CCIIO Issues Guidance on HRAs and Restricted Annual Limit Waiver Process

  On Aug. 19, 2011, the Center for Consumer Information and Insurance Oversight (CCIIO) introduced supplemental regulatory guidance regarding the annual limit waiver application process. Specifically, the guidance clarifies that sponsors of stand-alone HRAs will not be required to seek waivers from PPACA rules that restrict annual dollar limits on the coverage of essential benefits.

As background, PPACA Section 2711 generally prohibits group health plans and issuers from offering coverage that imposes lifetime or annual limits on the dollar value of “essential health benefits,” but PPACA allows restricted annual limits with respect to essential health benefits for plan years beginning before Jan. 1, 2014. The waiver program is an application process permitted under PPACA whereby the secretary of HHS is permitted to temporarily waive the restricted annual limits for limited benefit or mini-med plans if compliance would result in a significant decrease in access to benefits or a significant increase in premiums. For plan years beginning on or after Jan. 1, 2014, all group health plans may not impose annual dollar limits on essential health benefits.

 Prior regulations provided that HRAs that were integrated with group health coverage were exempt as long as the other group health coverage complied with the restricted annual limit requirements, meaning a waiver would not be needed. In those prior regulations, the CCIIO also requested comments on the process that should be imposed with respect to stand-alone HRAs.

 The new guidance recognizes that “all HRAs set limits on the amount that can be spent” and that the limits would always be less than the applicable restricted annual limit amounts, which would ultimately result in a “significant decrease in access to HRA benefits.” Therefore, the guidance “exempts as a class all HRAs that are subject to the requirements of Section 2711 and that were in effect prior to Sept. 23, 2010, from having to apply individually for an annual limit waiver for plan years beginning on or after Sept. 23, 2010, but before Jan. 1, 2014.” This means that HRAs established prior to Sept. 23, 2010, which were otherwise subject to the restricted annual limit requirements, such as stand-alone HRAs, have been granted a waiver from the requirements without the need to actually request a waiver.

 Significantly, while stand-alone HRAs are now exempt from the restricted annual limit waiver process, they still must comply with the record retention and annual notice requirements contained in the “Technical Instructions for the Waiver Extension and Waiver Application Process,” available below.

 Finally, if an employer that maintains an HRA also maintains other coverage, whether or not that coverage is integrated with the HRA, that other coverage must meet the annual limit requirements or obtain a waiver. All waiver and waiver extension applications must be received by Sept. 22, 2011, as set forth in the previous guidance issued on June 17, 2011.

 Technical Instructions for the Waiver Extension and Waiver Application Process
CCIIO Supplemental Guidance
Additional Information

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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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