IRS Guidance Addresses Tax Treatment Of Health Care Benefits Provided To Adult Children

Posted on June 1, 2010 by John Godsoe

Effective for plan years that begin after September 23, 2010, the recently-enacted health reform legislation ("Health Reform") generally requires group health plans and health issuers that provide dependent coverage for children to continue to make such coverage available to an adult child until the child reaches age 26. Health Reform also modifies the Internal Revenue Code ("Code") to extend the income exclusion for medical care reimbursements under an employer-provided accident or health plan to an employee's eligible children who have not attained age 27 as of the end of the taxable year. In Notice 2010-38 ("Notice"), the Internal Revenue Service ("IRS") provides employers with helpful guidance regarding the federal income tax issues associated with extending medical coverage to an employee's eligible adult children.

Background

The extension of health coverage to adult children until age 26 is among the first provisions to take effect under Health Reform. Plans that operate on a calendar year basis (including self-insured plans and so-called "grandfathered" plans) will be required to make such coverage available effective January 1, 2011. The coverage must be made available regardless of the child's marital status, but (until 2014) generally need not be provided to an adult child who is eligible to enroll for coverage under a group health plan of the child's employer.

Prior to Health Reform, health coverage generally could be extended tax-free to a child of an employee only if the child was the employee's "dependent," as defined under Section 152 of the Code. In many cases, adult children cannot qualify as a dependent under Code Section 152 because they cannot satisfy applicable age, support, residency or other requirements of Code Section 152. As a result, an employer that provided coverage to an adult child generally was required to include the fair market value of the health coverage provided to the child in the employee's income.

As further explained below, the changes to the Code made by Health Reform and the guidance provided in the Notice clarify the circumstances under which adult children may now be eligible for tax-free health coverage, regardless of whether they are considered a dependent of the employee under Code Section 152.
 

Tax-Exemption For Health Care Coverage Provided to Adult Children

The Health Reform legislation amended Section 105(b) of the Code to provide that employer-provided reimbursements for expenses incurred by an employee for the medical care of an employee's child (as defined under Section 152(f)(1)) of the Code) who has not attained age 27 as of the end of the taxable year ("Eligible Adult Child") are excluded from the employee's gross income. For this purpose, the end of the taxable year is the employee's taxable year and employers may assume that an employee's taxable year is the calendar year. Under Code Section 152(f)(1), an employee's child is an individual who is the son, daughter, stepson, or stepdaughter of the employee and includes both a legally-adopted individual of the employee and an individual who is lawfully placed with the employee for legal adoption by the employee. Child also includes an "eligible foster child," defined as an individual who is placed with the employee by an authorized placement agency or by judgment, decree, or other order.

Although the amendment to Code Section 105(b) is clearly a response to the Health Reform extension of coverage to adult children under the age of 26, the provisions are not exact parallels. For example, the exclusion under Section 105(b) of the Code is effective March 30, 2010, while coverage for adult children under age 26 is not required until the first plan year after September 23, 2010. Further, the income exclusion under Code Section 105(b) applies to children who have not attained age 27 as of the end of the taxable year, while the Health Reform extension only requires extended coverage to adult children under the age of 26.

Section 106 of the Code excludes from an employee's gross income coverage under an employer-provided accident or health plan (i.e., the portion, if any, of the health plan premium paid by the employer). The Notice provides that the IRS and Treasury Department intend to amend the regulations under Code Section 106, retroactively to March 30, 2010, to provide that the coverage under an employer provided accident or health plan for an Eligible Adult Child is also excludable from the employee's income.

As a result, on and after March 30, 2010, both coverage under an employer-provided accident or health plan and amounts paid or reimbursed under such a plan for medical care expenses of an Eligible Adult Child are excluded from the employee's gross income.

Cafeteria Plans, FSAs, and HSAs

The Notice clarifies that because coverage for an Eligible Adult Child is excludable from income under Code Sections 105 and 106, such coverage is considered a "qualified benefit" for cafeteria plan purposes, including health flexible spending accounts ("FSA"). Thus, effective March 30, 2010, employees may make pre-tax contributions under an employer's cafeteria plan (including pre-tax contributions to a health FSA) to provide benefits to an Eligible Adult Child.

Employers may also allow employees to make mid-year cafeteria plan election changes for an Eligible Adult Child, even if the child is not otherwise the employee's dependent under Code Section 152. The Notice provides that the IRS and Treasury intend to amend the regulations, retroactive to March 30, 2010, to include change in status events affecting Eligible Adult Children (including becoming newly eligible for coverage or eligible for coverage beyond the date on which the child otherwise would have lost coverage).

The Notice provides that amendments to cafeteria plans that are required to cover Eligible Adult Children may be made by December 31, 2010 (and made retroactive to the first day of the year), even if an employer wishes to permit employees to immediately make pre-tax salary reduction contributions for health benefits under a cafeteria plan (including a health FSA) for Eligible Adult Children. Normally, an amendment may be made to a cafeteria plan on a prospective basis only.

