Group Accident and Health Insurance

June 18, 2024

8794 / Are benefits provided under an employer’s noninsured accident and health plan excludable from an employee’s income?

<div class="Section1"><br /> <br /> Although there is no particular legal form of plan required, uninsured benefits must be received under some sort of accident and health plan established by the employer for its employees in order to be tax-exempt on the same basis as insured plans.<a href="#_ftn1" name="_ftnref1"><sup>1</sup></a> An Ohio federal District Court described the &ldquo;plan&rdquo; requirement as follows: &ldquo;there is no legal magic to a form; the essence of the arrangement must determine its legal character.&rdquo;<a href="#_ftn2" name="_ftnref2"><sup>2</sup></a><br /> <br /> A formal contract of insurance is not required if it is clear that, for an adequate consideration, the company has agreed and has become liable to pay and has paid sickness benefits based upon a reasonable plan of protection established for the benefit of its employees. For example, a provision for disability pay in an employment contract has been held to satisfy the condition.<a href="#_ftn3" name="_ftnref3"><sup>3</sup></a><br /> <br /> For tax purposes, it is not necessary for the plan to be in writing or even that an employee&rsquo;s rights to benefits under the plan be enforceable. For example, a plan has been found based on an employer&rsquo;s custom or policy of continuing wages during disability, which was generally known to employees.<a href="#_ftn4" name="_ftnref4"><sup>4</sup></a><br /> <br /> If an employee&rsquo;s rights are not enforceable, the employee must have been covered by a plan or a program, policy, or custom having the effect of a plan when the employee became sick or injured, and notice or knowledge of the plan must have been readily available to the employee.<a href="#_ftn5" name="_ftnref5"><sup>5</sup></a> Further, for a plan to exist an employer must commit to certain rules and regulations governing payment and these rules must be made known to employees as a definite policy before accident or sickness arises. <em>Ad hoc</em> payments that are made at the complete discretion of an employer do not qualify as a plan.<a href="#_ftn6" name="_ftnref6"><sup>6</sup></a><br /> <br /> The plan must be for employees. A plan may cover one or more employees and there may be different plans for different employees or classes of employees.<a href="#_ftn7" name="_ftnref7"><sup>7</sup></a> A plan that is found to cover individuals in a capacity other than their employee status, even though they are employees, is not a plan for employees. For purposes of determining the excludability of employer-provided accident and health benefits, self-employed individuals and certain shareholders owning more than 2 percent of the stock of an S corporation are not treated as employees.<a href="#_ftn8" name="_ftnref8"><sup>8</sup></a><br /> <br /> Further, uninsured medical expense reimbursement plans for employees must meet nondiscrimination requirements for medical expense reimbursements to be tax-free to highly compensated employees. See Q <a href="javascript:void(0)" class="accordion-cross-reference" id="8795">8795</a> for a discussion of the nondiscrimination requirements applicable to employer-provided health insurance plans.<br /> <br /> <div class="refs"><br /> <br /> <hr align="left" size="1" width="33%"><br /> <br /> <a href="#_ftnref1" name="_ftn1">1</a>. IRC &sect; 105(e).<br /> <br /> <a href="#_ftnref2" name="_ftn2">2</a>. Epmeier v. U.S., 199 F.2d 508, 511 (7th Cir. 1959).<br /> <br /> <a href="#_ftnref3" name="_ftn3">3</a>. Andress v. U.S., 198 F. Supp. 371 (N.D. Ohio 1961).<br /> <br /> <a href="#_ftnref4" name="_ftn4">4</a>. Niekamp v. U.S., 240 F. Supp. 195 (E.D. Mo. 1965); Pickle v. Comm., TC Memo 1971-304.<br /> <br /> <a href="#_ftnref5" name="_ftn5">5</a>. Treas. Reg. &sect; 1.105-5(a).<br /> <br /> <a href="#_ftnref6" name="_ftn6">6</a>. Est. of Kaufman, 35 TC 663 (1961), aff&rsquo;d, 300 F.2d 128 (6th Cir. 1962); Lang v. Comm., 41 TC 352 (1963); Levine v. Comm., 50 TC 422 (1968); Est. of Chism v. Comm., TC Memo 1962-6, aff&rsquo;d, 322 F.2d 956 (9th Cir. 1963); Burr v. Comm., TC Memo 1966-112; Frazier v. Comm., TC Memo 1994-358; Harris v. U.S., 77-1 USTC &para; 9414 (E.D. Va. 1977).<br /> <br /> <a href="#_ftnref7" name="_ftn7">7</a>. Treas. Reg. &sect; 1.105-5(a); Andress, 198 F. Supp. 371 (N.D. Ohio 1961).<br /> <br /> <a href="#_ftnref8" name="_ftn8">8</a>. IRC &sect; 105(g); Treas. Reg. &sect; 1.105-5(b).<br /> <br /> </div></div><br />

