex, Tom Torre from Metavante, and a number of other companies with major FSA products.
© Interpro Publications Inc. 2010 (used with permission 3-24-10)
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