Reimbursement Model

Tax Implications  for small businesses related to health insurance to include major medical. dental, vision and long-term care insurance.(©2013 Small Business Majority).

(The information on this site is intended for informational purposes only and does not constitute legal advice. To comply with IRS rules, we must inform you that if this site contains advice relating to federal taxes, it was not intended nor written to be, and cannot be, used for the purpose of avoiding penalties that may be imposed under federal tax law. Under these rules, a taxpayer may rely on professional advice to avoid federal tax penalties only if that advice is reflected in a comprehensive tax opinion that conforms to stringent requirements under federal law.)

What Does It Mean to Be Self-Employed?

Tax-Deductibility of Employer’s Premium Contributions

Tax-Deductibility of Employer’s Medical Reimbursements

Taxability of Value of Health Plan to Employee

Taxability of Reimbursements to Employees

Taxability of Employees’ Premium Contributions

Generally speaking, any expenses an employer incurs related to health insurance (for employees or for dependents) are 100% tax-deductible as ordinary business expenses, on both state and federal income taxes. Beyond this general rule, taxes get a bit more complicated. It is possible to set things up so that your employees save tax money. With just a little paperwork on your part, an employee can contribute to the cost of health insurance on a pre-tax basis. That means you deduct the cost of the premium from the employee’s paycheck before state and federal taxes are calculated and deducted. This increases the employee’s take-home pay and lowers the amount of the employee’s taxable income.The small business healthcare tax credits have been available since the 2010 tax year. To qualify for a tax credit of up to 35% of premium costs now and 50% in 2014, small business owners must pay at least half of employees’ healthcare premiums and have 25 or fewer full-time equivalent employees who earn an average of $50,000 or less per year.

Beyond this general rule, things get a bit more complicated. Below we offer detailed information on the tax implications of offering a group plan for your business. Before we get started, it’s important to understand a few key distinctions. When discussing taxability of health insurance, there are a few main issues:

Employers should also be aware that the Affordable Care Act offers small businesses healthcare tax credits to help offset the cost of insurance.

(The information on this site is intended for informational purposes only and does not constitute legal advice. To comply with IRS rules, we must inform you that if this site contains advice relating to federal taxes, it was not intended nor written to be, and cannot be, used for the purpose of avoiding penalties that may be imposed under federal tax law. Under these rules, a taxpayer may rely on professional advice to avoid federal tax penalties only if that advice is reflected in a comprehensive tax opinion that conforms to stringent requirements under federal law.)

For employers, main issues include:

Whether an employer’s health coverage premium contributions are tax-deductible as a business expense.

Whether an employer’s reimbursements for the costs of coverage and care are tax-deductible as a business expense.For employees, main issues include:

Whether an employer’s premium contributions are taxed as income.

Whether an employer’s medical reimbursements are taxed as income.

Whether an employee’s share of premium is paid with pre-tax or after-tax income.Obviously, tax issues can get complicated, so you should consult with your accountant or attorney about your specific circumstances. If you find yourself getting confused, just remember that most tax-related questions boil down to one or more of the main issues listed above. These are the main questions employers and employees find themselves asking. We will answer them below.

Keep in mind that the answers to these issues may differ depending on the legal structure of the business. Some employers are considered self-employed and are subject to special rules. Generally speaking, owners of C corporations and LLCs classified as corporations for tax purposes are not considered to be self-employed. These business owners are considered to be employees of the business.

On the other hand, the following types of employers are considered to be self-employed for purposes of health care benefits:

What Does It Mean to Be Self-Employed?

On the other hand, the following types of employers are considered to be self-employed for purposes of health care benefits:

Owner of a sole proprietorshipPartner in a partnership

Member of an LLC classified as a partnership for tax purposes

Shareholder of 2 percent or more of the stock of an S corporation

Tax-Deductibility of Employer’s Premium Contributions

As we continue to discuss rules below, keep in mind that employers who are not self-employed are considered to be workers, so any rules that apply to workers apply to the employer as well. If the employer is self-employed, a special rule may apply.

A common concern for employers is whether their contributions toward health coverage premiums are deductible as business expenses. In general:As we continue to discuss rules below, keep in mind that employers who are not self-employed are considered to be workers, so any rules that apply to workers apply to the employer as well.

If the employer is self-employed, a special rule may apply.Employer premium contributions for employees and their opposite-sex spouses and tax dependents are 100% deductible as business expenses under federal and state tax law. This is true regardless of business type-sole proprietorship, partnership, LLC, corporation, etc. These rules also apply to owners of C corporations and LLCs classified as corporations for tax purposes. Employer premium contributions for employees and their opposite-sex spouses and tax dependents are 100% deductible as business expenses under federal and state corporation rules.  These business owners are considered to be employees of the business for purposes of the tax treatment of premium contributions.

If an employer is self-employed, contributions for him or herself and his or her opposite-sex spouse and tax dependents are 100% deductible as a business expense on the business owner’s tax return.

Employers should be aware that the Patient Protection and Affordable Care Act offers small businesses healthcare tax credits to help offset the cost of insurance. These tax credits have been available since the 2010 tax year. To qualify for a tax credit of up to 35% now and 50% in 2014 through health exchanges, small business owners must pay at least half of employees’ healthcare premiums and have 25 or fewer full-time equivalent employees who earn an average of $50,000 or less per year.

Tax-Deductibility of Employer’s Medical Reimbursements

Reimbursements provided by employers for medical expenses and health care coverage of employees are treated similarly to employer-provided premium contributions, as long as some rules are followed. The employer must have a “plan” in writing that stipulates the employer will provide health coverage by reimbursing its employees for all or part of medical expenses or the cost of coverage purchased directly by the employees. Employers should obtain documentation of the medical services before reimbursing the employee.Employers who are self-employed may also deduct the cost of their own and their tax dependents’ healthcare expenses, but as personal expenses rather than business expenses. 

