GBurns

The first issue is the pre-taxing of the premiums. Unless the participating doctors are bona fide employees who are neither partners in a partnership, members of the LLC or more than 2% shareholders in an S Corp, they cannot pre-tax the premiums because they cannot participate in a section 125 cafeteria plan. http://www.infinisource.com/media/11669/who_cannot_participate_in_a_cafeteria_plan__fsa_or_hra.pdf If the policies are individual policies they cannot be reimbursed either tax free or post tax. http://www.irs.gov/pub/irs-drop/n-13-54.pdf I suggest that you check with your proposed insurance carrier to see what new plan designs they have come up with that would be different. The below Deloitte interpretation of Rev Rul 2004-55 explains a variation on the theme which should not be applicable and for which I suggest legal advice. The EBS explanation might be easier to follow. Note that the coverage in the Rev Rul is through a group policy. http://benefitslink.com/articles/washbull040614.html#.VIuG1aEo7Vg http://www.ebs-md.com/2012/07/30/disability-benefits-are-they-taxable/ http://www.ameriprise.com/budgeting-investing/tax-center/tax-planning-tax-strategies/taxation-of-disability-insurance.asp

Definitely not since 1984. Are these employees the doctors? I do not understand your question regarding doctor choosing ?

It reminds me of my first consulting assignment. I learned that you have to stretch it out and hype it, otherwise there will be no customer satisfaction.

I would think twice about that internist who would so eagerly remove your ingrown toenail. He might just have another motive but is too shy .

I was not aware that a Cafeteria Plan or a HFSA within the Plan could be "grandfathered". What does 2010 have to do with it? It is not the Cafeteria Plan or the HFSA that must qualify as an "Excepted Benefit". From Technical Release 2013-02: "Coverage provided through Code § 125 plans, employer payment plans, health FSAs, and HRAs are eligible employer-sponsored plans and, therefore, are minimum essential coverage, unless the coverage consists solely of excepted benefits. See Code § 5000A(f)(2) and Treas. Reg. §1.5000A-2, 78 Fed. Reg. 53646, 53658 (August 30, 2013)."

Doesn't that depend on how much your internist charges relative to others for the same service, with allowance for setting and availability ? In any case, should you be allowing an internist to remove an ingrown toenail? Should he be even offering the service?

30Rock Where is this employer located? You might want to reply privately.

If I were you, I would search for an employer who has such a plan design and see what documents they use. It might be easier to find such an employer in the public sector.

Please note " (2) Affordability safe harbors for section 4980H(b) purposes. The affordability safe harbors set forth in paragraph (e)(2)(ii) through (iv) of this section apply solely for purposes of section 4980H I also noted that "an applicable large employer member may choose to apply the safe harbors for any reasonable category of employees, provided it does so on a uniform and consistent basis for all employees in a category" It then addresses categories "an applicable large employer member may choose to apply the safe harbors for any reasonable category of employees, provided it does so on a uniform and consistent basis for all employees in a category." Therein lies the basic problem of having a level % for all employees unless you are able to also categorize them so that no discrimination occurs within each category. This only gets you out of the 4980D Affordability Penalty and is not applicable to the other laws. Although I do not see a problem with your intended approach since it should be able to categorize the employees sufficiently so as to avoid discrimination issues, it should be done with careful analysis and legal counsel. Remember, that the categorization is different from the premium contribution requirement.

KJohnson Can you provide a cite of where you found that wording? Thanks.

Off the cuff, I do not see a problem, especially since there is no favoring of HCEs nor any age or disability discrimination.

Basically, yes.

No. The cafeteria plan problems which would be more than just testing are additional to any HIPAA, ACA, ERISA and ADA violations.

There is the issue of the actual premium charged by the insurer in an insured plan or the imputed premium as calculated in a self funded plan. Let us say that the premium for individual coverage is $800 per month with the employee paying 25% or $200. Using 9.5% as an employment classification would mean that some employees would be over contributing while others would be under contributing. Using any across the board figure creates the same situation and you cannot take a lower $ amount from similarly situated employees. You also cannot charge more than the premium due. I also do not think that HIPAA should be your only concern there is your state insurance laws, ADEA, section 125, section 105 (105(h) in particular, FLSA and ERISA, each of which have a little piece of the action. I noticed that you stated that you were waiting on the release of the non-discrimination regulations. I assume that you mean the ACA regulations regarding self insured plans. If you are, be aware that the current regulations are still applicable until then and bear in mind that these will not change those which I listed in the previous paragraph. .

http://employeebenefits.foxrothschild.com/2013/12/articles/welfare-plans/the-9-5-conundrum-discrimination-in-employee-contributions/ http://bbibenefits.com/blog/2014/03/05/why-not-just-charge-everyone-9-5-for-health-care/

I recently read a good explanation of why this would be discriminatory. I will try to find it for you.

That is a cash out option under a cafeteria plan.

It might depend on the size of the employer and the wording of the cash option. State small group/employer health insurance law might prohibit reimbursement directly or indirectly, in any form, which means that there must be no wording that connects the cash out to the purchase. The same applies under ACA.

I have not seen or heard of such employer insurance premiums, so I advise that you check that out. Employee contributions which are controlled by IRC section 125 does not have age as an allowable category. You also would have a problem with ADEA. If you are a small group/employer your state health insurance laws might also be applicable. Considering all of the above along with this being new to you, I do suggest that you seek competent advice, preferably legal.

BG5150. You are correct. I did not click the link at the end. It is a promotion. Maybe, it should be treated as spam and deleted.

Rather than go on at length about the dangers of the scheme, I suggest that you do a search on Google using the term "IRC section 770".. You should first notice that the name "770" is made up for sales purposes and that there is no section 770 of the Internal Revenue Code that is relevant to life insurance anyway. This scheme surfaces every few years and has been addressed on snopes.com and quatloos.com, Take a look.

But the 30 hours existed before and has not changed. http://leg1.state.va.us/cgi-bin/legp504.exe?031+ful+CHAP0645

By the way, in case you had not noticed, small group in VA is now 100 lives.

I only had on file the small group statutes. that does not mean that there is not a general statute applicable to larger groups. I just did not have it at hand.

An "economic loss" does not mean that there are "damages" or that if there are "damages" the plan administrator is liable.