June 14, 2024

8804 / How is health insurance coverage taxed for S corporation shareholders?

<div class="Section1">A shareholder-employee who owns more than 2 percent of the outstanding stock or voting power of an S corporation (based on direct ownership as well as attributed ownership) will be treated as a partner, not an employee (see Q <a href="javascript:void(0)" class="accordion-cross-reference" id="8803">8803</a> for the rules applicable to partners).<a href="#_ftn1" name="_ftnref1"><sup>1</sup></a> Therefore, accident and health insurance premium payments for more-than percent shareholders paid in consideration for services rendered are treated as guaranteed payments made to partners. The result is that an S corporation can deduct premiums under IRC Section 162 and a shareholder-employee must include premium payments in income under IRC Section 61. The shareholder-employee cannot exclude them under IRC Section 106, but may deduct the cost of the premiums to the extent permitted by IRC Section 162(l), as discussed in Q <a href="javascript:void(0)" class="accordion-cross-reference" id="8803">8803</a>.<a href="#_ftn2" name="_ftnref2"><sup>2</sup></a> The IRS released a CCM clarifying that this remains the case even if the 2-percent shareholder-employee is treated as a 2-percent shareholder via the family attribution rules.<a href="#_ftn3" name="_ftnref3"><sup>3</sup></a><br /> <br /> <hr><br /> <br /> <strong>Planning Point:</strong> The IRS has released a set of frequently asked questions based upon the regulations governing the new Section 199A deduction for pass-through entities, such as S corporations. The FAQ provides that health insurance premiums paid by the S corporation for a greater-than-percent shareholder reduce qualified business income (QBI) at the entity level (by reducing the ordinary income used to calculate QBI). Similarly, when a self-employed individual takes a deduction for health insurance attributable to the trade or business, this will be a deduction in determining QBI and can reduce QBI at the entity and individual levels.<a href="#_ftn4" name="_ftnref4"><sup>4</sup></a><br /> <br /> <hr><br /> <br /> With respect to coverage purchased by an S corporation for employees who do not own any stock and for shareholder-employees who own 2 percent or less of the outstanding stock or voting power, the same rules apply as in any other employer-employee situation.<br /> <br /> <div class="refs"><br /> <br /> <hr align="left" size="1" width="33%"><br /> <br /> <a href="#_ftnref1" name="_ftn1">1</a>. IRC &sect; 1372.<br /> <br /> <a href="#_ftnref2" name="_ftn2">2</a>. Rev. Rul. 916, 1991-1 CB 184.<br /> <br /> <a href="#_ftnref3" name="_ftn3">3</a>. CCM 201912001.<br /> <br /> <a href="#_ftnref4" name="_ftn4">4</a>. FAQ is available at: https://www.irs.gov/newsroom/tax-cuts-and-jobs-act-provision-11011-section-199a-qualified-business-income-deduction-faqs.<br /> <br /> </div></div><br />

March 13, 2024

8791 / Is the value of employer-provided coverage under accident or health insurance taxable income to an employee when the coverage is provided for the employee’s spouse, children or dependents?

