Over the past few years, there has been a $100 per day per employee penalty for employers who provided certain Health Reimbursement Accounts (HRAs) and/or Employer Payment Plans.
Under an HRA, an employer reimburses employees for the medical expenses up to a certain limit. The reimbursement is deductible by the employer and tax-free to the employee.
Under an Employer Payment Plan, the employer either reimburses employees for the cost of health insurance premiums or directly pays the insurance company for the employees’ health insurance coverage. Again, the payment is deductible by the employer and tax-free to the employee.
Under the market reform provisions of Obamacare, these plans became disfavored and subjected the employer to a $100 per day per employee (i.e., $36,500 per employee per year) penalty. The primary reason for the penalty is because the market reform provisions eliminated any annual or lifetime cap on benefits. HRAs are generally subject to an annual cap and Employer Payment Plans are deemed to be capped at the cost of the employee’s premium that is being paid.
Qualified HRAs No Longer Subject to $100 per Day per Employee Penalty
Qualified HRAs are exempt from the $100 penalty. Employer Payment Plans remain subject to the penalty.
Eligible employers that do not offer group health insurance coverage to any employees can offer a Qualified Small Employer HRA (QSEHRA). Eligible employers are employers that are not applicable large employers under Obamacare (applicable large employers have 50 or more employees).
The employer must offer a QSEHRA to each eligible employee. An eligible employee is defined broadly as any employee; however, the employer can elect to exclude the following:
- Employees who have not completed 90 days of service
- Employees under age 25
- Part-time or seasonal employees
- Employees covered by a collective bargaining agreement covering accident and health benefits
- Nonresident alien employees with no U.S. source income
A QSEHRA must be provided on the same terms to all eligible employees and funded entirely by the employer. Payments and reimbursements are limited to $4,950 per year ($10,000 for family coverage) and are prorated if the employee is not covered for the whole year. For example, if a single person starts employment on July 1, then the limit is reduced by 50%–$2,475 ($4,950 times 50%). These amounts will be adjusted for inflation.
Payments/Reimbursements are Taxable If Employee Does Not Have Minimum Essential Coverage
Unlike a regular HRA, premiums for individual health insurance policies, as well as other medical expenses such as deductibles and copays, can be paid or reimbursed by a QSEHRA. However, any payments or reimbursements from a QSEHRA for medical care (including insurance premiums) that are provided when an individual does not have minimum essential coverage are included in the employee’s income. Generally, an individual health insurance policy qualifies as minimum essential coverage, but the employer must verify that the employee has minimum essential coverage. Payments under a QSEHRA will affect the employee’s amount and qualification for the premium tax credit.
Employer Must Provide Notice to Employees
An employer funding a QSEHRA must provide written notice to each eligible employee no later than 90 days before the beginning of the year (or the date the employee first becomes eligible to participate). The notice must state the amount that will be available for reimbursement or payment for the year. Additionally, the notice must remind the employee that any benefits available under a QSEHRA must be disclosed to the health insurance marketplace if the employee applies for coverage through the marketplace and requests advance payment of the premium tax credit. The notice must also include a statement that if the employee does not have minimum essential coverage for any month, he may be subject to a penalty for the month and that payments and reimbursements under the QSEHRA may be included in income.
Employers that do not provide proper notice to employees are subject to a penalty of $50 per employee. The total penalty that can be assessed for one year cannot exceed $2,500.
Finally, amounts paid under a QSEHRA must be reported on the employee’s W2 (even though the payments are generally tax-free).
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Buzzkill Disclaimer: This post contains general tax information that may or may not apply in your specific tax situation. Please consult a tax professional before relying on any information contained in this post.