Register for August 24 Health Law Update Briefing To Catch Up On Latest Affordable Care Act & Other Federal Health Plan Rules

The Affordable Care Act and other impending federal health plan changes will require employment-based group health plans, their employer and other plan sponsors – large and small, plan fiduciaries, plan administrators and other service providers and insurers to make quick decisions and to act quickly to meet impending federal compliance deadlines while preserving flexibility.  All employer and other group health plan sponsors, fiduciaries, insurers and administrators must act quickly to update their health plan documents, communications, insurance and vendor agreements and other practices to comply with new federal requirements that become effective under the Affordable Care Act on the first day of the plan year beginning after September 22, 2010 and various other changes in federal health plan rules effective or scheduled to take effect during 2010 or 2011 plan years. 

Information provided by the Internal Revenue Service (IRS) in April provides helpful insights about how the small employer tax credit works currently.  These tax credit rules generally will apply from 2010-2013.  An enhanced version of the credit will be effective beginning in 2014.   

The tax credit generally is available to qualified employers who provide health care coverage for employees and meet certain requirements (“qualified employers”) generally are eligible for a Federal income tax credit for health insurance premiums they pay for certain employees.  I 

• The employer must have fewer than 25 full-time equivalent employees (“FTEs”) for the tax year;
• The average annual wages of its employees for the year must be less than $50,000 per FTE,
• The employer must provide employees health care coverage by paying premiums under a “qualifying arrangement” within the meaning of the Act and regulations.

Either a for-profit or non-profit employer that meet these conditions generally can qualify as “qualifying employer.” However, special rules apply in calculating the credit for a tax-exempt qualified employer. 

Calculation of the Credit 

For purposes of the calculating the credit, the IRS Q&As indicate that only premiums paid by the employer under an arrangement meeting certain requirements (a “qualifying arrangement”) generally are counted in calculating the credit.  Under a qualifying arrangement, the employer pays premiums for each employee enrolled in health care coverage offered by the employer in an amount equal to a uniform percentage (not less than 50 percent) of the premium cost of the coverage.  Special transition rules apply for tax years beginning in 2010 with respect to the requirements for a qualifying arrangement. 

If an employer pays only a portion of the premiums for the coverage provided to employees under the arrangement (with employees paying the rest), the amount of premiums counted in calculating the credit is only the portion paid by the employer.  For example, if an employer pays 80 percent of the premiums for employees’ coverage (with employees paying the other 20 percent), the 80 percent premium amount paid by the employer counts in calculating the credit.  For purposes of the credit (including the 50-percent requirement), any premium paid pursuant to a salary reduction arrangement under a section 125 cafeteria plan is not treated as paid by the employer. 

 In addition, the amount of an employer’s premium payments that counts for purposes of the credit is capped by the premium payments the employer would have made under the same arrangement if the average premium for the small group market in the State (or an area within the State) in which the employer offers coverage were substituted for the actual premium.  If the employer pays only a portion of the premium for the coverage provided to employees (for example, under the terms of the plan the employer pays 80 percent of the premiums and the employees pay the other 20 percent), the premium amount that counts for purposes of the credit is the same portion (80 percent in the example) of the premiums that would have been paid for the coverage if the average premium for the small group market in the State were substituted for the actual premium. 

The Q&As also indicate that the average premium for the small group market in a State (or an area within the State) will be determined by the Department of Health and Human Services (HHS) and published by the IRS.  HHS and the IRS expect to publish the average premium for the small group market on a State-by-State basis is expected to be posted on the IRS website by the end of April. 

Maximum Credit For A Qualified Employer 

For tax years beginning in 2010 through 2013, the maximum credit is 35 percent of the employer’s premium expenses that count towards the credit unless the employer is a non-profit employer. 

For a non-profit employer, the maximum credit for a tax-exempt qualified employer for 2010 to 2013 tax years is 25 percent of the employer’s premium expenses that count towards the credit.  However, the amount of the credit cannot exceed the total amount of income and Medicare (i.e., Hospital Insurance) tax the employer is required to withhold from employees’ wages for the year and the employer share of Medicare tax on employees’ wages. 

