A group health plan is not subject to COBRA for any year if all employers maintaining the plan together employed fewer than 20 employees on a typical business day during the preceding year. Here are some general guidelines for which employees must be counted:
Count All Employees, Not Just Plan Participants. Be sure to count the number of employees working for all employers maintaining the plan, not just the number of employees covered by the group health plan.
Count Only Common-Law Employees. Only common-law employees are counted as “employees” for purposes of COBRA’s small employer exception. Do not count self-employed individuals, independent contractors, or members of a corporate employer’s board of directors, unless those individuals are also common-law employees of the employer. Keep in mind that common-law employee status is not determined solely by a worker’s payroll status, title, or job description but depends on various factors enumerated by the IRS and the courts, including whether the organization controls the manner in which the individual provides services.
Count Part-Time Employees. A part-time employee counts as a fraction of an employee. The fraction is equal to the number of hours that the part-time employee works divided by the number of hours that an employee must work to be considered a full-time employee. The number of hours that must be worked for an employee to be considered full-time is determined in a manner consistent with the employer’s general employment practices (but cannot be more than eight hours a day or more than 40 hours a week). You may count employees for each typical business day, or you may count employees for a pay period and attribute the total number of employees for that pay period to each typical business day that falls within the pay period. You also may count part-time employees on an aggregate basis (rather than on an individual basis) by totaling the hours worked by part-time employees and dividing that sum by the number of hours required for one worker to be considered full-time. However, you must use the same method for all employees and for the entire year for which the small employer plan determination is made.
Count Employees and Related Entities Outside the United States. The controlled group rules do not exclude entities outside the United States, so employees of a foreign entity must be counted if the entity otherwise qualifies as a member of the controlled group. Similarly, employees working outside the United States must be counted.
Count Employees of Related Entities (and Successors). You must count all employees of all entities that are related to your company. If your company is related to another entity, you’ll need to determine whether employees of the related entity must be counted. If so, you’ll also need to include employees of “successors” of those entities, i.e., entities that “result from a consolidation, merger, or similar restructuring.”
The rules for counting employees are complex, and if you mistakenly rely on the small employer exception, the consequences can be significant. Noncompliance can result in lawsuits and penalties, as well as the obligation to provide COBRA coverage to former employees and others without insurance or stop-loss coverage.
As a general rule, an employer may not take a tax deduction for flexible spending account (FSA) benefits until the benefits are provided to employees. Thus, no deduction may be taken at the time of the employee’s salary reduction. Moreover, employers who transmit salary reduction amounts to a third-party administrator (TPA) for administration of claims should be careful not to base the timing of deductions on when the amounts are transmitted.
Likewise, the employer may not take a tax deduction when a forfeiture occurs. Rather, deductions will arise when benefits are provided, or amounts are applied against permissible administrative expenses. The timing of an employer’s deduction should not be confused with its accrual of liability from a financial accounting standpoint. For financial accounting purposes, the employer’s liability for health FSA benefits accrues as of the first day of the coverage period (e.g., the plan year), due to the application of the uniform coverage rule. For DCAPs, the liability accrues when the salary reductions occur.
Self-insured medical benefits are governed by similar rules. If not paid from a trust, an accrual-basis taxpayer can deduct them in the year in which the expenses are incurred, even if paid in a later year. In contrast, a cash-basis taxpayer would deduct only when the expenses are paid. Likewise, premiums for insured benefits are deductible when accrued or paid, depending on whether the employer is an accrual-basis or cash-basis taxpayer. The deduction rules for a self-insured health plan that pays benefits from a trust or other “welfare benefit fund” are more complicated and are subject to limitations to prevent excess prefunding.
Certain entities that do not pay corporate taxes, such as governmental employers and nonprofits, can sponsor cafeteria plans without worrying about deductions as such, although these entities may recognize the costs of their plans on a similar accrual or cash basis.
The HSA Store is a fantastic outlet for consumers to buy eligible products to fit their HSA account. With over 4,000 products on hand — from allergy medicines, CT scans, mammograms, and thermometers – it’s a guarantee to find at least one product to enjoy.
To best utilize the virtual store, search any HSA eligible item you need for purchase. From there, add a promo code to any purchased HSA eligible item. All promo codes can be turned into points for future purchases.
The smallest denomination of points that can be redeemed for later use is 350 ($10) and largest is 1,500 ($50). You cannot redeem fewer than 350 points at a time. Balances under 350 points cannot be exchanged for a partial value dollar reward. Points expire six months (180 days) following your last order date. To learn about all HSA Store eligible items, look here.
As you may know, a Flexible Spending Account, or FSA, is an account for you to set aside pre-tax dollars to pay for eligible medical, dental, and vision expenses. But did you know there are different types of FSA plans? The first is a Dependent Care FSA, which is ideal to ensure dependent care costs are taken care for either a child under the age of 13 or if a spouse/dependent is unable to care of themselves.
This plan works as long as both spouses or custodial parents are employed. From there, you can contribute up to $5,000 pre-tax dollars per calendar year to pay for expenses such as: day care (child & adult), summer day camp (nursery school & preschool) plus before and after school programs.
The second plan to note is a Healthcare FSA, which is more straightforward. This plan allows you to contribute up to $2,850 annually to pay for eligible medical, dental, prescription, and vision expenses not covered by insurance. With the Healthcare FSA, the entire contribution election is available from day one. All payroll contributions throughout the year will go towards covering that individual’s election.
To familiarize yourself with the different types of FSA plans, check here.
A Health Reimbursement Arrangement (HRA) is an account funded by your employer that helps pay for qualified medical expenses acquired throughout a plan year. Here’s how you can benefit by participating in one.
You can use HRA account fund dollars to pay for doctor visits, copay, prescription drugs, and hospital services.
The funds in your account could be available from day one. They could also only be available as the employer deposits them into the HRA or any combination thereof. This will differ from employer to employer, as there are many different plan design options in a group HRA setting.
Funds that remain in your HRA at the end of the plan year may be carried over to the next year.
You can add HRA funds to your NueSynergy debit card to pay your providers for necessary healthcare expenses depending on plan design. In other cases, you will be able to file a claim for reimbursement and receive a refund for the expense from the HRA and into your personal bank account.
To learn more about an HRA and all of its utilizations, check here.
This week, the IRS released 2023 cost-of-living adjusted limits for health savings accounts (HSAs), high-deductible health plans (HDHPs), and excepted benefit health reimbursement arrangements (EBHRAs). All of these limits have increased from 2022. Everything you need to know about each limit increase is stated in our press release, which is down below.
