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May owners of an LLC (usually called “LLC members”) participate in the LLC’s medical or cafeteria plan and receive employer HSA contributions?

August 30th, 2011 | 2 Comments |
Category: Cafeteria Plans, Compliance and Regulatory, HSA, Health Reimbursement, Health Savings Account, Health Savings Accounts, IRS, Section 125 Plans, Taxes

 

A limited liability company’s (LLC’s) health plans may create special issues with respect to LLC member participation. This is because LLCs may be treated as either a partnership or a corporation (depending on how the LLC has elected to be treated), and for tax purposes the IRC treats partnerships and corporations differently. No IRS guidance specifically addresses the status of LLC members for purposes of health plan participation, including participation in a medical or cafeteria plan. But the general rules of Section 125 (also known as the cafeteria plan rules) would likely apply as described below.

 LLC Structured as a Partnership

 Pre-tax premium payroll deductions are subject to IRC Section 125. Under Section 125, as a general rule only employees are eligible to participate in the cafeteria plan. Partners in a partnership are considered self-employed individuals, not employees. Thus, for LLCs that are taxed as partnerships, members of the LLC generally cannot participate in a cafeteria plan. This means that the LLC members would not be eligible to benefit from the tax advantages of paying premiums on a pre-tax basis. But those LLC members may still be eligible to participate (on an after-tax basis) in the medical policy/plan as an eligible person, depending on the definition of eligibility under the plan.

 If, however, the plan is offered on a post-tax basis outside of a cafeteria plan, or on a non-contributory basis (where the employer pays all of the premiums), then the owner may participate in the group health plan. In addition, if they are self-employed as LLC members, the members may be able to take a deduction on their federal income tax returns; this would really be a taxation issue best addressed by an accountant or tax counsel.

 LLC Structured as a C Corporation Where LLC Members Are Considered Employees Because They Are Receiving W-2 Reportable Wages

 If the LLC has elected to be taxed as a C Corporation, then the LLC member may be considered an employee eligible to participate in the cafeteria plan. That said, the salary reduction under the cafeteria plan may only be from the individual’s compensation as an employee.

 Employer HSA Contributions

 With respect to an HSA, if the HSA contributions are made through the cafeteria plan, then the same rules as above would apply and the answer would depend on whether the LLC is treated as a partnership or a C Corporation. If the LLC is treated as a partnership, then the employer could not make a pre-tax contribution to the LLC member’s HSA account. However, if the LLC is treated as a corporation, and the LLC member is considered an employee, then the employer could make pre-tax contributions to the LLC member’s HSA accounts (although those members would likely be considered highly compensated, so there may be nondiscrimination issues if non-highly compensated individuals are not also receiving employer HSA contributions).

 If the HSA contributions are made on an after-tax basis, then the employer would not be bound by the Section 125 restrictions with respect to the LLC members. However, the comparability rules would then apply. The comparability requirements basically require employees to make comparable contributions for all comparable participating employees. Comparable participating employees are employees who are in the same group with respect to benefits (i.e., self-coverage, self-plus-one coverage, etc.). Thus, so long as the employer satisfies the comparability rules, the employer could contribute to the LLC members’ HSA accounts.

 Finally, regardless of the LLC structure, the LLC members could always make their own HSA contributions on a post-tax basis and take the contributed amount as a deduction on their own individual federal income tax return. Again, this may necessitate guidance from the member’s own tax professional.

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More than 11.4 million Americans now covered by HSA Eligible PLans

June 21st, 2011 | No Comments |
Category: CDHC, COBRA, Compliance and Regulatory, HRA, HSA, Health Care Reform, Health Reimbursement, Health Savings Account, Health Savings Accounts, IRS, PPACA, Taxes, Uncategorized

A release from America’s Health Insurance Plans:

AHIP Urges Policymakers to Prevent Disruption for HSA Policyholders 

Washington, DC – More than 11.4 million Americans are covered by Health Savings Account (HSA)-eligible insurance plans, a more than 14 percent increase since last year, according to a new census released today by America’s Health Insurance Plans (AHIP) finds. 

