1.
Health
reimbursement accounts (HRAs) are written plans where an employer agrees to
reimburse certain health care costs of employees. Such reimbursements are income tax free to
the employee. Except in a C corporation
scenario, the tax-free nature of the reimbursements is not generally available to
owner-employees. Stand-alone HRAs are no
longer permitted by the ACA unless they reimburse only excepted
benefits. Benefits excepted from the
ACA’s market reform rules include dental or vision coverage. If the HRA reimburses other health care costs
such as co-pays or deductibles, the HRA must be integrated with a qualifying
group health insurance policy. If it is
not, the employer is subject to a $100 per day per employee penalty, generally
capped at $500,000 per year per entity.
2.
An HRA that
covers fewer than two current employees is not subject to the ACA’s marketplace
reform rules. In this circumstance, the
HRA can cover any health care cost and avoid the $100 per day penalty.
3.
The IRS clarified
a fine point relating to HRAs that are integrated with a group policy. The HRA loses its integration if the
arrangement reimburses individuals not covered by the group policy. For example, if an employee chooses self-only
coverage, the HRA may not reimburse the health costs of the employee’s spouse
and/or dependents because they are not covered by the group health insurance
policy. The IRS offers transition relief
that ignores this violation through 2015 to give time for employers to come
into compliance.
4.
The ACA requires
applicable large employers to offer “affordable” health insurance to full time
employees or face a penalty. The law
states that an employee’s share of the group policy premium must not exceed
9.5% of household income to be deemed affordable. Because an employer will not know an
employee’s household income, the IRS has provided several safe harbors to
determine affordability. One safe harbor
is 9.5% of the employee’s W-2 compensation.
The 9.5% rate is adjusted for inflation.
For 2015 the percentage is 9.56% and for 2016 the percentage is 9.66%.
5.
An applicable
large employer will be penalized for failing to offer health insurance if at
least one full-time employee obtains health insurance on the exchange and
receives a premium tax credit. The
penalty amount is $2,000 times the total number of full-time employees in
excess of 30 (80 for 2015). The penalty
amount is indexed for inflation. For
2015 the penalty is $2,080 and for 2016 the penalty is $2,160.
6.
An applicable
large employer will also be penalized for failing to offer health insurance
that is “affordable” or failing to at least meet the “bronze” level of benefits
if at least one full-time employee obtains health insurance on the exchange and
receives a premium tax credit. The
penalty amount is $3,000 times the number of full-time employees receiving such
credits. The penalty amount is indexed
for inflation. For 2015 the penalty is $3,120
and for 2016 the penalty is $3,240.
7.
In Notice 2015-87
the IRS states that it will not impose penalties on employers who make good
faith efforts to comply with the ACA’s information reporting requirements for
2015 but who nevertheless make inaccuracies in the tax forms or miss the due
date. The penalty is up to $250 per form up to
a maximum of $3 million! In Notice
2016-4 the IRS extends the due dates for 2015 reporting. Applicable large employers are now required to
provide Form 1095-C by March 31, 2016 (instead of February 1, 2016) to
employees and to file Form 1094-C by May 31, 2016 if filed on paper (instead of
February 29, 2016) or by June 30, 2016 if filed electronically (instead of
March 31, 2016) with the IRS.
There is no penalty waiver for failure to meet the due date unless there is reasonable cause for the failure. Normally an extension of time should be requested. However, for the 2015 Forms 1095-C and 1094-C the IRS has extended the due dates beyond the normal extended due dates. Therefore, the IRS states that it will not grant any extension of the new 2015 due dates, but it will consider reasonable cause for late filing. Factors taken into account for establishing reasonable cause include whether the employer made reasonable efforts to gather and transmit the necessary data to an agent to prepare the data for submission to the IRS and whether steps are being taken to ensure that the employer will be able to timely comply with next year’s reporting requirements.
There is no penalty waiver for failure to meet the due date unless there is reasonable cause for the failure. Normally an extension of time should be requested. However, for the 2015 Forms 1095-C and 1094-C the IRS has extended the due dates beyond the normal extended due dates. Therefore, the IRS states that it will not grant any extension of the new 2015 due dates, but it will consider reasonable cause for late filing. Factors taken into account for establishing reasonable cause include whether the employer made reasonable efforts to gather and transmit the necessary data to an agent to prepare the data for submission to the IRS and whether steps are being taken to ensure that the employer will be able to timely comply with next year’s reporting requirements.
8.
Now that the IRS
has extended the ACA information reporting due dates, some individuals will
file their 2015 income returns before receiving their ACA tax forms. If such individuals have relied upon other
information received from employers, or from health insurance providers, they
will not be required to amend their income tax returns once they receive their
Forms 1095-B or 1095-C, including any corrected forms. However, the IRS has not extended the due
dates for the Health Insurance Marketplace (or Exchange) to issue Form
1095-A. Individuals who enrolled for
coverage through the Marketplace should receive Form 1095-A by February 1, 2016
and should wait to file their tax returns until they receive their Form 1095-A.