<div class="Section1">Employer-provided accident and health coverage for an employee and the employee&rsquo;s spouse and dependents, both before and after retirement, and for the employee&rsquo;s surviving spouse and dependents after the employee&rsquo;s death, does not have to be included in gross income by the active or retired employee or, after the employee&rsquo;s death, by the employee&rsquo;s survivors.<a href="#_ftn1" name="_ftnref1"><sup>1</sup></a><div class="Section1">In 2010, the Affordable Care Act (&ldquo;ACA&rdquo;), expanded the exclusion from gross income for amounts expended on medical care to include employer-provided health coverage for any adult child of the taxpayer if the adult child has not attained the age of 27 as of the end of the taxable year. The IRS has released guidance indicating that the exclusion applies regardless of whether the adult child is eligible to be claimed as a dependent for tax purposes.<a href="#_ftn2" name="_ftnref2"><sup>2</sup></a></div><div class="refs"><br /> <br /> <hr align="left" size="1" width="33%"><br /> <br /> <a href="#_ftnref1" name="_ftn1">1</a>. Rev. Rul. 82-196, 1982 CB 53; GCM 38917 (11-17-82).<br /> <br /> <a href="#_ftnref2" name="_ftn2">2</a>. IRC &sect; 105(b), as amended by the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010. Notice 2010-38, 20100 IRB 682.<br /> <br /> </div></div><br />

March 13, 2024

8793 / Are benefits paid under an employer-sponsored plan by reason of the employee’s death received tax-free?

<div class="Section1">Accidental death benefits under an employer&rsquo;s plan are received income tax-free by an employee&rsquo;s beneficiary under IRC Section 101(a) as life insurance proceeds payable by reason of the insured&rsquo;s death.<a href="#_ftn1" name="_ftnref1"><sup>1</sup></a> Death benefits payable under life insurance contracts issued after December 31, 1984, are excludable if the contract meets the statutory definition of a life insurance contract in IRC Section 7702. See Q <a href="javascript:void(0)" class="accordion-cross-reference" id="8763">8763</a> to Q <a href="javascript:void(0)" class="accordion-cross-reference" id="8785">8785</a> for a detailed discussion of the tax treatment of life insurance death proceeds.<br /> <p style="text-align: center">Survivors&rsquo; Benefits</p><br /> Benefits paid to a surviving spouse and dependents under an employer accident and health plan that provided coverage for an employee and the employee&rsquo;s spouse and dependents both before and after retirement, and to the employee&rsquo;s surviving spouse and dependents after the employee&rsquo;s death, are excludable to the extent that they would be if paid to the employee.<a href="#_ftn2" name="_ftnref2"><sup>2</sup></a><br /> <br /> <div class="refs"><br /> <br /> <hr align="left" size="1" width="33%"><br /> <br /> <a href="#_ftnref1" name="_ftn1">1</a>. Treas. Reg. &sect; 1.101-1(a).<br /> <br /> <a href="#_ftnref2" name="_ftn2">2</a>. Rev. Rul. 82-196, 1982 CB 53; GCM 38917 (11-17-82).<br /> <br /> </div></div><br />

March 13, 2024

8790 / Is the value of employer-provided coverage under accident or health insurance taxable income to an employee if the employee has a choice as to whether to receive coverage or a higher salary?

<p>Outside of the context of cafeteria plans, if an employer offers an employee a choice between a lower salary and employer-paid health insurance or a higher salary and no health insurance, the employee must include the full amount of the higher salary in income regardless of the employee&rsquo;s choice. If the employee selects the health insurance option, the IRS will deem the employee to have received the higher salary and, in turn, paid a portion of the salary equal to the health insurance premium to the insurance company.<a href="#_ftn1" name="_ftnref1">[1]</a><br /> <br /> However, a federal district court faced with a similar fact situation ruled that for employees who accept employer-paid health insurance coverage, the difference between the higher salary and the lower one is not subject to FICA and FUTA taxes or to income tax withholding.<a href="#_ftn2" name="_ftnref2">[2]</a><br /> <br /> <a href="#_ftnref1" name="_ftn1"><sup>[1]</sup></a>. Let. Rul. 9406002. See also Let. Rul. 9513027.<br /> <br /> <a href="#_ftnref2" name="_ftn2"><sup>[2]</sup></a>. Express Oil Change, Inc. v. U.S., 25 F. Supp. 2d 1313 (N.D. Ala. 1996), aff&rsquo;d, 162 F.3d 1290 (11th Cir. 1998).<br /> <br /> </p><br />