 

Health Savings Accounts were authorized starting in January 2004.  Since then, AHIP has conducted an annual census of health plans participating in the HSA health plan market. This year’s census shows that enrollment in HSA plans has nearly doubled over the last three years, from 6.1 million enrollees in January 2008 to 11.4 million in January 2011.
 
“HSA plans continue to be a vital source of affordable coverage for millions of families and employers across the country,” said Karen Ignagni, President and CEO of AHIP.
 
Key findings from the census include:

  • As of January 2011, approximately 11.4 million people were covered by HSA plans, an increase of more than 14 percent since last year.
     
  • Between January 2010 and January 2011, the fastest growing market for HSA plans was for large-group coverage, which rose by 26 percent, followed by individual market coverage, which grew by 15 percent.
     
  • In the individual market, 2.4 million covered lives are enrolled in HSA plans, while approximately 2.8 million lives were enrolled in HSA coverage in the small-group market and over 6.3 million lives were covered in the large-group market.
     
  • States with the highest levels of HSA enrollment were California (1,073,319 enrollees), Texas (844,832 enrollees), Ohio (728,868 enrollees), Illinois (690,509 enrollees), Florida (656,243 enrollees) and Minnesota (507,307 enrollees).

 

AHIP is reaching out to policymakers on both sides of the aisle about ways to mitigate the potential unintended consequences of provisions in the new health care reform law that could disrupt or limit the availability of coverage through HSA plans, including: 

  • Restrictions on Over-the-Counter Medications: Starting this year, HSA funds can no longer be used to purchase over-the-counter (OTC) medications without a prescription.  This requirement reduces consumers’ access to common OTC drugs, such as allergy medications, and instead provides an incentive to use higher-cost prescription drug alternatives. 
     
  • Medical Loss Ratio: The medical loss ratio (MLR) regulation is particularly problematic for HSA-eligible plans.  By Congressional design, these plans are intended to provide consumers with a high-deductible, low-premium coverage option along with the ability so save for health care expenses through an HSA.  While these plans typically have lower benefit costs, they are not necessarily less costly to administer on a per-enrollee basis, and, as a result, naturally have lower loss ratios.  Policymakers should recognize the unique nature of HSA plans to preserve consumers’ access to this important coverage option. 
     
  • Minimum Actuarial Value Requirement: Effective in 2014, insurance coverage sold in the individual and small-group markets must meet certain minimum actuarial values for each level of coverage provided: bronze, silver, gold, and platinum.  The lowest level, bronze, must have a minimum 60 percent actuarial value, which is the dollar value of the average expected benefits paid out by the plan.  The ACA directs the HHS Secretary to establish the process for determining actuarial values and states that the Secretary “may” include the amount of the annual employer HSA contributions toward the actuarial value calculation.  Including employer HSA contributions in the actuarial value calculation significantly increases the likelihood that HSA plans will meet the minimum requirement and will help ensure consumers continue to have access to the high-quality, affordable coverage they rely on today. 


For the full report and slides, please visit the links below:
Full Report: http://www.ahipresearch.org/pdfs/HSA2011.pdf
Slides: http://www.ahipresearch.org/pdfs/HSA2011-slides.pdf

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HSA Contributions and Assets Continue Rapid Growth Curve

June 2nd, 2011 | No Comments |
Category: CDHC, Compliance and Regulatory, FSA, Flexible Spending, HRA, HSA, Health Care Reform, Health Reimbursement, Health Savings Account, Health Savings Accounts, IRS, Taxes, Uncategorized

More Americans are using HSAs to save and pay for medical expenses, according to a new report from the J.P. Morgan Treasury Services. The report shows the average HSA balance is up 7 percent from 2009, at $1,494, and the average account contribution rose slightly in 2010 to $1,884, compared to $1,816 in 2009. The report includes the J.P. Morgan HSA Program Snapshot which details the saving, spending and investing patterns and trends among 700,000 HSA account holders in 2010. The average age of account holders is 43, and 73 percent of account holders contributed more than they spent during each month in 2010 (up from 68 percent in 2009), the report showed.

“As health care costs continue to rise year over year, Americans are increasingly leveraging HSAs as a means for using pre-tax dollars on medical expenses, as well as a way to invest and earn money for future health costs,” says David Josephs, managing director at J.P. Morgan.