As long as the requirements are satisfied, employers may deduct as business expenses any reimbursements provided for their employees and their opposite-sex spouses and tax dependents under federal and state tax law.

Taxability of Value of Health Plan to Employee

Another issue employers face is whether the value of the health plan—basically, the amount of the premium costs—is taxable to the recipient. Keep in mind that the recipient could be an employee or a self-employed business owner. The general rule is as follows:

Employees are not taxed on the value of their health coverage. The value of employer-provided health coverage for the employee and their opposite-sex spouse or tax dependents is not taxable income to the employee under federal and state tax law. The coverage is tax-exempt to the employee whether it is provided under a group or individual insurance policy.

An employee who is provided coverage for a same-sex spouse, domestic partner or their dependents is subject to federal tax on the value of the coverage provided by the employer for the non-tax dependents, less the amount (if any) paid by the employee for the coverage. Such amounts also are considered wages for purposes of federal payroll taxes.

Business owners who are considered to be self-employed are taxed on the value of their health coverage. As we explained above, the following types of employers are considered to be “self-employed”: owners of sole proprietorships, partnerships, LLCs classified as a partnership for tax purposes, and 2 percent shareholders in an S corporation. These business owners will be taxed on the value of their health coverage, but receive an offsetting deduction on their tax returns.If an employee pays the premiums on personally owned health insurance or incurs medical costs and is reimbursed by the employer, the reimbursement generally is excluded from the employee’s gross income and not taxed under both federal and state tax law. This includes premiums for tax dependents and opposite-sex spouses. However, there are some circumstances in which the reimbursement is taxable income, including the following:

Taxability of Reimbursements to Employees

If an employer simply pays the employee an extra amount and does not specify in writing that the amount must be used to pay the health coverage premium, it will be taxable to the employee as income.

If the employer is self-employed, any reimbursements for their own or their dependents’ health care costs are taxable income to the self-employed employer.

Taxability of Employees’ Premium ContributionsSection 125 plans include:

Generally speaking, an employee contribution toward health coverage is deducted from wages on an after-tax basis unless the employer establishes a special arrangement under Section 125 of the federal tax code. Without a Section 125 plan in place, taxes are imposed on employees’ pay before they pay their share of the premium.

To further explore these issues, contact a tax professional.

Before-tax “premium only” plans. Plans that allow employees to pay the premium for themselves and their tax dependents with before-tax dollars. Employees may also use pre-tax dollars to pay premiums for non-tax dependents as long as the value of the coverage is taken into account for purposes of calculating the employee’s taxable income.

Flexible spending account plans. Reimbursement plans that, in essence, allow employees to pay for certain eligible out-of-pocket medical expenses with before-tax dollars.

Cafeteria or flexible benefit plans. Plans that give the employee a choice of taxable pay or nontaxable benefits.Under the Affordable Care Act, for FSAs under a cafeteria plan, annual contributions will be limited to $2,500 beginning in 2013; the limit is indexed to the Consumer Price Index for following years. There is currently no federal limit and employers set the annual cap.  

Another note: The FSA definition of qualified medical expenses is the same as those allowed under itemized tax deduction. This change, effective January 1, 2011, no longer allows coverage of over-the-counter items unless directed by a physician.

In various ways, these plans allow you and the employee to save on taxes. If employees contribute to the premium with before-tax pay, they will reduce their federal income tax, state income tax, Social Security tax, and other payroll taxes. You will also save employer taxes (FICA and FUTA) on the amount of employees’ before-tax contributions.

 

Long Term CAre Insurance Reimbursement Model policies repay the insured for qualifying long-term care expenses that he or she incurred, subject to the amount of coverage purchased.

Reimbursement Example 1

Sandy purchases a Reimbursement Long-Term Care Insurance Policy with coverage of $150 per day. Sandy later needs Home Health Care services and the cost is $80 per day. Sandy's Reimbursement insurance coverage would reimburse her for her expenses and as a result she would receive $80 per day of qualifying services. The remaining $70 ($150 per day in coverage minus $80 paid in benefits = $70) remains with the insurance company and is available for Sandy's use down the road.

Reimbursement Example 2

Charles purchases a Reimbursement Long-Term Care Insurance Policy with coverage of $150 per day. Charles later needs Home Health Care services and the cost is $200 per day. Charles' Reimbursement insurance coverage would reimburse him for his expenses up to the amount of coverage purchased, and as a result he would receive $150 per day of qualifying services. Charles would be personally financially responsible for the remaining $50 ($200 per day in expenses minus $150 received in benefits = $50).

Tax Treatment of Benefits Received

For policies that pay benefits under the Reimbursement Model, the benefits received are considered to be a reimbursement for expenses incurred for medical services. This is true regardless of whether the Tax-Qualified Long-Term Care Insurancepolicy reimburses pays benefits on a daily, weekly, monthly or other periodic basis (IRC Sec. 7702B(a)). As a result, benefits under a Reimbursement Model are generally not considered income.

We do not provide tax or legal advice. Any decisions whether to implement these ideas should be made by the client in consultation with professional financial, tax, and legal counsel.

The information on this site is intended for informational purposes only and does not constitute legal advice. To comply with IRS rules, we must inform you that if this site contains advice relating to federal taxes, it was not intended nor written to be, and cannot be, used for the purpose of avoiding penalties that may be imposed under federal tax law. Under these rules, a taxpayer may rely on professional advice to avoid federal tax penalties only if that advice is reflected in a comprehensive tax opinion that conforms to stringent requirements under federal law.