March 13, 2024

8797 / Are reimbursements attributable to employee contributions to a self-insured health plan taxable to the employee?

<div class="Section1">Generally, reimbursements attributable to employee contributions are received tax-free. However, an employee must include any reimbursed amount to the extent that the employee has taken a deduction for the expense.Amounts attributable to employer contributions are determined based on the ratio that employer contributions bear to total contributions for the calendar years immediately preceding the year of receipt (up to three years may be taken into account). If the plan has been in effect for less than a year, then the determination may be based upon the portion of the year, or such determination may be made periodically (such as monthly or quarterly) and used throughout the succeeding period.<a href="#_ftn1" name="_ftnref1"><sup>1</sup></a><br /> <br /> For example, if an employee leaves employment on April 15, 2023, and 2023 is the first year the plan was in effect, the determination may be based upon the contributions of the employer and the employees during the period beginning with January 1 and ending with April 15, or during the month of March, or during the quarter consisting of January, February, and March.<br /> <br /> <div class="refs"><br /> <br /> <hr align="left" size="1" width="33%"><br /> <br /> <a href="#_ftnref1" name="_ftn1">1</a>. Treas. Reg. &sect; 1.105-11(i).<br /> <br /> </div></div><br />

March 13, 2024

8807 / Can HRA contributions be made via salary reduction or through a cafeteria plan?

<div class="Section1"><br /> <br /> Employer contributions to an HRA may not be attributable in any way to salary reductions. Thus, an HRA may not be offered under a cafeteria plan, but may be offered in connection with a cafeteria plan. Where an HRA is offered in connection with another accident or health plan funded by a salary reduction plan, a facts and circumstances test is used to determine if salary reductions are attributable to the HRA. If a salary reduction amount for a coverage period to fund a non-HRA accident or health plan exceeds the actual cost of the non-specified accident or health plan coverage, the salary reduction will be attributed to the HRA. An example of the application of this rule can be found in Revenue Ruling 2002-41.<a href="#_ftn1" name="_ftnref1"><sup>1</sup></a>Because an HRA may not be paid for through salary reduction, the following restrictions on health FSAs are not applicable to HRAs:<br /> <p style="padding-left: 40px">(1) The ban against a benefit that defers compensation by permitting employees to carry over an unlimited amount of unused elective contributions or plan benefits from one plan year to another plan year.</p><br /> <p style="padding-left: 40px">(2) The requirement that the maximum amount of reimbursement must be available at all times during the coverage period.</p><br /> <p style="padding-left: 40px">(3) The mandatory 12-month period of coverage.</p><br /> <p style="padding-left: 40px">(4) The limitation that reimbursed medical expenses must be incurred during the period of coverage.<a href="#_ftn2" name="_ftnref2"><sup>2</sup></a></p><br /> <br /> <div class="refs"><br /> <br /> <hr align="left" size="1" width="33%"><br /> <br /> <a href="#_ftnref1" name="_ftn1">1</a>. 2002 CB 75.<br /> <br /> <a href="#_ftnref2" name="_ftn2">2</a>. Notice 2002-45, 2002 CB 93.<br /> <br /> </div></div><br />

March 13, 2024

8788 / What credit is available for small employers who contribute to employee health insurance costs?

