Can FSAs Survive Healthcare Reform?

Friday, March 28, 2014

Flexible Spending Accounts (FSAs) or Health FSAs have for years enabled employers to offer employees the opportunity to spend non-taxable compensation on eligible medical expenses.  FSAs could not only be used to pay for routine deductibles and co-insurance, but they also could buffer against unexpected health care costs. Now, Health Care Reform under the Affordable Care Act (ACA) has changed the way in which FSAs can be offered to employees.

First, for plan years beginning in 2013, the amount an employee can contribute to an FSA through salary reductions is capped at $2,500. Next, for plan years beginning in 2014, Health FSAs can only be offered through Section 125 Cafeteria Plans. Otherwise, the FSA would not be exempt from the ACA requirement that group health plans may not establish any annual limit on the dollar amount of benefits for any individual. Finally, the FSA itself must be structured to qualify as something called an “excepted benefit.” If the employer provides a Health FSA that does not qualify as an excepted benefit, the Health FSA is subject to the ACA’s market reform rules, including the requirement that non-grandfathered group health plans provide certain preventive care services without imposing any cost-sharing requirements for these services. Health HSA’s are considered group health plans under the ACA.

Excepted benefits include, among other things, accident-only coverage, disability income, certain limited scope dental and vision benefits, and certain long-term care benefits.  In order to qualify an FSA as an excepted benefit, an employer must make available group health plan coverage that is not limited to excepted benefits.  In other words, if it offers its employees the opportunity to elect group health coverage, an employer will have satisfied this part of the test.

In addition to the availability of group health coverage, the FSA must be structured so that the maximum benefit payable to any participant cannot exceed two times the participant’s salary reduction election for the Health FSA for the year, or if greater, cannot exceed $500 plus the amount of the participant’s salary reduction election.  Thus, for example, if an employee elects a Health FSA salary reduction of $2,500, the employer can match the employee’s contribution dollar for dollar up to a maximum of $2,500. If this were to happen, the employee would have $5,000 available in her or his FSA account for the plan year.

Health Care Reform has not eliminated the Health FSA. If an employer modifies plan documents as necessary and follows the rules summarized above, Health FSAs can continue to provide tax-free compensation to employees to pay for medical care expenses that are not covered by group health insurance.