Reproduced with permission from BNA's Pension & Benefits Daily, (July 9, 2013). Copyright 2013 by The Bureau of National Affairs, Inc. (800-372-1033) <http://www.bna.com>
The Affordable Care Act requires employers to review and, in most instances, revise the health coverage provided to employees. One area of employee health coverage that merits careful attention is executive health care coverage, both for actively employed and for terminated executives.
Many companies have historically offered enhanced or supplemental health benefits to their executives. Because benefits offered to employees through self-insured health plans have long been subject to nondiscrimination rules intended to prevent such plans from providing greater benefits to highly compensated employees than to other employees, many executive health programs have been provided under fully insured plans, which were not subject to nondiscrimination rules.
However, the Affordable Care Act added a requirement that nondiscrimination rules, basically similar to those applicable to self-insured plans but significantly different in many respects, apply to fully insured plans. The effective date of these rules has been delayed until the Internal Revenue Service issues guidance or regulations. No such guidance or regulations have yet been issued, but now is the time to review existing executive health arrangements in anticipation of these rules.
Nondiscrimination Rules Applicable to Self-Insured Plans: Risk for Highly Compensated Employees
Generally, benefits provided through self-insured medical plans are not included in the taxable income of the employees who receive the benefits. However, if benefits are provided under a plan in a manner that discriminates in favor of highly compensated employees as to eligibility for the benefit or the amount of the benefit provided, the highly compensated employee loses the tax benefit and the value of the benefits paid to the executive in excess of the benefits provided to rank-and-file employees is included in the highly compensated employee's income. If nothing is done to address discriminatory benefits under a self-insured health plan, the costs of underlying medical benefits provided (e.g., the costs associated with a surgery or other medical treatment) would be included in the executive's income. A simple and common fix to avoid this consequence is to have executives pay the fair market value of the coverage (e.g., the Consolidated Omnibus Budget Reconciliation Act (COBRA) cost) for participating in the plan. This allows the value of the benefits provided to be provided on a tax-free basis, but it does require the executive to incur a cost to participate.
Whether a plan discriminates as to benefits depends on whether it provides benefits to highly compensated individuals that it does not provide to all other participants. For purposes of these rules, in general, a highly compensated employee is a 10 percent shareholder of the employer, one of the five highest paid officers, or is among the highest paid 25 percent of all employees. Whether a plan discriminates as to eligibility is determined either by a numerical test based on the percentage of all employees eligible to benefit under the plan or a nondiscriminatory classification of employees eligible to participate. These rules apply in the same manner to benefits provided to former employees. In evaluating whether benefits provided to former employees are discriminatory, the covered employee's status as a highly compensated employee is determined as of his or her termination of employment.
Nondiscrimination Rules Applicable to Fully Insured Plans: Risk for the Employer
We don't yet know the details of when a fully insured plan will be considered discriminatory, only that such rules will be similar to those applicable to self-insured plans. The consequences, however, of providing discriminatory benefits under a fully insured plan differ significantly from providing discriminatory benefits under a self-insured plan.
As noted above, providing discriminatory benefits under a self-insured plan causes the highly compensated employees to have income tax inclusion for the value of the excess benefits. Under the Affordable Care Act, if a fully insured plan does not comply with the nondiscrimination rules, the sponsoring employer may be subject to monetary penalties of up to $100 per day per nonhighly compensated employee, up to a maximum of $500,000 per year, unless the violation is corrected within 30 days, or could not have been discovered if the employer exercised reasonable diligence. In addition, employees may also have a private right of action to enforce the rule. It would appear that a participant who is not a highly compensated employee in a fully insured plan, as well as the Department of Labor, would have the right to file a lawsuit under the Employee Retirement Income Security Act to compel the sponsoring employer to provide nondiscriminatory benefits.
In addition, although not entirely clear, it appears that having executives pay the fair market value of the coverage (e.g., the COBRA cost) on an after-tax basis under the fully insured plan may not avoid the new nondiscrimination issues. We expect this to be clarified in future guidance.
Exceptions Under the Affordable Care Act
The Affordable Care Act potentially excludes two types of fully insured health arrangements from the new nondiscrimination rules, although it is likely that the scope of these exceptions will be clarified by future regulation:
Pending issuance of IRS guidance implementing the nondiscrimination rules applicable to fully insured plans, employers should review existing plans that provide supplemental benefits for executives and plan for compliance with the new nondiscrimination rules.
Because focus on the nondiscrimination rules applicable to self-insured plans and enforcement of those rules is expected to increase once the nondiscrimination rules for fully insured plans are issued, employers should also review the executive benefits being provided under self-insured plans and consider alternatives.
. Section 10101(d) of the Affordable Care Act added § 2716 to the Public Health Service Act, which applies rules similar to the tax code § 105(h) to fully insured health plans. All references to the tax code in this article refer to the Internal Revenue Code of 1986, as amended.
. See IRS Notice 2011-1, 2011-2 I.R.B. 259.
. See tax code § 105(b).
. See tax code § 105(h).
. For an active employee, the COBRA cost may be imputed because the employee will be getting a Form W-2 from the employer and has other income from which to take applicable withholdings. For former employees, it is easiest to have the employee pay the COBRA cost with a check.
. The cost to the executive may, of course, be covered by increased taxable compensation (with or without a gross-up), but may not be covered on a pretax basis.
. See tax code § 105(h)(3)(A) and Treas. Reg. § 1.105-11(c)(3(d)).
. See tax code § 105(h)(3) and Treas. Reg. § 1.105-11(c)(2).
. See Treas. Reg. § 1.105-11(c)(3)(iii).
. It appears that the monetary penalties will not apply to an employer with fewer than 50 employees, if the failure to comply is due "solely" to the health insurance coverage offered by the issuer. See tax code § 4980D(d).
. The enforcement regime of ERISA § 502 applies to group health plans, both insured and self-insured. ERISA § 502(a)(3) permits a participant, beneficiary, or fiduciary to bring a civil action to enjoin any act or practice that violates ERISA or the terms of the plan, or to obtain "other appropriate equitable relief" due to an ERISA violation. See also IRS Notice 2010-63, 2010-41 I.R.B. 420, which states that if an insured group health plan fails to comply with § 2716 of the Public Health Service Act, "the plan is subject to a civil action to compel it to provide nondiscriminatory benefits."
. The definition of "plan" that is used for COBRA purposes under Treas. Reg. § 54.4980B-2, Q& A 2-1(a) looks to an individual's employment-related connection to the employer to determine whether there is a plan. Thus, the question may become whether the executive's after-tax payment is itself a plan that is discriminatory under the new nondiscrimination rules.