Reductions Of Tax Credit 

The available tax credit declines if the number of FTEs of an employer exceeds 10 or if average annual wages exceed $25,000, the amount of the credit is reduced as follows (but not below zero).  If the number of FTEs exceeds 10, the reduction is determined by multiplying the otherwise applicable credit amount by a fraction, the numerator of which is the number of FTEs in excess of 10 and the denominator of which is 15.  If average annual wages exceed $25,000, the reduction is determined by multiplying the otherwise applicable credit amount by a fraction, the numerator of which is the amount by which average annual wages exceed $25,000 and the denominator of which is $25,000.  In both cases, the result of the calculation is subtracted from the otherwise applicable credit to determine the credit to which the employer is entitled.  For an employer with both more than 10 FTEs and average annual wages exceeding $25,000, the reduction is the sum of the amount of the two reductions.  This sum may reduce the credit to zero for some employers with fewer than 25 FTEs and average annual wages of less than $50,000.   The Regulations provide guidance for calculating the amount of the actual credit and claiming that amount. 

Certain workers are not counted for purposes of determining the number of FTEs or average annual wages.  

Qualifying small employers with taxable income for the year claim the credit on their e employer’s annual income tax return.  For a tax-exempt employer, special rules apply.   Since employers qualifying for the credit can consider the credit in determining estimated tax payments for the year to which the credit applies in accordance with regular estimated tax rules, employers qualifying for and planning to claim the credit may want to recalculate their quarterly income taxes taking into their projected tax credit. When taking the credit, an employer should keep in mind that claiming the credit does affect an employer’s deduction for health insurance premiums. by reducing the amount of premiums that can be deducted by the amount of the credit.  

Other Health Plan Changes Require Prompt Action By All Sponsoring Employers Including Small Employers 

The Small Employer Tax Credit is only one of many changes in federal health plan compliance requirements enacted under the Affordable Care Act.  Narrowly passed by Congress in March after a year of contentious debate, the comprehensive health care reform legislation imposes a complex array of reforms impacting employment based health plans, employers, and the insurers and other vendors and administrators of these programs. 

Solutions Law Press invites you to catch up on the latest guidance about the new group health plan mandates imposed under the Patient Protection and Affordable Care Act (Affordable Care Act) and other federal health plan regulations by participating in a live “2010 Health Plan Update” internet[i] broadcast briefing on Tuesday, August 24 2010.  The briefing will be conducted via live video broadcast from 11:00 A.M.-1:30 P.M. Central Time.  Register here for a registration fee of $150.00[ii] per participant.  

The August 24, 2010 “2010 Health Plan Update” briefing will cover the latest guidance on Affordable Care Act and other federal health plan regulatory changes impacting employment-based group health plans and their sponsors for plan years beginning between September 23, 2010 and September 22, 2011 and other key information to help employers, group health plans, insurers, plan administrators, fiduciaries, broker and others working with these plans to understand and respond to these new requirements including: 

• How to qualify your health plan as a grandfathered plan under Affordable Care Act
• How to decide if maintaining grandfathered plan status is worthwhile
• Claims & appeals requirements for grandfathered & non-grandfathered plans
• Preventive care coverage mandates & wellness program requirements & rules under Affordable Care Act & other federal regulations
• Updated dependent child eligibility, pre-existing condition & other requirements for grandfathered & non-grandfathered plans
• Special enrollment, preexisting condition & other eligibility mandates for grandfathered & non-grandfathered plans under new Affordable Care Act, new FMLA, COBRA, Michelle’s Law, HIPAA & other federal regulations
• Mental health & substance abuse, provider choice & other benefit mandates under Affordable Care Act, Mental Health Parity & other federal rules
• Update on other recent & pending Affordable Care Act group health plan rule guidance
• Tips to review & update your plans, vendor agreements & processes to meet Affordable Care Act & other federal group health plan dictates
• Expected future Affordable Care Act & other federal rule changes & tips for preparing
• Practical strategies for responding to new requirements & changing rules
• Participant questions

The program will be conducted by the author of this update, attorney Cynthia Marcotte Stamer. With more than 23 years of experience advising employers, group health plans, plan fiduciaries, plan administrators and vendors, insurers and others about health plan and managed care matters, Ms. Stamer is nationally known for her work, publications and presentations on health plan and other employee benefit, health care and insurance matters.  

