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Health Care Accounts

The Affordable Care Act (ACA) affects cafeteria plans as well as health care accounts such as flexible spending accounts (FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs) and Archer medical savings accounts (Archer MSAs).

Articles

CARES Act Prompts Changes to Employer-Sponsored Health Plans, Ogletree Deakins, 4/6/2020

IRS Outlines How Individual-Coverage HRAs Can Meet ACA Employer Mandate, Mercer, 10/29/2019

Health Reform Bulletin, CBIZ Benefits & Insurance Services, Inc., 10/9/2019

Ten things employers should know about individual coverage HRAs, Thompson Coburn, 8/28/2019

What Do the Courts Have in Store for the ACA? An Update on Health Reform Lawsuits , The Commonwealth Fund, 8/20/2019

“Stand-Alone” HRAs Are Back – Sort Of: Individual Coverage HRAs May Offer Simpler Means For Compliance With Employer Mandate , Bons, Schoeneck & King, 8/9/2019

Universities and Health Insurance: Higher Ed Institutions Now Have More Options With the New HRA Regs, Ogletree Deakins, 8/8/2019

ACA Litigation Round-Up: AHPs, Short-Term Plans, CSRs, And Risk Adjustment, Health Affairs, 8/5/2019

IRS expands preventive care benefits that are not subject to HDHPs’ deductible, Greensfelder, 7/19/2019

New Tool to Contain Employer Healthcare Costs , Jackson Walker, 7/11/2019

The HRA Final Rule Is Here (Part 2), International Foundation, 6/28/2019

The HRA Final Rule Is Here (Part 1), International Foundation, 6/27/2019

Final Regulations Permit Individual Coverage HRAs in 2020, ABD Insurance & Financial Services, 6/19/2019

Some 2020 inflation adjustments roll out in time for benefits planning , Lockton, 5/30/2019

Proposed Rules to Expand HRAs Part 3: The Impact of Individual Coverage HRAs on PTC Eligibility (IRC Section 36B) and the Employer Shared Responsibility Mandate (IRC Section 4980H), Boutwell Fay LLP, 2/5/2019

ACA Litigation Round-Up: CSRs, Risk Adjustment, AHPs, And Short-Term Plans, Health Affairs, 1/3/2019

New IRS And Treasury Guidance On Safe Harbors For HRAs, Health Affairs, 12/4/2018

Employer options for health insurance may expand with new rules on health reimbursement arrangements, Willis Towers Watson, 11/29/2018

An Employer’s Guide to Proposed Regulations Expanding HRAs, Davis Wright Tremaine LLP, 10/29/2018

Departments Propose Regulations Permitting HRAs for Individual Policies, ABD Insurance & Financial Services, 10/23/2018

What is QSEHRA? A practical guide for small employers, Take Command Health, 6/26/2018

New Guidance on Qualified Small Employer Health Reimbursement Arrangements, von Briesen & Roper, SC, 1/18/2018

Challenges of Embedded Deductibles and Out-of-Pocket Maximums, HUB International, 11/15/2017

Executive Order on Health Care Discontinuation of Cost-Sharing Subsidies in the Marketplaces, Marsh & McLennan, 10/30/2017

HRAs, AHPs, and STLDIs: What the Executive Order Means for Benefit Plans, IFEBP, 10/20/2017 Blog explains President Trump's Executive Order dated October 12, 2017, and how it could affect employers and employees

The Revolution of Employer-Sponsored Health Insurance, Trucker Huss, 10/19/2017 Article explores possible effects of 10/12/17 Executive Order on HRAs and Employer Payment Plans (EPPs).

