Posts Tagged Tax

Small Employer Health Tax Credit


“Small employers” who qualify for this 2010 income tax credit (including churches and section 501(C) (3) charitable organizations) must satisfy ALL of the following conditions:

One component of  the huge  healthcare legislation is a tax credit for small employers who pay at least 50% of their employees’ health insurance premiums. Unlike most of the future healthcare bill provisions, this employer federal tax credit can be claimed for year 2010 tax returns due this Spring.

Calculations for this new tax credit are very complex (even by tax law standards!) and are reported on new IRS Form 8941 – a one page tax form which requires completion of 7 different worksheets to accurately calculate the tax credit. You can review IRS Form 8941 with instructions at www.irs.gov.  IRS information and resources

Initially, the IRS outlined rules for the tax credit in Notice 2010-44. A follow-up document, Notice 2010-82, explained transition relief related to the rules for a qualifying arrangement and provided more details about the requirements. For example, Notice 2010-82 clarifies how an employer that offers more than one plan determines whether its contribution amount meets the threshold for a qualifying arrangement. The IRS has released several additional items related to the tax credit, including:

Three Simple Steps Fact Sheet |  Frequently Asked Questions |  YouTube Video |  More information is available on the IRS website

“Small employers” who qualify for this 2010 income tax credit (including churches and section 501(C) (3) charitable organizations) must satisfy ALL of the following conditions:

1)      You paid at least 50% of the “single employee” premium cost for year 2010. Insurance costs are for primary health insurance and dental and vision insurance. Employer contributions to HSAs, HRAs and FSA medical accounts are not deemed insurance and thus are not eligible for the tax credit; AND

2)      You employed fewer than 25 “full-time equivalent” (FTE) employees during 2010. In determining FTE employees, 30 employees who worked 20 hours per week count as 15 FTE employees. Employees who you exclude from this FTE “count” include:

  • Owners of the employer and their relatives (parents, children, in-laws, aunts/uncles, etc);
  • “Seasonal” employees who worked 120 or fewer days for you during 2010; AND

3)   Your “average annual wages” paid to employees during 2010 were less than $50,000 per FTE employee. For this purpose “wages” are gross wages paid before any tax or retirement withholdings.

IF YOU MEET ALL 3 OF THESE CONDITIONS, YOU LIKELY QUALIFY FOR THE TAX CREDIT.

How Much is the Tax Credit?

Small employers who pay at least 50% of their employees’ health insurance, have 10 or fewer full-time equivalent employees, with average annual wages of $25,000 or less per “FTE” employee, will receive a tax credit of 35% (25% for churches and 501(C) (3) charitable organizations) of the employer-paid health insurance premiums in 2010. This can be a large tax credit! HOWEVER, as the FTE employee count trends from 10 employees to 25, and the “average wages” per FTE employee trends from $25,000 to $50,000, the tax credit percentage decreases from the 35%/25% ”starting” tax credit rates.

CAN I “EYEBALL” IT?

Catalist has posted a “Short-Cut Small Employer Insurance Credit Percentage” worksheet as a downloadable form, CLICK HERE .  Note that the worksheet is divided unto 2 sections, For-Profit Business and Nonprofit Entity. A for-profit business with 14 “FTE” employees and with average 2010 wages per FTE employee of $35,000 would be eligible to claim a federal tax credit of 12% of the employer-paid health insurance premiums paid during 2010. If the employer paid $30,000 of health insurance premiums for their employees in 2010, their 2010 tax credit would be $3,600.

CLAIMING THE TAX CREDIT

So you have met all three of the eligibility requirements and have “eyeballed” our worksheet and estimated you can claim a tax credit of several thousand dollars. Now what?

You begin the process of completing IRS Form 8941, which for-profit employers will attach to their 2010 business income tax return, and churches and other 501 (C) (3) charities/ministries will complete and attach to non-profit IRS Form 990-T.

Since the Form 8941 calculations are confusing and lack substantial guidance from the IRS, we recommend that you be “pragmatic” and make your best effort to complete an accurate Form 8941 and claim the tax credit based on your calculations. “Close is good enough” in horseshoes and with Form 8941 calculations! If your calculations are later found to be slightly incorrect by the IRS, and you have made a “reasonable effort” to accurately prepare Form 8941, then you will be fine.

The small business tax credit is designed to encourage small businesses to offer health care coverage for the first time or to help them maintain the coverage they already have. To help make health care reform work for our customers, One of our Carriers has partnered with H&R Block® to develop the tax credit calculator tool that is available on Anthem’s health care reform website for employers and brokers. Neither this document nor the tax credit calculator is intended to give tax advice. Customers should consult with their tax adviser due to the complexity of the calculation required to determine the amount of credit.

The calculations require that you capture 2010 payroll information for employee hours paid during 2010, and gross wages paid for 2010. Legal updates and tax considerations intended to inform clients and colleagues of Catalist about current payroll issues and planning techniques.  You should consult with your CPA or tax advisor before implementing any ideas, comments or planning techniques.  For a recommendations, Catalist recommends first consulting with Strategic Partner Profitable Accounting Services.

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Federal Mental Health Parity Interim Final Regulations Explained

Mental Health Parity Act

The Federal Mental Health Parity Act requires our fully-insured employers with 50-2,999 employees, as well as self-funded customers, to offer the same level of coverage for mental health and substance use disorder services as that offered for medical and surgical services through their plan.

