





Cascade Mountains
CITIES: Brightwood, Camp
Sherman,
Cascade Locks, Cascadia, Chemult,
Chiloquin, Crescent, Crescent Lake, Detroit, Diamond Lake, Drew,
Estacada, Fort Klamath, Gates, Gilchrist, Government Camp, Idanha,
Klamath Agency, La Pine, Lakeview, McKenzie Bridge, Mill City, North
Umpqua, Oakridge, Prospect, Rhododendron, Sandy,
Sisters,
Sunriver, Warm Springs,
Welches, Westfir, Zigzag
AREAS: Crater Lake National Park, Deshutes National Forest,
Fremont National Forest, Mount Hood National Forest, Rogue River
National Forest, The Three Sisters, Umpqua National Forest, Willamette
National Forest, Winema National Forest
Central Oregon
CITIES: Antelope,
Arlington,
Bend, Brothers, Condon, Culver, Dufur,
Fossil, Grass Valley, Hampton, Lonerock,
Madras, Maupin, Metolius, Mitchell, Moro,
Mosier, Paulina, Post, Prineville,
Redmond, Rowena,
Rufus, Shaniko, Spray,
The Dalles, Wasco
Northeast Oregon
CITIES: Adams, Arlington,
Athena,
Baker City, Boardman, Canyon City, Condon,
Cove, Dayville, Echo, Elgin,
Enterprise, Fossil, Greenhorn, Haines, Halfway,
Heppner, Hermiston, Huntington, Imbler, Imnaha, Irrigon, Island City, John Day,
Joseph,
La Grande, Lexington, Long Creek, Lostine,
Medical Springs, Milton-Freewater, Monument, Mt Vernon, North Powder, Oxbow,
Pendleton, Pilot Rock, Prairie City,
Richland, Seneca, Summerville, Sumpter, Ukiah, Umatilla, Union, Unity,
Wallowa, Weston
AREAS:
Hell's Canyon
Oregon Coast
North Coast
Astoria, Bay City, Beaver,
Cannon Beach,
Garibaldi,
Gearhart, Hebo,
Nehalem,
Manzanita, Neahkahnie, Oceanside,
Pacific City,
Rockaway Beach,
Seaside,
Tillamook,
Warrenton,
Wheeler
Central Coast
Depoe Bay,
Dunes City,
Florence,
Gleneden Beach,
Lincoln City, Mapleton,
Newport, Otter Rock, Reedsport, Seal Rock,
Siletz,
Toledo,
Waldport,
Winchester Bay,
Yachats
South Coast
Agness,
Bandon,
Brookings,
Charleston,
Coos Bay, Coquille,
Gold Beach,
Lakeside,
Myrtle Point,
North Bend,
Port Orford, Powers, Wedderburn
Portland and Vicinity
Banks, Barlow,
Beaverton, Camas, Canby,
Clackamas, Clatskanie, Columbia City,
Cornelius,
Forest Grove, Gaston,
Gresham, Happy Valley,
Hillsboro,
Lake Oswego, Marquam,
Milwaukie, Molalla, North Plains,
Oregon City,
Portland, Rainier, Sandy, Scappoose, St.