What If Employees Could Buy Coverage with Tax-Free HRA Contributions?, Mercer, 10/12/2017

QSEHRA – The 21st Century Cures Act Creates a New Health Care Plan Option for Small Employers, Mintz Levin, 3/31/2017

IRS Proposes Additional Regulations Clarifying Handling of 'Opt-Out' or 'Cash-in-Lieu' Programs Under PPACA, Benefit Revolution, 7/23/2016

Fact Sheets

ACA Numbers & Limits 2014-2020, Kaufman & Canoles, 9/26/2019

FAQs

What are Individual Coverage HRAs and how do they affect employers? , International Foundation, 10/7/2019

Can an employer with under 50 employees offer a stipend for employees to use to purchase their own individual health insurance policies?, International Foundation, 3/15/2019

What is a “qualified small employer health reimbursement arrangement” (QSEHRA) and is it considered a group health plan?, International Foundation, 1/23/2017

Can HMOs exclude dependents under age 26 because they live outside the service area?, International Foundation, 6/23/2016

What is the difference between out-of-pocket limits for essential health benefits and out-of-pocket limits imposed on high deductible health plans?, International Foundation, 3/4/2016

Does the ACA require an annual open enrollment period for large, self-funded employer plans?, International Foundation, 7/22/2015

Government Resources

HHS Notice of Benefit and Payment Parameters for 2021 Final Rule Fact Sheet, CMS, 5/7/2020

Health Reimbursement Arrangements and Other Account-Based Group Health Plans Final Rule, DOL, Treasury, HHS, 6/13/2019

Fact Sheet: Proposed HHS Notice of Benefit and Payment Parameters for 2019, CMS, 10/30/2017

FAQs About ACA Implementation Part 37, EBSA, 1/12/2017 Q&A on integration of Health Reimbursement Arrangements (HRAs) with group health plans sponsored by the employer of a spouse of an employee; Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs)

FAQs About ACA Implementation Part 35, EBSA, 12/20/2016 Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs) and women's preventive services

Questions and Answers on Over-the-Counter Medicines and Drugs, IRS, 8/5/2016

Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium Tax Credit, IRS, 12/18/2015 Final rule on whether wellness incentives, flex credits and HRA contributions are included when calculating minimum value and affordability

Further Guidance on the Application of the Group Health Plan Market Reform Provisions of the Affordable Care Act to Employer-Provided Health Coverage, IRS, 12/16/2015 Notice 2015-87 on HRAs, FSAs and employer payment plans in which the employer directly pays employees' individual health insurance premiums

Guidance on the Application of Code � 4980D to Certain Types of Health Coverage Reimbursement Arrangements, IRS, 2/18/2015 Notice 2015-17 on failure to satisfy prohibition on annual limits. Small employers with employer payment plans get relief for 2014 and up to July 1, 2015

FAQs About ACA Implementation Part XXII, EBSA, 11/1/2014 Premium reimbursement arrangements for individual market policies

FAQs About ACA Implementation Part XIX, EBSA, 5/1/2014 Model COBRA notices, out-of-pocket (OOP) maximums, reference-based pricing, preventive coverage for tobacco cessation interventions, FSA carryovers

Application of Market Reform and Other Provisions of the ACA to HRAs, Health FSAs, and Certain other Employer Healthcare Arrangements, IRS, 9/13/2013 Notice 2013-54 on employer payment plans considered to be group health plans subject to the market reforms, including prohibition on annual limits for essential health benefits and the requirement to provide preventive care without cost sharing. Employer payment plans may be subject to a $100 per day excise tax per applicable employee

FAQs About ACA Implementation Part XI, EBSA, 1/24/2013 HRAs cannot be integrated with individual market coverage and multiemployer PCORI fee payment from plan assets

Use of Health FSA and HRA Debit Cards to Reimburse Expenses for Over-the-Counter (OTC) Medicines or Drugs, IRS, 12/23/2010 Notice 2011-5 stating after January 15, 2011, FSA and HRA debit cards may continue to be used to buy OTC drugs at drug stores and pharmacies, mail order and web-based vendors if the prescription is presented to the pharmacist and other requirements.

Payment of Reimbursement of Medicines or Drugs Restricted to Prescribed Drugs, Insulin, and Over-the-Counter (OTC) Drugs That Are Prescribed, IRS, 9/3/2010 Notice 2010-59 on revised definition of qualifying medical expenses subject to preferred tax treatment. Effective Jan. 1, 2011, distributions from health FSAs, HSAs, Archer MSAs and HRAs will be allowed to reimburse the cost of over-the-counter medicines or drugs only with a prescription

Webcasts

ACA: Where We Are Now, International Foundation, 2/27/2020