By Jerry Geisel, Crain News Service
WASHINGTON (Jan. 28, 2014) — Financial incentives that employers provide to employees participating in wellness programs generally could not be included in determining if an employee is exempt from a healthcare reform law requirement to enroll in a plan offering minimum essential coverage under newly proposed regulations.
Healthcare plan premium contribution discounts are an example of such an incentive.
The Internal Revenue Service (IRS) regulations proposed Jan. 23 and published in the Jan. 27 Federal Register involve the relationship between a premium affordability test established by the Patient Protection and Affordability Act and the financial incentives employers provide for employees to participate in wellness programs.
Under the healthcare reform law, employees are required to enroll in a plan offering minimum essential coverage. If they do not, they are liable for a financial penalty. In 2014, the penalty is $95 or 1 percent of income, whichever is greater.
Employees are exempt from the penalty, however, if the premium their employer charges for coverage is “unaffordable,” which the law defines as greater than 8 percent of household income, and they did not enroll in the plan.
Under the proposed regulations, financial incentives, such as premium discounts for wellness program participation, would be excluded in running the 8 percent affordability test.
For example, if an employer charged employees a monthly premium of $100 for single coverage if they participated in a wellness program and $120 if they did not, the $120 premium assessment would be used to determine if the employee had access to affordable coverage.
In the case of premium discounts offered in connection with tobacco-cessation programs, however, the lower premium offered to employees participating in these programs would be used in running the premium affordability test, the IRS said.
“This rule is consistent with other Affordable Care Act provisions, such as one allowing insurers to charge higher premiums based on tobacco use,” the IRS said.
“There is more of a consensus among regulators on the benefits of tobacco-cessation programs compared with other wellness programs,” said Amy Bergner, managing director of human resources solutions at PricewaterhouseCoopers L.L.P. in Washington, referring to the different treatment for tobacco-cessation programs than other wellness programs.
This report appeared in Crain’s Business Insurance magazine, a Chicago-based sister publication of Tire Business.