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The Wagner Law Group

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 

 

Established in 1996, The Wagner Law Group has 22 attorneys engaged exclusively in employee benefits, estate planning and employment law. Six of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.

 

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

 

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

315 Montgomery Street

Suite 904

San Francisco, CA 94104

 

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
100 South 4th Street, Suite 550
St. Louis, MO  63102 

 

www.wagnerlawgroup.com

 

 

 

 

December 29, 2015

 

 Health and Welfare Law Alert

 

 

 

   Guidance on Health Reimbursement Arrangements

 

 

 

The IRS has issued Notice 2015-87, which provides guidance on a myriad of Affordable Care Act ("ACA") market reforms, including ACA compliance issues raised by health reimbursement arrangements ("HRAs"). 

 

 

Background.  ACA generally prohibits group health plans from imposing annual or lifetime dollar limits on "essential health benefits."  The IRS has previously indicated that arrangements whereby employers reimburse employees for medically-related costs are group health plans subject to the ACA's market reforms.  Accordingly, all such reimbursement arrangements must satisfy ACA market reforms. 

 

 

HRAs are group health plans that typically reimburse medical expenses up to a specified dollar amount.  Thus, HRAs cannot satisfy certain ACA market reforms, including the required coverage of preventive services and the prohibition on annual or lifetime dollar limits. 

 

 

Prior IRS guidance has explained that in order to comply with ACA's market reforms, an HRA must be "integrated" with a group health plan that is ACA-compliant.  While IRS rules allow an HRA to be integrated with a group health plan not sponsored by the employer sponsoring the HRA, IRS has confirmed that, in general, an HRA cannot be integrated with an individual market plan.

 

 

Notice 2015-87.  Notice 2015-87 covers the following ACA compliance issues presented by HRAs:

 

  • HRAs that cover only former employees or retirees need not be integrated with a group health.
  • A former employee covered by an HRA is ineligible for premium tax credits as long as funds remain available in the HRA.  
  • Retiree-only HRAs may reimburse individual market insurance premiums and other medical-related costs. 
  • Unless the retiree-only exception applies, unused amounts in an HRA cannot be used to reimburse premiums paid by former employees for individual market coverage, even if the amounts were originally earned when the HRA was properly integrated with a group health plan. 
  • Amounts credited to an HRA before 2014 may be used to reimburse medical expenses pursuant to the terms in effect before 2014 without violating ACA market reforms.  
  • An HRA that reimburses medical expenses for an employee and the employee's spouse and dependents cannot be integrated with self-only group health plan coverage but must be integrated with coverage in which the spouse and dependents are enrolled to comply with ACA requirements.  (Note:  IRS will not enforce this rule until 2017.)
  • An HRA that reimburses an employee for premiums paid for individual market coverage will not violate ACA market reforms if such coverage only provides excepted benefits.
  • An employer payment plan or an HRA that is part of an Internal Revenue Code Section 125 cafeteria plan must be integrated with a group health plan in order to be ACA-compliant.
  • An HRA must be properly documented and be in operational compliance with ACA market reforms. 

 

Takeaway for Employers.  As a result of the documentary compliance requirement for HRAs provided in Notice 2015-87, employers must now carefully review their HRA documentation to ensure that it satisfies the ACA's market reforms.  Employers that are considering sponsoring HRAs should proceed with caution and consult with qualified benefits advisors. 

 

 

 

Notice 2015-87 is available at: https://www.irs.gov/pub/irs-drop/n-15-87.pdf
 
Extension of Due Dates for 2015 Information Reporting under ACA

 

 

 

The IRS has extended the due dates  (1) for furnishing to individuals the 2015 Form 1095-B, Health Coverage, and the 2015 Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, from February 1, 2016, to March 31, 2016, and (2) for filing with IRS: Form 1094-B, Transmittal of Health Coverage Information Returns; the 2015 Form 1095-B, Health Coverage; the 2015 Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; and the 2015 Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, from February 29, 2016, to May 31, 2016, if not filing electronically, and from March 31, 2016, to June 30, 2016, if filing electronically. The IRS also provided guidance to individuals who do not receive a Form 1095-B or Form 1095-C by the time they file their 2015 tax returns.

 

 

 

Additional information concerning the extensions is available at: https://www.irs.gov/pub/irs-drop/n-16-4.pdf

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.