Current Chair of the American Bar Association (ABA) RPTE Employee Benefit & Other Compensation Committee, a Council Member of the ABA Joint Committee on Employee Benefits and Past Chair of the ABA Health Law Section Managed Care & Insurance  Interest Group, Ms. Stamer continuously advises employers, health plans, plan sponsors, fiduciaries, plan administrators, plan vendors, insurers and others about health program related legal, operational, documentation, public policy, enforcement, privacy, technology, litigation and risk management and other concerns. Ms. Stamer also publishes and speaks extensively on these and other health and managed care program concerns and practices.  Her insights on these and related topics have appeared in Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, Managed Healthcare, Health Leaders, various ABA publications and a many other national and local publications. For additional information about Ms. Stamer and her experience, see here. 

If you need assistance with these or other employee benefits, employment, compensation insurance or other management concerns, wish to inquire about compliance, risk management or training, or need legal representation on other matters please contact Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here,   

About Solutions Law Press 

Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources available for review here. If you or someone else you know would like to receive future updates and notices about other upcoming Solutions Law Press events, please be sure that we have your current contact information – including your preferred e-mail- by creating or updating your profile at here. For important information concerning this communication click here.  If you do not wish to receive these updates in the future, send an e-mail with the word   

If you found this information of interest, you also may be interested in reviewing other updates and publications by Ms. Stamer including: 

• Rite Aid Pays $1 Million HIPAA Privacy Settlement As OCR Tightens HIPAA Regulations
• New Affordable Care Act Mandated High Risk Pre-Existing Condition Insurance Pool Program Regulations Prohibit Plan Dumping of High Risk Members, Set Other Rules
• Register Now For 8/24 2010 Health Plan Update Briefing
• Congress & Labor Department Considering Tightening of Retirement Plan Regulations
• Testimony Highlights Growing Exposure of Businesses Misclassifying Workers; Businesses Should Act to Minimize Risks
• Businesses Employing Children Should Review & Tighten Practices In Light of Tightened Rules & Increased Penalties
• 2010 Health Plan Update: Learn What You Must Do Now To Meet Key 2010/2011 Affordable Care Act & Other Federal Health Plan Deadlines
• New Affordable Care Act Health Plan Appeals Regulations Require Health Plan Updates
• Blockbuster & Health Delivery Disability Discrimination Settlements Highlight Need For Tightened Disability Discrimination Risk Management
• CMS & ONC To Co-Host 7/22 ONC Certification & Medicare/Medicaid EHR Incentive Program Audio Training
• Free 7/22 Study Group Teleconference Call on Self Correction, Determination Letters & Other Administrative Practices
• Labor Department FMLA Guidance Signals Need For Employer Care Determining Who Qualifies As Child
• Agencies Release Regulations Implementing Affordable Care Act Health Plan Preventative Care Mandates
• New Retirement Plan Resource To Help Spanish-Speaking Participants With Retirement Planning
• Office of Civil Rights Proposes Changes To HIPAA Privacy, Security & Civil Sanctions Rules
• Review & Strengthen Defensibility of Existing Worker Classification Practices In Light of Rising Congressional & Regulatory Scrutiny
• Key Affordable Care Act Health Plan Coverage Mandates Guidance Issued June 28; Apply ASAP For Early Retirement Reinsurance Program
• Key Affordable Care Act Health Plan Coverage Mandates Guidance Issued June 28; Apply ASAP For Early Retirement Reinsurance Program
• Key Guidance Issued About New Affordable Care Act Health Plan Requirements; Teleconference Briefing Planned July 9
• Registration Open For July 9 In “Affordable Care Act & Other Federal Health Plan Guidance Update”
• HHS, DOL & IRS Rules Define “Grandfathered” Group Health Plans & Health Insurance Coverage under Affordable Care Act

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile here. Or by registering to participate in the distribution of these and other updates on our Solutions Law Press distributions in blog form here. For important information concerning this communication click here.    If you do not wish to receive these updates in the future, send an e-mail with the word “Remove” in the Subject to here. 

©2010 Cynthia Marcotte Stamer. All rights reserved. 
 

[ii] Discounts available for groups registering three or more participants.  E-mail support@solutionslawyer.net.