Why offer a tax favored health plan?

1. Tax Favored Health PlansDifferences Between FSA, HSA, HRA and other Health Savings AccountsFlex-Pay Payroll Services * 723 Coliseum Drive, Suite 200 *Winston-Salem, NC 27106 * info@flex-pay.com * (800) 457-2143

2. Why offer a tax favored health plan?

3. Types of Plans • POP - Premium Only Plan • HSA - Health Savings Accounts • FSA - Flexible Spending Arrangements • HRA – Health Reimbursement Arrangements • Link to Publication 969 below: http://www.irs.gov/pub/irs-pdf/p969.pdf • MSA – Medical Savings Accounts (Archer MSAs and Medicare Advantage MSAs) Handled like an individual IRA account

4. Consumer Driven Health Plan • Theoretically, employers reduce health related expenses to the company including health insurance premiums, health related absences, and productivity through involving the employees in the decision making of choosing their plan and coverage. • Each year, employees and employers are offered less coverage, higher deductibles, higher co-payments, more plan limitations and higher premiums from the insurance companies. • With health savings accounts, employees can choose and pay for health care treatment that may not be covered under the employer provided insurance plan, improving their overall wellness. • Health savings accounts also provide a method for the employee to fund the future costs of the higher deductible either with their own money or with EE and ER funds if the ER contributes.

5. Employee Benefits of All Plans • Pretax deduction for employee contributions including income, Social Security and Medicare tax. Reimbursements or distributions from the accounts that are used to pay qualified medical expenses are not taxed. Refer to IRS Publication 502 for qualified expenses • No taxes on interest or earnings on the assets of the account.

6. Employer Benefits of All Plans • Tax savings on employee pretax deduction • Social Security, Medicare, FUTA, SUI. • Employer contributions are tax free and are considered a business expense. • These plans provide a relatively low cost way to offer a valuable employee benefit. • The administrative costs and employer contributions may possibly be recouped through lower health insurance premiums and payroll tax savings.

7. Premium Only Plan Features (POP) • Designated deductions are pretax, typically insurance premiums such as medical, dental, vision, etc. and HSA employee contributions. • Low cost and easy to establish plan. • No monthly fees to maintain plan. • Saves employee and employer FICA taxes along with employer FUTA and SUI taxes. • Requires a plan document.

8. Differences of Medical Savings Accounts Flexible Spending Account Health Savings Account Health Reimbursement Account

9. Features of HDHP’s • Higher deductible than typical health plans. • Minimum annual deductible: individual is $1,250, and family is $2,500. • Maximum on the sum of the annual deductible and out of pocket expenses are: individual is $6,250, and family is $12,500. • An HDHP may provide preventive care at no or lower deductible (annual physicals, routine pre-natal, well-child care, screening ,etc.). • Link to 2013 limits: http://www.irs.gov/pub/irs-drop/rp-12-26.pdf

10. Flexible Spending Arrangement Features (FSA) • The employer has flexibility in the plan’s design. • An FSA allows employees to be reimbursed for medical expenses. • FSAs are usually funded through voluntary salary reduction agreements (125 deductions). • The employer may also contribute as a tax free fringe benefit. • Requires a plan document. • Does not require a HDHP.

11. FSA Benefits/Risks • Employee contributions are tax free. • Employer contributions are tax free. • Withdrawals for qualified medical expenses are tax free. • Employer Risk - employee can withdraw funds through a large medical expense reimbursement in advance of their contributions. • Employee Risk – unspent funds are forfeited annually (plans may have a grace period)

12. FSA Plan design • No HDHP or any type of specialized insurance plan is required. • The IRS limit on medical FSA is $2,500 as of 2013 (for plan years beginning in 2013). • IRS limit on dependent care FSA $5,000. • EE can not change election during the year unless there is a qualifying event.

13. FSA Types of Accounts • Medical Expenses which typically covers deductibles, copayments, prescription copayments and over the counter medication if the doctor prescribed the OTC. • Dependent Care which typically covers expenses to care for dependents while the employee is at work. Along with day care, this can also cover adult day care for senior citizen dependents. • Premium Reimbursement – individually owned, non-employer sponsored policies covering health, dental, vision, Medicare B, LTD, STD and accident insurance. Beware of possible issues with COBRA, HIPAA, ERISA and Medicare before adopting this. • Limited Scope of premium reimbursement offerings if offered in conjunction with an HSA. • Vision, dental, etc. but not health insurance

14. FSA W2 Reporting • FSA employee or employer contributions are not required to be reported on the W2 except dependent care contributions in Box 10. • The amounts can voluntarily be reported in box 14 for informational purposes. • The employee isn’t required to report FSA contributions on their income tax return.