<div class="Section1"><br /> <br /> Eligible small employers may take advantage of a tax credit for employee health insurance expenses for taxable years beginning after December 31, 2009, provided the employer offers health insurance to its employees and makes a non-elective contribution on behalf of each employee who participates in the plan.<a href="#_ftn1" name="_ftnref1"><sup>1</sup></a><br /> <br /> An eligible small employer is defined as an employer that has no more than 25 full time employees, the average annual wages of whom do not exceed $61,400 (in 2023, $57,400 for 2022, $55,600 for 2021 and $55,200 for 2020).<a href="#_ftn2" name="_ftnref2"><sup>2</sup></a><br /> <br /> In order to qualify, the employer must have a contribution arrangement for each employee who enrolls in the health plan offered by the employer through an exchange that requires that the employer make a non-elective contribution in an amount equal to a uniform percentage, not less than 50 percent, of the premium cost.<a href="#_ftn3" name="_ftnref3"><sup>3</sup></a><br /> <br /> Subject to <span style="color: windowtext">phase-out</span><a href="#_ftn4" name="_ftnref4"><sup>4</sup></a> based on the number of employees and average wages, the amount of the credit is equal to 50 percent, and 35 percent in the case of tax-exempt organizations, of the lesser of:<br /> <p class="PC-P" style="margin-bottom: 0.3pt;margin-left: 36pt;text-indent: -18pt"><span class="PC-H">(1)the aggregate amount of non-elective contributions made by the employer on behalf of its employees for health insurance premiums for health plans offered by the employer to employees through an exchange; or </span></p><br /> <p class="PC-P" style="margin-bottom: 0.3pt;margin-left: 36pt;text-indent: -18pt"><span class="PC-H">(2)the aggregate amount of non-elective contributions the employer would have made if each employee had been enrolled in a health plan that had a premium equal to the average premium for the small group market in the ratings area.<a href="#_ftn5" name="_ftnref5"><sup>5</sup></a></span></p><br /> For years 2010 through 2013, the following modifications apply in determining the amount of the credit:<br /> <p class="PC-P" style="margin-bottom: 0.3pt;margin-left: 36pt;text-indent: -18pt"><span class="PC-H">(1)The credit percentage is reduced to 35 percent (25 percent in the case of tax-exempt entities).<a href="#_ftn6" name="_ftnref6"><sup>6</sup></a></span></p><br /> <p class="PC-P" style="margin-bottom: 0.3pt;margin-left: 36pt;text-indent: -18pt"><span class="PC-H">(2)The amount under (1) is determined by reference to non-elective contributions for premiums paid for health insurance, and there is no exchange requirement.<a href="#_ftn7" name="_ftnref7"><sup>7</sup></a></span></p><br /> <p class="PC-P" style="margin-bottom: 0.3pt;margin-left: 36pt;text-indent: -18pt"><span class="PC-H">(3)The amount under (2) is determined by the average premium for the state small group market.<a href="#_ftn8" name="_ftnref8"><sup>8</sup></a></span></p><br /> The credit <span style="color: windowtext">also is</span>allowed against the alternative minimum tax.<a href="#_ftn9" name="_ftnref9"><sup>9</sup></a><br /> <div style="border-top: solid 0.5pt windowtext;padding-top: 1pt;border-bottom: solid 0.5pt windowtext;padding-bottom: 1pt"><br /> <div><br /> <p class="PP-P" style="margin-bottom: 0.3pt"><span class="PP-H"><span style="font-weight: bold">Planning Point:</span> Proposed regulations explain how to calculate employer tax credits after 2013.<a href="#_ftn10" name="_ftnref10"><sup>10</sup></a> The regulations propose that the maximum credit for taxable years after 2014 (available for only two years) increase to 50 percent (35 percent for tax-exempt organizations), with some adjustments. There is a proposed phase out for small employers with more than ten employees or whose average annual wages exceed $25,000 (adjusted for inflation). In addition, the proposed regulations clarify that employer contributions to an HRA, FSA, or HSA are not considered premium payments<a href="#_ftn11" name="_ftnref11"><sup>11</sup></a> (See Q <a href="javascript:void(0)" class="accordion-cross-reference" id="8840">8840</a><span class="Hyperlink-H" style="text-decoration: none underline">.</span>)</span></p><br /> <br /> </div><br /> </div><br /> <div class="refs"><br /> <br /> <hr align="left" size="1" width="33%"><br /> <br /> <a href="#_ftnref1" name="_ftn1">1</a>. IRC &sect; 45R, as added by PPACA 2010.<br /> <br /> <a href="#_ftnref2" name="_ftn2">2</a>. IRC &sect; 45R(d), as added by PPACA 2010; IRC Sec. 45R(d)(3)(B), as amended by Section 10105(e)(1) of PPACA 2010.<br /> <br /> <a href="#_ftnref3" name="_ftn3">3</a>. IRC &sect; 45R(d)(4), as added by PPACA 2010.<br /> <br /> <a href="#_ftnref4" name="_ftn4">4</a>. IRC &sect; 45R(c), as added by PPACA 2010.<br /> <br /> <a href="#_ftnref5" name="_ftn5">5</a>. IRC &sect; 45R(b), as added by PPACA 2010.<br /> <br /> <a href="#_ftnref6" name="_ftn6">6</a>. IRC &sect; 45R(g)(2)(A), as added by PPACA 2010.<br /> <br /> <a href="#_ftnref7" name="_ftn7">7</a>. IRC &sect; 45R(g)(2)(B), 45R(g)(3), as added by PPACA 2010.<br /> <br /> <a href="#_ftnref8" name="_ftn8">8</a>. IRC &sect; 45R(g)(2)(C), as added by PPACA 2010.<br /> <br /> <a href="#_ftnref9" name="_ftn9">9</a>. IRC &sect; 38(c)(4)(B), as amended by PPACA 2010. The IRS has issued guidance; see Notice 2010-44, 20102 IRB 717; Notice 2010-82, 2010-51 IRB 1.<br /> <br /> <a href="#_ftnref10" name="_ftn10">10</a>. 2013 IRB LEXIS, 2013-38 IRB 211 (modifying Notice 2010-44, 20102 IRB 717; Notice 2010-82, 2010-51 IRB 1).<br /> <br /> <a href="#_ftnref11" name="_ftn11">11</a>. Prop. Treas. Reg. &sect;1.45R-3.<br /> <br /> </div></div><br />