One issue to note for employers is that neither the Health Reform legislation nor the Notice modified the reimbursement rules governing Health Savings Accounts ("HSAs"). Thus, until further guidance is issued, reimbursements from an HSA may not be made on a tax-free basis for medical expenses incurred on behalf of an Eligible Adult Child.
Employer Considerations

Employer Considerations

The Notice provides employers with much needed guidance regarding the tax consequences associated with the Health Reform extension of coverage to adult children under the age of 26. Because the effective date of the tax-exclusion with respect to coverage provided to an Eligible Adult Child is March 30, 2010, employers that wish to extend coverage to adult children prior to the date they are required to do so under Health Reform may do so without creating negative tax consequences for employees.

Medical plans that provide coverage to children will need to be amended to reflect the Health Reform requirements. As indicated in the Notice, amendments will also need to be made to cafeteria plans to permit pre-tax salary reduction contributions with respect to coverage for Eligible Adult Children. Such amendments may be made retroactively (by December 31, 2010), if the employer wishes to allow employees to make such contributions immediately.
 
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Health Care Reform: Where Do Things Stand for Employers?

Posted on January 14, 2010 by Kristen Smith

While there has been significant press coverage of the health care reform bills being considered by Congress, there has not been as much attention given to the impact that this legislation could have on employers. As widely publicized, both the House and Senate passed their own versions of a health care reform bill. The House passed the Affordable Health Care for America Act (H.R. 3962) on November 7, and the Senate passed the Patient Protection and Affordable Care Act (H.R. 3590) on December 24. Both houses promise to act quickly to reconcile these two bills, with the goal of presenting President Obama with a bill for signing early in the year.

The bills differ in many ways, and it is too early to predict which provisions of the bills will survive the conference process, but at this stage, there are a few core concepts employers should understand:
 

Employer Mandate: Commonly referred to as “pay or play,” both bills contain provisions designed to force employers to offer health care coverage to employees. In the House bill, any employer that fails to offer an acceptable health plan must pay a tax of 8% of payroll. (The tax is phased out for smaller employers.) Under the Senate bill, employers are not technically required to provide coverage, but a “free rider penalty” penalizes employers with over 50 employees in certain circumstances. Generally, if an employer does not provide coverage or offers a plan that is considered “unaffordable,” and at least one employee enrolls in an exchange plan instead (explained below) and receives a government subsidy, the employer would pay a penalty of as much as $750 per year for every full-time employee it employs (not just the number of employees who purchase coverage through an exchange and receive a subsidy.)


Individual Mandate: Subject to certain exceptions, individuals will be required to obtain health insurance coverage through their employer or on their own through an exchange, or pay a penalty. Certain low income individuals would receive subsidies to help pay for the costs of premiums and cost-sharing. The amount of the penalty differs between the two bills, with the House bill imposing a potentially larger penalty.


New Rules for Insurance Policies: Both bills specify categories of benefits that must be covered under “qualified” health plans, and impose specific cost-sharing limits, out-of-pocket spending limits, and rules regarding annual and lifetime limits. The House bill would subject all plans, including all employer-sponsored plans, to these requirements, although plans currently offered by employers would be grandfathered for five years. Under the Senate bill, only plans offered through the exchange (explained below) or in the individual or small group market would be subject to most of these requirements. Since the exchange would be open only to individuals and small businesses, plans offered by larger employers would be exempt from most of these rules.


Small Business Tax Credits: Both bills provide tax credits to small businesses that offer health insurance. Businesses with 10 or fewer employees and average taxable wages of $20,000 or less would be eligible for the credits. The credits would be phased out as average compensation increases to $40,000 (House bill) or $50,000 (Senate bill) and the number of employees increases to 25. The amount of the credit differs between the bills.


Health Insurance Exchange: Both bills set up health insurance exchanges to facilitate the purchase of insurance by individuals and small businesses. The exchange would not be an insurer, but would provide access to insurers’ plans. Exchange plans would be required to contain specified features and cover specified benefits. Individuals eligible for employer plans would not be allowed to apply their employer’s contribution toward an exchange plan (i.e., the employee would be responsible for the entire exchange premium), thus deterring individuals from dropping employer coverage for an exchange plan (although the Senate bill would require employers who provide coverage to offer “free choice vouchers” to a small segment of low-income employees to purchase insurance through the exchange.) Certain small businesses would be “exchange-eligible,” meaning the employer could make exchange plans available to employees.


Excise Tax on Certain Employer-Sponsored Plans: This controversial tax on so-called “Cadillac plans” is included only in the Senate bill and would place a 40% tax on employer-provided health insurance plans with an aggregate value of more than $8,500 for individuals and $23,000 for families (with some exceptions), and would be adjusted for inflation. Note that these amounts apply to the full value of the plan, not just the premium. This includes not only the premium of the health plan, but also any dental, vision or supplemental plan, as well as employer contributions to HSA or FSA accounts. Only the value of the plan in excess of the limit would be taxed. The tax would be imposed on the insurer, which in the case of some self-insured plans would be the employer. Opponents of this provision see it as an unfair tax on the middle-class that would drive employers to reduce coverage for their employees. Supporters see it as a tool to reduce the use of excessive health insurance plans that do not improve heath outcomes, but encourage unnecessary health care spending.


Flexible Savings Accounts: Under both bills, FSA contributions would be capped at $2,500 per year. Currently, employers have the discretion to set FSA contribution limits. In addition, employees would no longer be able to use tax-free FSA or HSA funds for non-prescription drugs and medical supplies.


These are just a few highlights of two lengthy, complex bills. All of these provisions are subject to change in the conference process.
 
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