The 154-page Federal Mental Health Parity Interim Regulations and comments, were published in February in the Federal Register. Highlights of new/updated information from the interim  regulations are as follows:

Effective Date/Applicability

  • Regulations published as the Interim Final Rule are effective on the first day of the plan year beginning or renewing on or after July 1 and must be complied with even though it is not the Final Rule.
  • The U.S. Department of Labor (DOL), Department of The Treasury and Centers for Medicare and Medicaid Services (CMS) are seeking feedback on the interim final regulations via an open comment period which ends May 3.
  • Regulations are not applicable to Medicaid Managed Care Plans. Separate regulations will be provided from CMS for those plans, but they are still subject to the law.

Benefit Requirements
Establish six classifications of benefits: Parity for treatment limits and financial requirements defined by the regulations, is to be applied classification by classification:

  1. Inpatient In-Network
  2. Inpatient Out-of-Network
  3. Outpatient In-Network
  4. Outpatient Out-of-Network
  5. Emergency
  6. Prescription Drugs
  • The definitions of what constitutes Inpatient, Outpatient and Emergency are not defined by the regulations but instead defined by the plan or applicable state law. However, the terms cannot be defined differently for mental health/substance use disorder than for medical/surgical.
  • Benefits for mental health and substance use disorder are not mandated, but to the extent benefits are provided in one of the six classifications, they must be in parity with that classification’s medical benefits. Plans are not required to cover all mental health conditions or all substance use disorders but may define which they will or will not cover.  Fully-insured plans are still subject to state mandates which may require certain mental health or substance use disorder benefits.
  • Financial requirements and quantitative treatment limitations must be in parity with the requirements and limitations applied to substantially all benefits for the applicable classification on medical benefits. “Substantially all” means the requirement/limitations apply to at least two-thirds of the benefits in that classification.
  • Regulations do not allow recognition of distinction between primary and specialty financial requirements/treatment limitations for parity purposes.
  • Regulations prohibit separate cost sharing, e.g., no separate but equal deductibles or out-of-pocket maximums.
  • Parity applies to non-quantitative limits and specifically lists the following classifications and specifies these mustbe in parity:
    • Medical management standards, such as medical necessity
    • Formulary design for prescription drugs
    • Standards for provider admission to network, including reimbursement rates
    • Plan methods for determining usual and customary rates Fail-first or step therapy requirements (e.g., must try certain treatment before obtaining approval for another treatment
    • Exclusions for failure to complete a course of treatment   These limits must be comparable to and applied no more stringently for mental health/substance use disorder benefits than they are for medical benefits.

Product Requirements

  • Employee Assistance Program (EAP) gatekeeper models are prohibited.
  • A plan sponsor cannot avoid parity requirements by establishing a separate group health plan for mental health/substance use disorder benefits.
  • Plan sponsors with multiple medical benefit plans but a single mental health/substance use disorder plan must ensure compliance for parity purposes between the mental health/substance use disorder benefit plan and eachmedical plan.
  • No guidance is available yet on cost exemption. (This remains under development.)

Parity Relevance
Federal Mental Health Parity is relevant to all group health plans (fully insured and self-funded) with few exceptions, such as self-funded non-ERISA government (non-federal) plans that have expressly opted out under existing law and groups with 50 or fewer total employees.

Reference Materials
The Federal Mental Health Parity — A Summary of the Interim Final Rules: What You Need to Know brochure (available upon request) provides an overview of the new Federal Mental Health Parity regulations. The document highlights the key provisions, including implementing parity regulations for financial requirements and treatment limitations.

For more information please contact your Catalist Health Representative

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Promises Made; Promises Broken.

Obama Promises Made Promises Broken

Promises Made; Promises Broken. Senate Majority Leader Harry Reid is in full get-a-bill mode. Virtually every promise of reform has been thrown out the window, even as those willing to work with the president have been thrown under the bus. Just consider some of the promises broken.

Promises:

  • Family health insurance premiums will drop by $2,500 a year by the end of the president’s first term.
  • Everyone will be covered.
  • If you like your current health insurance plan you can keep it.
  • Electronic medical records will save significant amounts of money.
  • The president will sit down with members of Congress and go over the legislation line by line.
  • Discussions will be an open process that even C-Span could broadcast.
  • Health care reform will cost about $60 billion a year (which would only be $600 billion over 10 years).

All those promises and more have been broken; they aren’t even considered serious anymore. And yet reform efforts move on. That’s one of the reasons those of us opposing the reform effort are so frustrated. No one — and certainly not the media — appears to be holding the president accountable.

Déjà vu. Actually, this effort isn’t all that different than the 1993-4 Clinton health care reform debate. When Clinton was elected there was also a sense of inevitability about the success of the bill. Most of the various trade associations — the AMA, PMA (now PhRMA), the AHA, the big business groups, and even HIAA — wanted to work with the administration and have a “seat at the table.”

It wasn’t until January or February of the following year (1994) — about where we are now — that many of the major groups started turning against the plan. The business groups have been turning, and some of the associations are turning.

Of course, there are differences. The Democrats are much further along this time than in 1993-4. And some of the trade associations have continued their support, even when it’s clear they will be hammered by the legislation.

But don’t let people tell you things are completely different this time. There are a lot of similarities.

No More Cards. Last week Senator John McCain (R-AZ) went on the floor of the Senate to complain that AARP has opposed every past cut to Medicare, even as it supports the proposed new cuts to Medicare — which are substantially larger than anything the Republicans ever proposed. And so McCain urged seniors to cut up their AARP membership cards.

It’s an important point. The media regularly refer to AARP as a seniors’ lobby or a consumer group. It’s not. It has effectively become an arm of the Democratic Party. Yes, AARP supported the Republican-led Medicare prescription drug legislation that passed in 2003. But Democrats roundly chastised AARP for doing so — even though several Democrats voted for the bill — and AARP apparently learned its lesson. If Democrats say something’s good, AARP must say something’s good. I just wish the media would recognize the relationship.

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