March 13, 2024

8796 / What is a self-insured health plan?

<div class="Section1"><br /> <br /> A self-insured plan is one in which reimbursement of medical expenses is not provided under a policy of accident and health insurance.<a href="#_ftn1" name="_ftnref1"><sup>1</sup></a> According to regulations, a plan underwritten by a cost-plus policy or a policy that, in effect, merely provides administrative or bookkeeping services is considered self-insured.<a href="#_ftn2" name="_ftnref2"><sup>2</sup></a><br /> <br /> An accident or health insurance policy may be an individual or a group policy issued by a licensed insurance company, or an arrangement in the nature of a prepaid health care plan regulated under federal or state law including an HMO. A plan will be found to be self-insured unless the policy involves shifting of risk to an unrelated third party.<br /> <br /> A plan is not considered self-insured merely because prior claims experience is one factor in determining the premium.<a href="#_ftn3" name="_ftnref3"><sup>3</sup></a> Further, a policy of a captive insurance company is not considered self-insurance if, for the plan year, premiums paid to a captive insurer by unrelated companies are equal to at least one-half of the total premiums received and the policy is similar to those sold to unrelated companies.<a href="#_ftn4" name="_ftnref4"><sup>4</sup></a><br /> <br /> <hr><br /> <br /> <strong>Planning Point:</strong> Many stop loss insurance plans used in conjunction with self-insured health plans contain an actively at work clause. Employees who are not actively at work, yet who continue to participate in an employer&rsquo;s plan, may find that their claims are denied. Employers should carefully review their health plan terms in light of COVID-19 trends where employers allowed employees to continue participating even while not actively working.<br /> <br /> <hr><br /> <p style="text-align: center">Withholding</p><br /> An employer does not have to withhold income tax on an amount paid for any medical care reimbursement made to or for the benefit of an employee under a self-insured medical reimbursement plan within the meaning of IRC Section 105(h)(6).<a href="#_ftn5" name="_ftnref5"><sup>5</sup></a><br /> <br /> <div class="refs"><br /> <br /> <hr align="left" size="1" width="33%"><br /> <br /> <a href="#_ftnref1" name="_ftn1">1</a>. See IRC &sect; 105(h)(6).<br /> <br /> <a href="#_ftnref2" name="_ftn2">2</a>. Treas. Reg. &sect; 1.105-11(b).<br /> <br /> <a href="#_ftnref3" name="_ftn3">3</a>. See, for example, Let. Rul. 8235047.<br /> <br /> <a href="#_ftnref4" name="_ftn4">4</a>. Treas. Reg. &sect; 1.105-11(b).<br /> <br /> <a href="#_ftnref5" name="_ftn5">5</a>. IRC &sect; 3401(a)(20).<br /> <br /> </div></div><br />