15. Health Savings Accounts (HSA) Features • An HSA is a tax-exempt trust or custodial account that you set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur. • A qualified trustee can be a bank, an insurance company, or anyone already approved by the IRS. • Does not require a plan document. • Began in 2003, which may indicate there will be future IRS changes, annually indexed by IRS.

16. Benefits of HSA • Contributions by employer or by employee through cafeteria plan are excluded from income. (Exempt from income tax only if contributions made outside of 125.) • Contributions carry over from year to year. • Interest earned on the account is tax free. • Distributions are tax free if used for qualified medical expenses. (Reference IRS Publication 502.) • Portable – stays with employee, not employer owned.

17. How do Employees Qualify for HSA? • The employee must be covered under a High Deductible Health Plan (HDHP). • The employee cannot be enrolled in Medicare. • The employee cannot be claimed as a dependent on someone else’s tax return. • The employee cannot have any other health coverage other than the next slide.

18. HSA Other allowed coverage • Specific disease or illness • Fixed amount per day of hospitalization • Accidents • Disability • Dental • Vision • Long-term care

19. Maximum contributions (total EE and ER): Individual $3,250 Family $6,450 If the employee is 55 or older, an additional $1,000 can be contributed. Additional limits apply for partial year eligibility. Pub 969 HSA Contribution Limits

20. HSA W2 Reporting • Both the employee’s pretax contributions and the employer’s contributions must be reported in Box 12W of the employee’s W2 form. • This information is required to be recorded on Form 8889 with the individual’s 1040.

21. Health Reimbursement Arrangements (HRA) Features • HRA allows employees to be reimbursed for medical expenses. • More flexible, does not require a HDHP. • HRA must be funded solely be employer, no employee contributions allowed. • Requires a plan document.

22. Benefits of an HRA • Employer contributions are tax free. • Withdrawals for qualified medical expenses are tax free. Reference IRS Publication 502. • Unused amounts can be carried forward for reimbursements in later years. • Not as flexible as an HSA since only employers are allowed to fund the account and employees cannot contribute pretax dollars to the account. • Funds cannot be invested.

23. HRA Plan Design • The design options provide limitless customization for employers. • No IRS limit on Employer contributions. • Funds stay with employer upon employee termination.

24. HRA W2 Reporting • HRA employer contributions are not reported on the W2. • The employee is not required to report HRA contributions on their 1040 return.

25. Benefit Comparison

26. More Comparisons • HRA’s are considered to benefit employers more while HSA’s are considered more of a benefit to employees. • HRA’s were created in 1954 and the rules are considered stable while HSA’s were created in 2003 and clarifications on the rules may still be pending. • The employer has authority over how the funds are spent for HRA’s while the employee controls how funds are spent for HSA’s. • Employers have the ability to exclude employees based on type, age, length of service, etc… with HRA’s while employers must make comparable contributions for all employees with HSA’s.

27. Reminders on Medical Savings Plans • For FSA and HRA, coverage and reimbursement is allowed for a child under age 27 at the end of the year. • For FSA, HSA and HRA, over the counter medicine is not eligible for reimbursement unless there is a prescription written for it. • For HSA’s, distributions that are not used for qualified medical expenses are subject to taxation and a penalty if used before age 65.

28. Q & A Session • Does anyone have any questions? • How many companies have an FSA, HRA or an HSA? • How does it work for you? • How do the employees respond? • Any tips or information that can be shared with others?

29. Links and Resources • Link to US Department of Labor article on Consumer-Drive Health Care: http://www.bls.gov/opub/cwc/cm20101019ar01p1.htm • Link to the IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans: http://www.irs.gov/pub/irs-pdf/p969.pdf • Link to the IRS Publication 502, Medical and Dental Expenses: http://www.irs.gov/pub/irs-pdf/p502.pdf • Link to Revenue Procedure 2011-32, 2012 Adjusted Amounts for HSAs: http://www.irs.gov/irb/2011-22_IRB/ar07.html • Link to Revenue Procedure 2011-32, 2013 Adjusted Amounts for HSAs: http://www.irs.gov/irb/2012-20_IRB/ar13.html • Link to the US Department of Labor topic and requirements on Summary Plan Descriptions: • http://www.dol.gov/dol/topic/health-plans/planinformation.htm

30. Flex-Pay offers FSA administration and HRA administration. Please contact Kia Ramseur, Section 125 Manager, at Flex-Pay for additional information. (336) 714-1208 kia@flex-pay.com