Helens,
Tigard, Troutdale,
Tualatin, Vernonia, West Linn,
Wilsonville
Southeast Oregon
Adel, Adrian, Burns, Diamond, Drewsey,
Frenchglen, Hines, Jordan Valley, Juntura, Lakeview, Nyssa,
Ontario, Plush, Vale
Southern Oregon
CITIES:
Ashland, Butte Falls, Cave Junction,
Canyonville, Central Point, Dillard, Drain, Eagle Point, Elkton, Glendale,
Glide, Gold Hill,
Grants Pass, Jacksonville, Klamath Falls, Malin,
Medford,
Merlin, Myrtle Creek, Oakland, Phoenix,
Prospect, Riddle, Rouge River, Roseburg, Shady Cove, Sutherlin, Talent,
Umpqua, White City, Winchester, Winston, Wolf Creek, Yoncalla
AREAS: Applegate Valley, Illinois Valley
Willamette Valley
Albany, Alsea, Amity, Aumsville,
Aurora, Brooks,
Brownsville, Canby, Canyonville, Carlton,
Corvallis, Coburg, Cottage Grove, Creswell,
Culp Creek, Dallas, Dayton, Detroit, Donald,
Dundee,
Eugene, Falls City, Gates, Gervais, Halsey,
Harrisburg, Independence, Jefferson, Junction City, Keizer, Lebanon, Lowell,
Lyons,
McMinnville, Mill City, Millersburg, Mt.Angel,
Molalla, Monmouth, Newberg, Oakridge, Oregon City, Philomath,
Salem, Scio, Scott Mills, Sheridan,
Silverton, Sodaville, Springfield, Stayton, St. Paul, Sublimity, Sweet Home,
Tangerit, Turner, Veneta, Walterville, Waterloo, Willamina, Woodburn, Yamhill
|
|
|
Changes to COBRA
The American Recovery and Reinvestment Act (ARRA) of 2009 was
signed by President Obama on Feb. 17, 2009. This Act provides
insurance payment relief for eligible individuals who were
involuntarily terminated and who were otherwise eligible for
continuation coverage under the Consolidated Omnibus Budget
Reconciliation Act of 1985, commonly called COBRA. Relief also
will be available to eligible individuals on Oregon
continuation coverage. However, Washington state
does not have continuation coverage.
Eligible individuals pay only 35 percent of their COBRA
premiums and the remaining 65 percent is reimbursed to the
coverage provider (usually an employer) through a tax credit. The
premium period affected began on March 1, 2009. There are many
details to the new law and not all involved parties are ready to
begin implementing the assistance program. The following is a
high-level summary of the program.
COBRA payment assistance
Generally applies to companies with 20 or more employees
Eligibility
- COBRA-eligible individuals who were involuntarily terminated
from employment between Sept. 1, 2008, and Dec. 31, 2009.
- COBRA-eligible dependents of individuals who were
involuntarily terminated from employment between Sept. 1, 2008,
and Dec. 31, 2009.
- Individuals who meet these criteria and who previously
declined COBRA coverage on or after Sept. 1, 2008, will be given
another chance to enroll.
- An individual ceases to be eligible for the subsidy when the
individual becomes eligible for other group health plan
coverage.
Timing
- The first premium period affected began on March 1, 2009.
- The subsidy is generally available for up to nine months for
those who remain eligible.
- Maximum period of COBRA coverage (typically 18 months for
terminations of employment) is not extended.
- No one is eligible for the subsidy before date of enactment,
which was Feb. 17, 2009.
- Eligible individuals who pay the full monthly premium for
their March or April coverage will be able to arrange a subsidy
credit with the employer.
Income
- Individuals are ineligible for the subsidy if adjusted gross
income exceeds $145,000, or $290,000 for joint filers.
- Subsidy is phased out if adjusted gross income is between
$125,000 and $145,000 for individuals, or between $250,000 and
$290,000 for joint filers.
What does this mean for you?
Affected individuals
Eligible individuals are obligated to pay only 35 percent of
their COBRA premium beginning with the March 1, 2009, premium
payment; however, the former employer may not yet be ready to
administer the premium assistance. Most individuals whose coverage
terminated on or after Sept. 1, 2008, will receive a notice
regarding COBRA assistance in the mail within 60 days of Feb. 17,
2009. The notice will provide additional details on next steps.
For more information, please review the information provided by
the government by clicking on the links at the bottom of this
page. If you have questions, then please call your former
employer.
Employers
Eligible individuals are obligated to pay only 35 percent of
their premiums as early as the period of coverage beginning March
1, 2009. You will be reimbursed the subsidized amount, 65 percent,
by the government. Please review this helpful
IRS question and answer regarding reimbursement. Employers are
responsible for notifying affected individuals as required by law
within 60 days of Feb. 17, 2009, and for paying 100
percent of all COBRA premiums to the insurer.
Producers
When communicating with employers, please discuss the fact that
eligible individuals are only obligated to pay 35 percent of their
premiums effective March 1, 2009. Also, it is important to alert
them to the employers' responsibility of notifying affected
individuals and paying 100 percent of all COBRA premiums
to the insurer.
Regarding individual communication, please alert individuals to
the March 1, 2009, effective date for reduced premiums and inform
them that their former employer will provide them with a notice
with additional information regarding next steps. Refer them to
their former employers with questions.