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Proposed Family and Retirement Health Investment Act of 2011 would benefits FSAs and HSAs

May 31st, 2011 | 2 Comments |
Category: CDHC, Compliance and Regulatory, FSA, Flexible Spending, HSA, Health Care Reform, Health Savings Account, Health Savings Accounts, IRS, Uncategorized

Sen. Orrin Hatch, R-Utah, introduced Thursday a bill that would modify and streamline rules for health savings accounts and flexible spending accounts.

Companion legislation was introduced in the U.S. House of Representatives by U.S. Rep. Erik Paulsen (R-Minn.).

Known as The Family and Retirement Health Investment Act of 2011, Hatch’s bill would:

  • Allow a husband and wife to make catch-up contributions to the same HSA
  • Remove the onerous new restrictions on the use of HSA and FSA dollars for the purchase of over-the-counter drugs
  • Allow individuals to roll-over up to $500 from their FSA accounts
  • Clarify the use of prescription drugs as preventive care that will not be subject to an HSA-eligible plan deductible
  • Reauthorize the use of Medicaid health opportunity accounts
  • Promote wellness by expanding the definition of qualified medical expenses to encourage more exercise and better diet
  • Allow seniors enrolled in Medicare Part A to continue contributing to their HSAs
  • Allow for the purchase of low-premium health insurance and long-term care insurance with HSA dollars.
  • Repeals the recently enacted deductible limits of $2,000 for single coverage and $4,000 for family coverage for plans sold to small employers.
  • Allows purchase of COBRA coverage, long-term care insurance, and HSA-qualified policies from an HSA.

“This legislation will provide American workers and retirees with a common-sense way of improving access to quality, affordable health care,” said Hatch, a ranking member of the Senate Finance Committee. “These health plans empower Americans to take control of their health and well-being. Health Savings Accounts and Flexible Spending Accounts allow consumers to make informed decisions about their health care and will help restrain costs by putting people in charge of their health choices. ”

Just three months ago, Republican lawmakers introduced legislation that would abolish a provision in health reform law, which prohibits Americans to use their FSA and HSA funds to purchase over-the-counter medications without a prescription. [See FSA changes go into effect]

Rep. Erik Paulsen, R-Minn., and Sen. Kay Bailey Hutchison, R-Texas, introduced the bill, known as The Patients’ Freedom to Choose Act of 2011.

Groups such as the Consumer Healthcare Products Association, the Health Choices Coaltion, and the National Association of Chain Drug Stores have pushed for the repeal of the OTC provision, saying it undermines tax-advantaged health plans and increases costs for patients.

“Instead of saving consumers money and encouraging them to proactively address their health needs when they can and should, this provision will increase costs to the health care system and place a new burden on already over-burdened physician offices,” Shawn Martin, director of government relations for the American Osteopathic Association recently said in a statement.

The American Osteopathic Association is part of the Health Choices Coalition, which sent a letter to Congress earlier this month.

The House of Representatives also passed a measure earlier this month that prohibits workers from receiving tax-free reimbursement from their HSA or FSA for out-of-pocket expenses relating to most abortions. The law does not apply to abortions performed in the cases of pregnancy resulting from rape or incest.

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As health costs continue to rise, CDH plan adoption increased 25% in 2010

May 20th, 2011 | No Comments |
Category: CDHC, Compliance and Regulatory, HRA, HSA, Health Care Reform, Health Reimbursement, Health Savings Account, Health Savings Accounts, PPACA, Uncategorized

Health benefit cost growth accelerated to 6.9% in 2010, following almost 10 years of stable or slowing increases, reports Mercer Inc.

Last year, health benefit costs rose just 5.5%, according to a new study by Mercer, part of Mercer Marsh & McLennan Companies Inc., New York (NYSE:MMC).

Health benefit costs in 2010 averaged $9,562 per employee

Health care reform requirements could add 1% to 2% to health care costs next year, Mercer notes. Employers it surveyed said health care benefit costs could increase 10% next year, but on average they hoped to hold increases to 6.4%.