March 13, 2024

8803 / How is health insurance coverage for partners and sole proprietors taxed?

<div class="Section1"><br /> <br /> Partners and sole proprietors are self-employed individuals, not employees, and the rules for personal health insurance, rather than employer-provided health insurance, usually apply. Partners and sole proprietors, are, therefore, entitled to deduct 100 percent of amounts paid during a taxable year for insurance that provides medical care for the individual, spouse, and dependents during the tax year.<br /> <br /> The insurance can also cover a child who was under age 27 at the end of the tax year, even if the child did not qualify as the taxpayer&rsquo;s dependent. A &ldquo;child&rdquo; for this purpose is defined to include a taxpayer&rsquo;s child, stepchild, adopted child, or foster child. A foster child is any child placed with the taxpayer by an authorized placement agency or by judgment, decree, or other order of any court of competent jurisdiction.<br /> <br /> In additional, certain premiums paid for long-term care insurance are eligible for this deduction.<a href="#_ftn1" name="_ftnref1"><sup>1</sup></a><br /> <br /> A partner or sole proprietor is not entitled to this deduction for any calendar month in which the partner or proprietor is eligible to participate in any subsidized health plan maintained by any employer of the self-employed individual or spouse. This rule is applied separately to plans that include coverage for qualified long-term care services or are qualified long-term care insurance contracts, and plans that do not include that coverage and are not those kinds of contracts.<a href="#_ftn2" name="_ftnref2"><sup>2</sup></a><br /> <br /> The deduction is allowable in calculating adjusted gross income and is limited to the self-employed individual&rsquo;s earned income for the tax year that is derived from the trade or business with respect to which the plan providing medical care coverage is established. Earned income means, in general, net earnings from self-employment with respect to a trade or business in which the personal services of the taxpayer are a material income-producing factor.<br /> <br /> Any amounts paid for this kind of insurance may <em>not</em> be taken into account in computing:<br /> <p style="padding-left: 40px">(1) the amount of a medical expense deduction under IRC Section 213; and</p><br /> <p style="padding-left: 40px">(2) net-earnings from self-employment for the purpose of determining the tax on self-employment income.<a href="#_ftn3" name="_ftnref3"><sup>3</sup></a></p><br /> Additional considerations may apply in the case of a partnership. If a partnership pays accident and health insurance premiums for services rendered by partners in their capacity as partners and without regard to partnership income, premium payments are considered to be &ldquo;guaranteed payments&rdquo; under IRC Section 707(c). As such, the premiums are deductible by the partnership under IRC Section 162, subject to IRC Section 263, and must be included in partners&rsquo; income under IRC Section 61.<br /> <br /> A partner is not entitled to exclude premium payments from income under IRC Section 106 but may deduct payments to the extent allowable under IRC Section 162(l), as discussed above.