Producers also may direct employers and individuals to the
Department of Labor, Internal Revenue Service and the Oregon
Insurance Division's Web sites for more information. Links to
these Web sites are highlighted below.
Oregon continuation
Continuation coverage applies to companies whose insurance is
based in Oregon and are not eligible for COBRA, such as those with
19 or fewer employees. Individuals involuntarily terminated from
employment between Sept. 1, 2008, and Dec. 31, 2009, and who were
otherwise eligible for Oregon continuation coverage will have
premium assistance available to them beginning with their March 1,
2009, premium payment. Affected individuals will receive a notice
regarding premium assistance in the mail within 60 days of Feb.
17, 2009. While many of the details that apply to individuals
eligible for COBRA coverage will apply to those eligible for
Oregon continuation coverage, there are some important
differences. For example, Oregon continuation coverage provides a
maximum of six months of continuation coverage from the date that
group coverage terminated. At this time, the process for providing
assistance is being reviewed and refined. The written notices sent
will explain the process to affected individuals and provide
additional information.
Washington continuation
Washington state does not have continuation of coverage for
employers who are not subject to Federal COBRA, such as those with
fewer than 20 employees. Therefore, affected individuals are not
able to access premium assistance.
Return
to Top of page |
|
|
| |
| Under the American Recovery and Reinvestment Act of
2009, certain individuals who are eligible for COBRA
continuation health coverage, or similar coverage under
State law, may receive a subsidy for 65 percent of the
premium. These individuals are required to pay only 35
percent of the premium. The employer may recover the subsidy
provided to assistance-eligible individuals by taking the
subsidy amount as a credit on its quarterly employment tax
return. The employer may provide the subsidy — and take the
credit on its employment tax return — only after it has
received the 35 percent premium payment from the individual.
Q: How will an employer be reimbursed for the COBRA
subsidy that it has provided to eligible individuals?
A: The COBRA subsidy amount is reimbursed by being
claimed as a credit on the Form 941. The
Form 941 has
been revised to allow for this credit.
Q: How does an employer claim the credit for the
COBRA subsidy?
A: The credit is claimed on Line 12a of the January 2009
revision of the Form 941, which was posted on the IRS
website on Feb. 20. In addition, the Form 941 filer also
needs to include the number of individuals provided COBRA
premium assistance on Line 12b.
Q: What other information relating to the COBRA
subsidy must be submitted with the Form 941 besides the
entries on Lines 12a and 12b?
A: No additional information relating to the COBRA
subsidy is to be submitted with the Form 941, either
electronically or in paper form. However, those claiming the
credit must maintain supporting documentation for the credit
claimed. Such documentation includes:
-
Information on the receipt, including dates and amounts,
of the assistance eligible individuals’ 35% share of the
premium.
-
In the case of an insured plan, copy of invoice or other
supporting statement from the insurance carrier and
proof of timely payment of the full premium to the
insurance carrier required under COBRA.
-
In the case of a self-insured plan, proof of the premium
amount and proof of the coverage provided to the
assistance eligible individuals.
-
Attestation of involuntary termination, including the
date of the involuntary termination (which must be
during the period from September 1, 2008, to December
31, 2009), for each covered employee whose involuntary
termination is the basis for eligibility for the
subsidy.
-
Proof of each assistance eligible individual’s
eligibility for COBRA coverage at any time during the
period from September 1, 2008, to December 31, 2009, and
election of COBRA coverage.
-
A record of the SSN’s of all covered employees, the
amount of the subsidy reimbursed with respect to each
covered employee, and whether the subsidy was for 1
individual or 2 or more individuals.
-
Other documents necessary to verify the correct amount
of reimbursement.
Q: I haven't seen the legislation, but why does
this belong on the Form 941?
A: The legislation as passed provides for reimbursement
of the subsidy through the employment tax process, so Form
941 is the applicable form.
Q: What will happen if Line 12a ends up being
larger than Line 10 on a 941 return? Will this result in a
net negative of taxes for a company?
A: If Line 12a is larger than Line 10, Line 13 would also
be larger than Line 10, resulting in an overpayment that
could be applied to the next return, or requested as a
refund.
Q: Is the IRS considering any other form changes
(e.g., 941X)?