Many large employers added consumer-directed health plans (CDHPs) in 2010, helping to push up enrollment in these high-deductible plans to 11% of all covered employees. Overall enrollment in CDHPs grew from 9% of all covered employees in 2009 to 11% in 2010. CDHP enrollment has risen by 2% each year since 2006, Mercer reports.

CDHP enrollment rose fastest for employers with 20,000 or more employees. In 2010, 51% of these employers offered a CDHP, up sharply from 43% last year.

Health benefit cost rose three times faster than the CPI in 2010. Cost rose 8.5% among employers with 500 or more employees and 4.4% among those with 10 to 499 employees.

Mercer surveyed 2,836 public and private organizations with 10 or more employees.

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Restoration of OTC expenses for FSA, HRA and HSA gains momentum

March 9th, 2011 | 2 Comments |
Category: CDHC, Compliance and Regulatory, FSA, Flexible Spending, HRA, HSA, Health Care Reform, Health Reimbursement, Health Savings Account, Health Savings Accounts, IIAS, PPACA, Uncategorized

This morning a long front-page article in the Wall Street Journal attacks the adverse impact of PPACA restrictions on OTC purchases by FSAs, coming just as several bills are introduced in House and Senate to fix CDH accounts.

The article cites several newly-discovered problems with the OTC ban impact, including perverse incentives that are created for patients to move back to brand name drugs, to seek more office visits, and to increase the admin expenses of pharmacies, physicians and retail chains. Although most of it is anecdotal there is strong evidence that the OTC ban is causing higher national health spending, and possibly reducing medical quality.

“Some 33 million Americans are in families that have flexible spending accounts,” the article notes, and HRAs and HSAs are also impact by the ban. “The over-the-counter provision is emerging as a top target for change,” and both HHS Secretary Sebelius and Treasury officials are looking at it. The AMA and chain drug stores are backing a repeal of the OTC ban.

12 Bills Eye CDHP Changes In PPACA

So far at least 12 bills have been introduced in Congress to fix or repeal changes in CDH plans under PPACA including 3 bills in the Senate. At least 35 House members co-sponsored a bill. The most popular change is removing the OTC payment ban for HSAs, HRAs and FSAs, including a bill by Sen. Kay Bailey Hutchison with 9 co-sponsors that is expected to be part of a Senate Finance Committee bill. Even a bill by liberal Sen. Barbara Boxer (D-CA) and co-sponsored by a Republican gives FSAs to members of the military. None of the bills expands CDH accounts or modifies PPACA in other ways.

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Educating Clients and Employees Is the Key To HSA Sales

March 2nd, 2011 | No Comments |
Category: HSA, Health Care Reform, Health Savings Account, Health Savings Accounts

 Savvy brokers understand that health savings accounts can not only offer clients substantial savings on health insurance premiums, but also triple tax advantages and help clients save for health care and other expenses in retirement. The key is to educate your clients to think in this way.

Over the years, more and more brokers have come to believe that HSAs are a very appealing benefits option. Many brokers, especially in the early years, had difficulty talking with their clients about HSAs because the concept was so new and different. This made them hesitant to introduce HSAs as a solution; yet, once brokers were able to demonstrate to their clients the savings, flexibility, and control that HSAs bring, they quickly became advocates.

Since HSAs were introduced on a widespread basis in 2004, plan enrollment has continued to expand steadily. According to America’s Health Insurance Plans, as of Jan. 1, 2010, more than 10 million Americans had HSA/high-deductible health plan coverage. Moreover, a recent National Business Group on Health survey of large companies found that 61 percent of employers are offering consumer-directed health plans in 2011, and 20 percent expect to make the consumer-directed health plan the only choice offered to their employees.

Driving factors

The growth this year is particularly impressive when you consider that it has taken place in a highly uncertain environment. Prior to the passage of health care reform legislation, there were questions about new limitations that might be imposed on HSAs, and even whether the products would continue to exist at all. Now we know that the near-term effect of the new health care reform law will be limited to two areas where HSAs are specifically concerned — an increased penalty for non-medical withdrawals for consumers under age 65, and the exclusion of coverage for over-the-counter medications purchased without a prescription.

To be sure, some of the growth in HSA plans stems from the fact that more employers are offering them as an option to help them control the costs of providing health care benefits. But brokers who sell individual coverage are also doing their part to show their clients that HSAs can be the right solution for them and can help their families control their health care spending.

