Medical Reimbursement - Section 105
The "Benefits" of Section 105 Plans
Medical Reimbursement Plans in General
reimbursement plans are designed to reimburse employees for medical
expenses incurred. The plans may be insured or uninsured. The sample
corporate resolution and announcement letter, which follows, are
appropriate for an uninsured excess medical reimbursement plan
established by a closely held corporation.
excess medical reimbursement plan provides reimbursement to
employees for unreimbursed medical and dental expenses not covered by
the employer’s group medical and dental program. Section 105(b) of the
Internal Revenue Code provides that an employee’s gross income does
not include amounts received under an “accident or health plan for
employees.” Contributions by an employer to an accident and health
plan to provide health or disability benefits (through insurance or
otherwise) generally are deductible by the employer as an ordinary and
necessary business expense under section 162(a) of the Code. These
provisions result in one of the few instances where corporate funds
be used directly for the benefit of employees (including
shareholder-employees of regular C corporations) totally tax-free, with
the employer obtaining a full income tax deduction for the amount of the
excess medical reimbursement plan is an attractive fringe benefit for
employees because taxpayers are allowed a deduction for family medical
expenses only to the extent such unreimbursed medical expenses exceed
7.5% of adjusted gross income.
Requirements for Excess Medical Reimbursement Plans
The Tax Reform Act of 1986 added new nondiscrimination requirements for business health insurance plans under section 89 of the Code. Complicated testing of plans was required to determine whether they discriminated against lower-paid employees. In response to pressure from business and labor groups, section 89 was repealed retroactively in 1989. Generally, the nondiscrimination rules applicable before enactment of section 89 have been reinstated. Health benefits provided by an employer under an insured plan are not subject to nondiscrimination tests. However, employer-provided health benefits under an uninsured medical reimbursement plan must satisfy the nondiscrimination requirements of section 105(h) of the Code. Medical reimbursements under such plans are excludible from the taxable income of “highly compensated” individuals only to the extent that the plan does not discriminate in their favor, either as to eligibility to participate or as to benefits. For this reason, such plans will primarily be attractive to smaller corporations in which the owners are willing to provide the benefit for nearly all of the corporation’s employees. Family owned businesses and professional corporations often provide medical reimbursement benefits. S corporations, partnerships and sole proprietorships generally do not establish such plans because the owners of the business are not eligible to participate.
plan discriminates as to eligibility to participate unless the plan
(1) Seventy percent
or more of all employees, or 80% or more of all the employees who are
eligible to benefit under the plan if 70% or more of all employees are
eligible to benefit under the plan; or
(2) Such employees as qualified under a classification
set up by the employer and found by the IRS not to be discriminatory in
favor of highly compensated participants.
of meeting either of the above eligibility requirements, the following
employees may be excluded: (1) those who have not completed three years
of service; (2) those under age 25; (3) part-time or seasonal employees;
(4) those not included in the plan who are included in a unit of
employees covered by a collective bargaining agreement, if accident and
health benefits were the subject of good faith bargaining; and (5)
nonresident aliens who receive no earned income from the employer within
the United States. (IRC sec. 105(h)(3)(B)). Employees whose customary
weekly employment is less than 35 hours or less than nine months a year
will be considered part-time or seasonal if other employees in similar
work with the same employer (or, if there are no employees of the
employer in similar work, other employees in similar work in the same
industry and location) have substantially more hours or months of
employment. Notwithstanding the previous statement, a safe harbor rule
to apply is: any employee whose customary weekly employment is less than
25 hours or whose customary annual employment is less than seven months
may be considered as part-time or seasonal. (Reg. sec. 1.105-1 1(c)(2)(iii)(C)).
plan discriminates as to benefits unless “all benefits provided for
participants who are highly compensated individuals are provided for all
other participants.” (IRC sec. 105(h)(4)).
waiting period to become eligible for benefits must be identical for all
participants. (Let. Ruls. 8411050 and 8336065). Benefits available to
dependents of highly compensated employees must be equally available to
dependents of all participants. Any maximum limit on reimbursement must
be uniform for all participants and for all dependents. A plan is
discriminatory if the type or amount of benefits subject to
reimbursement is offered in proportion to compensation and highly
compensated employees are eligible for benefits. The tests are applied
to benefits subject to reimbursement, not to the actual benefit payments
or claims. (Reg. sec. 1.105-11(c)(3)).
A “highly compensated individual” is one who (1) is one of the five highest paid officers; (2) is a shareholder who owns (either actually or constructively with the application of Section 318) more than 10% in value of the company’s stock; or (3) is among the highest paid 25% of all employees (other than those who may be excluded for the purpose of meeting eligibility requirements and who are not participants).
amount paid under a discriminatory self-insured medical expense
reimbursement plan to a highly compensated individual which is
includible in gross income is called an “excess reimbursement.” If
the benefit paid is not available to a broad cross-section of employees,
the entire benefit paid is an “excess reimbursement.” If the benefit
is available to a broad cross-section of employees but the plan fails to
meet other nondiscriminatory provisions, a proportion of the benefit,
based on the ratio of reimbursements paid to highly compensated
individuals for the plan year to all reimbursements paid, will be
considered to be an “excess reimbursement.”
reimbursed to employees (not dependents) for medical diagnostic
procedures performed at a facility which provides only medical services
are not considered a part of the medical reimbursement plan and do not
need to meet the above nondiscrimination requirements. (Reg. sec.
that are attributable to employee contributions are income tax-free to
the employee, unless the expense was previously deducted. Amounts
attributable to employer contributions are determined in the ratio that
the employer contributions bear to total contributions for the calendar
years preceding the year of receipt, up to three years. (Reg. sec.
tax need not be withheld by the employer from any amounts reimbursed
under a self-insured plan as defined in section 105(h)(6) of the Code. (IRC
sec. 3401 (a)(20)).
The Importance of a Written Plan
the Treasury Regulations do not specifically require that accident or
health plans be in writing, a number of court decisions have made it
clear that it is imperative that a corporation, by a resolution adopted
by its Board of Directors, formally establish certain rules and
regulations governing payment of benefits and that these rules be
communicated to the employees involved as a definite policy of the
corporation. Without such a written
plan, deductions can be lost, premiums
may become taxable income, and benefits can lose their tax shelter.
Presumably, all medical reimbursement plans will need to be in writing in order to satisfy the IRS that nondiscrimination requirements have been met. Also, Title I of the Employee Retirement Income Security Act (ERISA) requires that a written instrument establish Employee Welfare Plans. Any plan providing medical, surgical or hospital care, sickness or accident benefits, or disability benefits is an Employee Welfare Plan and is subject to ERISA requirements. Provisions have been included in our sample resolution and plan document package, which are designed to meet ERISA requirements in regard to a named fiduciary, allocation of responsibilities for the operation and administration of the plan, claims procedures and amendment procedures. Such provisions may not be necessary if the corporation has adopted a resolution applicable to all of the corporation’s Employee Welfare Plans, which incorporates the provisions required by Title I of ERISA.
contact us at 1-800-622-2411 or via e-mail: firstname.lastname@example.org
a sample resolution and plan document template package.
Information is provided for review and consideration only. Please consult legal and tax advisors for practical advice pertaining to your business and personal situations.
This page was last reviewed and/or updated on Monday, October 21, 2013 09:58 AM