Peter Gulia Posted August 24, 2017 Posted August 24, 2017 I tell many clients and friends that the only dumb question is the one you didn’t ask. And for myself I think it’s better to reveal my ignorance than pretend knowledge I don’t have. I’ve never seen an individual health insurance contract, so this is my naïve question. To meet tax-law conditions for a qualified small employer health reimbursement arrangement within the meaning of Internal Revenue Code § 9831(d)(2), a plan must provide its reimbursement only for medical care and only after the employee furnishes proof of minimum essential coverage. Further, imagine a QSEHRA plan that reimburses only purchases of individual health insurance, not other medical expenses. Following this, to be reimbursable the insurance contract must meet two conditions: it must include (i) minimum essential coverage within the meaning of IRC § 5000A(f)(C) and (ii) no coverage beyond medical care within the meaning of IRC § 213(d). If a small-business employer puts in a decent effort to apply those conditions, how does one discern that a contract meets them? Does a contract that provides minimum essential coverage recite that it does? If so, where in the contract would one expect to see that language? If there is no such recital, what language clues would one look for to find that a contract includes minimum essential coverage? Without reading the whole contract, what shortcut might one use to form a reasonable belief that a contract insures nothing beyond medical care? Peter Gulia PC Fiduciary Guidance Counsel Philadelphia, Pennsylvania 215-732-1552 Peter@FiduciaryGuidanceCounsel.com
Peter Gulia Posted August 24, 2017 Author Posted August 24, 2017 Or is it reasonable for an employer/administrator to approve its employee's claim for a reimbursement on no more than the employee's written statement that the individual health insurance contract he or she paid a premium for meets the conditions? Peter Gulia PC Fiduciary Guidance Counsel Philadelphia, Pennsylvania 215-732-1552 Peter@FiduciaryGuidanceCounsel.com
Flyboyjohn Posted August 24, 2017 Posted August 24, 2017 Any health insurance indemnity contract issued by a licensed insurance company will meet "minimum essential coverage" (ACA requirement). I wouldn't get too hung up on worrying about whether the contract provided benefits other than medical care.
Peter Gulia Posted August 24, 2017 Author Posted August 24, 2017 Flyboyjohn, thank you for your good help. On presuming that a licensed insurance company would not offer a contract that fails to include minimum essential coverage, is that because there is some Federal law that makes it unlawful to offer such a contract? Peter Gulia PC Fiduciary Guidance Counsel Philadelphia, Pennsylvania 215-732-1552 Peter@FiduciaryGuidanceCounsel.com
Flyboyjohn Posted August 24, 2017 Posted August 24, 2017 Yes, ACA requires that all health insurance policies issued in the individual market meet certain minimum requirements (ACA outlawed so called "skinny" plans in the fully insured arena, can still exist in the self-insured arena)
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