Making it work

So, how do the brokers who have had a great deal of success educate clients whose coverage experience previously consisted of traditional health plans?

“It’s just talking with people — getting them to understand that once you meet the deductible, everything else is covered,” said Anthony Nefouse, vice president of Indianapolis, IN-based Nefouse & Associates. “A family can budget for the worst-case scenario, put the money aside, and if they don’t use it, they can carry it over year after year.”

According to Nefouse, today’s consumer is gaining greater access to health care information over the Internet — and that can only be beneficial for HSA clients as they set their budgets and shop around for their health care.

“As more programs and resources become available, people will better educate themselves on the cost of care,” he said. “Eventually, consumers with HSAs will know and can compare the cost of a procedure before they are treated.”

William Steffen of Steffen Financial Inc., based in Peoria, AZ and also licensed in Florida, explains to his clients that HSAs are a form of “pure” insurance.

“All clients start out expecting everything to be covered in a health plan, no matter what type,” Steffen said. “Then, the questions are: Do they want to reduce their health care costs and are they really looking for protection for the major, catastrophic risks?”

Steffen adds that the education process doesn’t end with the sale, and that “you need to keep in contact with your clients to make certain they understand how the HSA works, especially in the beginning.”

Nefouse said about 90 percent of his sales come from HSAs, and Steffen estimates that 85 percent of his clients have purchased HSA plans. Steffen and Nefouse both use their respective websites as tools to help educate clients and prospects about HSAs.

With millions of Americans looking to save on their health insurance premiums, control health care spending, and reduce taxes, educating consumers about the value of HSAs is a win for the broker and the client.

“In the end,” Steffen said, “my HSA clients become better consumers, they ask more questions about what is absolutely necessary, and are better able to do what’s in their best interests.” 

Susan Fowler is vice president of sales for Golden Rule Insurance Company.

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IRS Expands Use of Debit Card for OTC Drugs

December 28th, 2010 | No Comments |
Category: Compliance and Regulatory, FSA, Flexible Spending, HSA, Health Care Reform, Health Reimbursement, Health Savings Account, Health Savings Accounts, IRS, Uncategorized
 

On Thursday, December 23, 2010, the IRS issued Notice 2011-5, which clarifies the rules for when a Health FSA or Health Reimbursement Arrangement (HRA) may reimburse prescribed over-the-counter (OTC) medicine or drugs.

 Under the health care reform law called the Affordable Care Act (ACA), OTC drugs require a prescription if incurred on or after January 1, 2011. Previously, Notice 2010-59 delayed the effective date to January 16, 2011, for purchases made with debit cards.

Notice 2011-5 provides a further exception for debit cards, outlining a procedure where a prescribed OTC drug could be reimbursed through a debit card if the all five of the following requirements are met:
  • Before the purchase, the FSA/HRA participant gives the pharmacist a copy of the prescription, the pharmacist provides the OTC drug and assigns an Rx number
  • The pharmacy or other vendor retains a record of the Rx number, the name of the purchaser or person for whom the prescription applies, and the date and amount of the purchase
  • The pharmacy retains all records for review by the employer or its agent upon request
  • The card will not work without an assigned Rx number
  • All of the other usual requirements are met

The above requirements must be met for the following types of vendors:

  • Drug stores and pharmacies
  • Non-health care merchants with pharmacies (e.g., Walmart)
  • Mail order and web-based vendors that sell prescription drugs

The card could also be used at other vendors with a health care-related Merchant Category Code, except the requirements above related to an Rx number do not apply because no pharmacy is involved.

If all of the above requirements are met, the purchase will be considered fully substantiated at the point of sale. Notice 2011-5 states that the rules for debit card purchases at “90 percent pharmacies” continue to be subject to the ACA rules in Notice 2010-59, which was issued earlier in 2010.

 
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SIGIS Releases Significant Updates to IIAS Eligible Products List

September 27th, 2010 | 4 Comments |
Category: Compliance and Regulatory, FSA, Flexible Spending, HSA, Health Care Reform, Health Reimbursement, Health Savings Account, Health Savings Accounts, IIAS, Uncategorized

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


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