FAQ: What are “excepted benefits” for purposes of ACA minimum essential coverage?

The ACA created Code Sec. 5000A. Individuals must have minimum essential health insurance coverage, qualify for a health coverage exemption, or make an individual shared responsibility payment. Minimum essential coverage includes most government-sponsored health care programs, such as Medicaid, Medicare, and TRICARE.  Eligible employer-sponsored plans; individual market plans, including plans obtained through the ACA Heath Insurance Marketplace, and grandfathered plans provide minimum essential coverage. 

The ACA also provided that certain types of coverage are not treated as minimum essential coverage. These benefits are known as “excepted benefits.” 

There are a number of types of excepted benefits for ACA purposes. They include (not an exhaustive list): 

  • Coverage only for accident, including accidental death and dismemberment; 
  • Disability income insurance; 
  • Liability insurance, including general liability insurance and automobile liability insurance; 
  • Coverage issued as a supplement to liability insurance; 
  • Workers’ compensation or similar insurance; Automobile medical payment insurance; 
  • Credit-only insurance, such as mortgage insurance; and  Coverage for on-site medical clinics 

Additionally, the ACA created a number of health insurance market reforms.  These reforms impose new minimum requirements related to coverage, premiums, benefits, cost sharing, and consumer protections. Generally, health plans must comply with the market reforms. The market reforms generally affect insurance offered to groups and individuals. The market reforms generally do not apply to excepted benefits. 

After the passage of the ACA, questions arose if Employee Assistance Programs (EAPs) were excepted benefits. EAPs are programs offered by employers, which frequently provide a wide-ranging set of benefits. Benefits may include referral services and short-term substance use disorder or mental health counseling, as well as financial counseling and legal services. They are typically available free of charge to employees and are often provided through third-party vendors. The IRS has issued guidance, explaining that generally EAPs are excepted benefits. 

Please contact our office for more details about excepted benefits and the ACA.  

 

Written by

Steve Moss, CPA is a partner at Holden Moss CPAs and loves helping businesses and their owners grow to be the very best they can be. Our other offices include Raleigh, Oxford and Warrenton. We are a little different at Holden Moss CPAs. While we still provide traditional tax and accounting services, years ago we realized many clients wanted help in running their businesses and were hungry for ideas, solutions, strategy, and execution. In response, we expanded our skill set and joined Ran One, a global network of business consulting firms. Our membership with Ran One gives us access to proprietary resources and analytical software to help our clients grow, become more profitable and valuable, and have the lifestyle they desire. Now, blended into the fabric of our normal tax and accounting needs, we are focused on our clients’ businesses in a very different way. While our approach is not right for everyone, for those whom it is, incredible results may be obtained. Whether you have a new, or established, business, or for those in transition of selling or retiring, or for those who simply need to develop an exit strategy or succession plan, our unique approach to client service may be the edge you need.

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