<a href="#_ftn4" name="_ftnref4"><sup>4</sup></a> For partners, a policy can be either in the name of the partnership or in the name of the partner. The partner can either self-pay the premiums, or the partnership can pay them and report the premium amounts on Schedule K-1 (Form 1065) as guaranteed payments to be included in the partner&rsquo;s gross income. However, if the policy is in the partner&rsquo;s name and the partner self- pays the premiums, the partnership must reimburse the partner and report the premium amounts on Schedule K-1 (Form 1065) as guaranteed payments to be included in the partner&rsquo;s gross income. Otherwise, the insurance plan will not be considered to be established under the business.<br /> <br /> The IRS has found that the cost of consumer medical cards purchased for partners is not deductible by the partners under either IRC Section 162(l) or IRC Section 213. This conclusion was based on the rationale that consumer medical cards that provide discounts on certain medical services and items are not actually insurance products.<a href="#_ftn5" name="_ftnref5"><sup>5</sup></a><br /> <br /> The IRS has also concluded that payments from a self-funded medical reimbursement plan set up by a partnership, and made to partners and their dependents, are excludable from partners&rsquo; income. Premiums paid by partners for coverage under a self-funded plan are deductible, subject to the limits of IRC Section 162(l).<a href="#_ftn6" name="_ftnref6"><sup>6</sup></a><br /> <br /> There is no limit on the amount of benefits a partner or sole proprietor can receive tax-free.<a href="#_ftn7" name="_ftnref7"><sup>7</sup></a><br /> <br /> The IRS has also found that coverage purchased by a sole proprietor or partnership for non-owner-employees, including an owner&rsquo;s spouse, generally are subject to the same rules that apply in any other employer-employee situation.<a href="#_ftn8" name="_ftnref8"><sup>8</sup></a><br /> <br /> The IRS has issued settlement guidelines addressing whether a self-employed individual (&ldquo;employer-spouse&rdquo;) may hire his or her spouse as an employee (&ldquo;employee-spouse&rdquo;) and provide family health benefits to the employee-spouse, who then elects family coverage including the employer-spouse. The IRS position is that if an employee-spouse is a bona fide employee, the employer-spouse may deduct the cost of the coverage and the value of the coverage also is excludable from the employee-spouse&rsquo;s gross income.<br /> <br /> However, the IRS will closely examine the situation to determine whether an employee-spouse qualifies as a bona fide employee. Part-time employment does not negate employee status, but nominal or insignificant services that have no economic substance or independent significance will be challenged.<a href="#_ftn9" name="_ftnref9"><sup>9</sup></a><br /> <br /> <div class="refs"><br /> <br /> <hr align="left" size="1" width="33%"><br /> <br /> <a href="#_ftnref1" name="_ftn1">1</a>. IRC &sect;&sect; 162(l); 213(d)(1).<br /> <br /> <a href="#_ftnref2" name="_ftn2">2</a>. IRC &sect; 162(l).<br /> <br /> <a href="#_ftnref3" name="_ftn3">3</a>. IRC &sect; 162(l).<br /> <br /> <a href="#_ftnref4" name="_ftn4">4</a>. Rev. Rul. 916, 1991-1 CB 184.<br /> <br /> <a href="#_ftnref5" name="_ftn5">5</a>. Let. Rul. 9814023.<br /> <br /> <a href="#_ftnref6" name="_ftn6">6</a>. Let. Rul. 200007025.<br /> <br /> <a href="#_ftnref7" name="_ftn7">7</a>. Rev. Rul. 56-326, 1956 CB 100; Rev. Rul. 58-90, 1958-1 CB 88.<br /> <br /> <a href="#_ftnref8" name="_ftn8">8</a>. Rev. Rul. 71-588, 1971 CB 91; TAM 9409006.<br /> <br /> <a href="#_ftnref9" name="_ftn9">9</a>. IRS Settlement Guidelines, 2001 TNT 2225 (Nov. 16, 2001); see also <em>Poyda v. Comm.</em>, TC Summary Opinion 2001-91.<br /> <br /> </div></div><br />