Chandler Health Insurance

New IRS Rules For Employers Regarding Health Insurance

Last year, the IRS spelled out how it would treat employer contributions to employees to help them buy coverage on their own. More recently, it reiterated its position in Q&A format. The question the IRS posed to itself:

What are the consequences to the employer if the employer does not establish a health insurance plan for its own employees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health plan in the marketplace or outside the marketplace)?

Employer Payment Plans

In answering its own question, the IRS characterized such arrangements as “employer payment plans.” These are different from health reimbursement accounts (HRA’s) and healthcare flexible spending accounts (FSA’s).

The IRS considers employer payment plans as group health plans, subject to the provisions of the Affordable Care Act (ACA), including the ban on annual limits for essential health benefits and the requirement for full coverage of preventive health services. But, even if employees bought coverage which featured those benefits, employer payment plans “cannot be integrated with individual policies to satisfy the market reforms,” according to the IRS.

The penalty for having an employer payment plan would make it prohibitively expensive. Specifically, employers could be subject to an excise tax as high as $100 per day per employee (that is, $36,500 per year per employee).

The IRS and the Department of Labor also take the position that an HRA cannot be integrated with “individual market coverage or with an employer plan which provides coverage through individual policies” without violating the ACA. However, HRA’s and healthcare FSA’s can still be used to help employees pay for “excepted” benefits, including vision, dental, accident, long-term care and automobile medical payment coverage.

Wraparound Coverage

Another form of health coverage, not subject to ACA requirements, which employers can help employees buy beginning in 2015 without being penalized is “wraparound coverage.” That’s basic health insurance to supplement a standard health plan which meets ACA requirements. This coverage cannot cost more than 15 percent of the cost of the basic health plan offered to your employees, however.

If you are still determined to get out from between your employees and their health plan coverage, you could avoid the “employer payment plan” penalties by simply giving employees a pay raise sufficient to subsidize their health benefits to the degree you want and can afford.

Keep in mind, however, you will be subject to higher payroll taxes, and since this income is taxable to employees, the amount of the raise they’ll have available to buy health coverage will be reduced by their added tax liability. Also, workers may eventually forget why they got the raise, and consider themselves employees of a company that doesn’t value its workers enough to offer health benefits.

Finally, if you are large enough to be subject to the ACA’s employer mandate, the salary increase tactic won’t allow you to avoid the penalty for not providing health coverage.

Sincerely,
Your Team at Phoenix Health Insurance

IMPORTANT UPDATE FROM YOUR BROKER ABOUT YOUR 2016 HEALTH INSURANCE

2016 Is shaping up to be the most challenging year we have ever seen in the Individual Health Insurance Market in Arizona. Due to massive losses sustained by every carrier in AZ there will be huge changes this year so please take a few minutes to read this update.

So what is happening with the Individual Health Insurance Market?

1. Blue Cross Blue Shield lost over $90 million and as a result will no longer offer any PPO plans for 2016 except for those people who have grandfathered plans that were written before 01/01/2014. Over 77,000 people will be getting a letter notifying them that their coverage will no longer be available. Blue Cross Blue Shield of AZ will only offer HMO plans in 2016. The average rate increases for theses HMO plans will be around 29% compared to last year’s same HMO plans. Current HMO members may want to either increase their deductibles to save money or look elsewhere because the Blue Cross Alliance and Select network plans will still be some of the most competitive in Maricopa County.
2. Health Net of Arizona lost a reported $86 million dollars and will follow the lead of Blue Cross and will drop all PPO’s except for one basic Bronze plan that we will not be selling. They will no longer be offering their benefit rich Platinum $750 deductible or Gold $1500 deductible plans. These two plans represented 90% of the plans that we at Phoenix Health Insurance sold for Health Net. Health Net’s prices also increased on average 21% for remaining HMO plans.
3. Meritus only lost $16 million and is our states only local CO-OP and was a very good option that provided predictable benefits along with some of the lowest prices. Unfortunately last week the Department of Insurance placed Meritus into Receivership, which means that unless something can be worked out in the next week or so all 58,000 Meritus customers should plan on finding a new home for 2016. This is unfortunate as some believe that this is a political move but you can view more about this here http://www.meritusaz.com/content
   /meritus-frequently-asked-questions-faqs.
4. Assurant was the first recorded casualty this year with losses exceeding over $120 million dollars. They announced that after 102 years in the health insurance market they would be closing its doors for individual health as of the middle of 2015. Assurant was the ONLY OPTION for MAYO CLINIC that we had here in Arizona.

So how do I find a new plan for 2016?

1. Off Exchange: Visit our new website phxhealthinsurance.com and click on the Health Insurance Quote Now button. This is a custom quote link that will allow you to compare and apply.
2. On Exchange: You have to use the www.healthcare.gov and please check the box that says you are working with a broker and enter 15856993 in the NPN Number. It is a small box in the first section of the application that you have to click on.

 *OR quote our top 3 carriers for 2016 one at a time