Simple Cafeteria Plans – A GIFT for small employers.

 
Effective January 1, 2011, certain employers that establish “simple cafeteria plans” are exempt from the Code Section 125 nondiscrimination requirements as well as the non-discrimination requirements applicable to the plans offered through the cafeteria plan (e.g. Code Section 129 non-discrimination testing for dependent care FSAs, Code Section 105(h) non-discrimination testing for self-insured medical plans, etc).   The Act defines a simple cafeteria plan as a plan “which is established and maintained by an eligible employer,” and for which certain contribution, eligibility and participation requirements are met. In general, an eligible employer is an employer that employed an average of 100 or fewer employees for either of the prior two years.  

Plans that qualify as a simple cafeteria plan for any given year are treated as meeting any applicable nondiscrimination requirements for that year (i.e., non-discrimination testing is not required for these plans).

 

Eligible Employer Definition

 

Under the Act, a small employer is any employer that had, on average, 100 or fewer employees on business days during either of the 2 preceding years.

If an employer was not in existence during the prior year, the number of employees is based on the average number of employees that is reasonably expected to be employed on business days during the current year.

 

The Act contains a provision for growing businesses that allows employers who offer a simple cafeteria plan in a qualifying year and then subsequently grow beyond 100 employees to maintain that plan in subsequent years.

A growing employer may continue the simple cafeteria plan until the employer exceeds an average of 200 or more employees during a preceding year.

 

Eligibility, Participation, and Contribution Requirements

 

 

To establish and maintain a simple cafeteria plan, an eligible small employer must design their plan to meet the following requirements:

· All employees with at least 1,000 hours of service during the preceding plan year must be eligible to participate in the plan (other than employees that may be excluded, as outlined below)

 

· Each employee that is eligible to participate in the plan must have the right, subject to terms and conditions applicable to all participants, to elect any benefit available under the plan

  

Allowable Exclusions

 

The Act allows employers to exclude the following employees from participating in the plan:

 

· Employees who have not attained the age of 21 before the close of the plan year

 

· Employees who have less than one year of service with the employer as of any day during the plan year

 

· Employees covered under a collective bargaining agreement if there is evidence that the benefits covered under the plan were the subject of good faith bargaining between employee representatives and the employer.

 

· Employees described in Code Section 410(b) (3)(c) (relating to non-resident aliens working outside the United States)

 

Contribution Requirements

 

· The employer must make a contribution to provide qualified benefits under the plan on

behalf of each qualified employee, regardless of whether the employee makes a contribution of their own. This contribution amount must be in an amount equal to:

 

  1. A uniform percentage (not less than 2 percent) of the employee’s compensation for the plan year, or — An amount which is not less than the lesser of:

 

  1. 6 percent of the employee’s compensation for the plan year, or;

 

  1. Twice the amount of the salary reduction contributions of each qualified employee

 

 

Section 125(j)(3)(C) allows comparable contributions for HCEs and key employees, as it provides:

 

Subject to subparagraph (B)(regarding matching contributions), nothing in this

paragraph shall be treated as prohibiting an employer from making contributions to provide qualified benefits under the plan in addition to contributions required under subparagraph (A).

 

The required contributions in (A) are for “qualified employees” but the employer contributions for at least 2% of pay are for all employees under (A)(i), not just qualified employees, and (B) indicates that matching contributions can be made for HCEs and key employees.

 

 

The rate of matching contributions made by the employer on behalf of highly compensated or key employees cannot be greater than the rate of matching contributions for non-highly compensated or key employees.

 

 

Qualified, Highly Compensated, and Key

Employees Defined

 

For the purposes of the Act, a qualified employee is any employee that is eligible to participate in the cafeteria plan and is not a highly compensated or key employee.

 

The term “highly compensated employee” is defined in Code Section 414(q). The income limitation for highly compensated employees is adjusted from time to time and is currently set at $110,000.

 

The term “key employee” is defined in Code Section 416(i).

 

For 2010, an individual is an HCE if his or her compensation from the same employer in 2009 exceeded $110,000 or the person is an officer, more than 5% owner, a spouse or dependent working for the same employer.

 

For 2010, an individual is a key employee if:

 

· An officer earning more than $160,000 in the 2009 plan year; or

· A more than a 5% owner; or

· A more than a 1% owner receiving compensation in excess of $150,000 in the prior plan year.

· Government entities do not have Key Employees.

 

 

The Benefits of Establishing a Simple Cafeteria Plan

 Under the Act, simple cafeteria plans are exempt from the Code Section 125 nondiscrimination requirements as well as the nondiscrimination requirements applicable to the plans offered through the cafeteria plan (e.g. Code Section 129 non-discrimination testing for dependent care FSAs, Code Section 105(h) nondiscrimination testing for self-insured medical plans, etc).

 Because the sponsor of a simple cafeteria plan is not required to perform nondiscrimination testing, the administrative burden of offering the plan is lessened; making it easier for small employers to offer a plan to their employees.

 In addition, because C Corporation owner employees or other Key Employees can participate without limitation, Simple Cafeteria Plans present a new opportunity to  a large market segment that has previously been restricted by the non discrimination requirements.

 For more information or a proposal call Rich Sormanti, Sales and Marketing Director at 800-499-3539 ext. 233, rsormanti@amben.com

American Benefits Group will continue to keep you apprised of breaking news and developments. For up to the minute benefits news and views, important regulatory updates, candid discussion forums and insightful commentary,  subscribe now with an RSS feed to www.myBenefitsBlog.com 

 
 

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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).
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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.

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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.

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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.

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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.

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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

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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.

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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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