A: Yes. All appropriate forms are being revised and will
be updated on the IRS.gov web site as soon as possible.
Q: Will the due date for the first-quarter Form
941 be extended?
A: No.
Q: Will the number of assistance-eligible
individuals need to be reported each quarter, whether or not
there was a tax credit amount to apply?
A: Line 12b of the revised Form 941 must indicate the
number of individuals who received the total COBRA subsidy
reported on Line 12a of the Form 941. If there is no tax
credit amount because no subsidy was provided, then the
entry on Line 12b would be zero.
Q: Now that the legislation has passed, how is
this going to be communicated to the employer/payroll
community?
A: The IRS will continue to provide updated information
through this Web site as it becomes available.
Q: Can an employer decide only to claim the
credit at the end of the quarter rather than reducing its
tax deposits during the quarter?
A: Yes. The employer can decide either to offset its
payroll tax deposits or claim the subsidy as an overpayment
at the end of the quarter.
Q: When does the law become effective?
A: The law became effective on the date of enactment,
Feb. 17, 2009. However, under a transition rule, the regular
premium amount may continue to be paid for up to two months
after enactment (e.g., for March and April), and the subsidy
can be provided retroactively.
Q: It was mentioned that this would be a
temporary statute. How long is this change expected to be in
effect?
A: For assistance-eligible individuals, the qualifying
event must occur on or before Dec. 31, 2009, and the COBRA
subsidy may apply for up to nine months.
Q: What individuals are eligible for the COBRA
subsidy?
A: An assistance-eligible individual can be any COBRA
qualified beneficiary associated with the related covered
employee, such as a dependent child of an employee, who is
covered immediately prior to the qualifying event. The
qualifying event for purposes of eligibility for the subsidy
is involuntary termination of the covered employee’s
employment that occurs during the period beginning Sept. 1,
2008, and ending Dec. 31, 2009. The individual must also be
eligible for COBRA coverage, or similar state coverage,
during this period.
Q: Is this provision for employees who
involuntarily lose their jobs — or will it apply to all
employees even if they leave voluntarily?
A: The credit applies only to involuntarily terminated
employees and their family members who are qualified
beneficiaries.
Q: Will the COBRA premium subsidy be taxable
income for the individual?
A: The premium subsidy is not included in the
individual’s income. However, there is a phase-out of
eligibility for the subsidy, which will increase some
high-income individuals’ tax liability if they receive the
subsidy. The phase-out impacts individuals whose modified
adjusted gross income exceeds $125,000, $250,000 for those
filing joint returns. Tax liability is increased, to achieve
repayment of a portion of the subsidy, for those taxpayers
whose modified adjusted gross income is between $125,000 and
$145,000, or $250,000 and $290,000 for those filing joint
returns. If a taxpayer’s modified adjusted gross income
exceeds $145,000, $290,000 for those filing joint returns,
the full amount of the subsidy must be repaid as an
additional tax. There is no additional tax for individuals
with modified adjusted gross income less than these income
levels.
Q: When more than one entity may be responsible for
receiving COBRA premiums, who should claim the credit?
A: The law as enacted clarifies that the person to whom
the reimbursement is payable is (1) the multiemployer group
health plan, (2) the employer maintaining a group health
plan that is subject to Federal COBRA continuation coverage
requirements or that is self-insured, or (3) the insurer
providing coverage under a plan not included in (1) or
(2). Only this person is eligible to offset its payroll
taxes by the amount of the subsidy.
Q: Is the employer required to provide the COBRA
subsidy?
A: The subsidy requirement applies to group health plans
that are subject to the Federal COBRA continuation coverage
requirements or to similar requirements under State law. If
you are an employer with such a plan and you receive a
35 percent payment from an assistance-eligible individual,
you are required to make the remaining 65 percent payment.
Q: What if the employer’s group health plan is
self-insured? Do the subsidy requirements apply?
A: Yes, the subsidy requirements apply to all plans
subject to the COBRA requirements, including self-insured
plans. In that case, the employer must provide the COBRA
coverage if the assistance eligible individual pays 35
percent of the otherwise required premium. The remaining 65
percent is treated as a payment of payroll taxes by the
employer maintaining the plan.
Q: What other agencies will provide information
about the COBRA subsidy?
A: Information about the COBRA subsidy will also be
available through the Department of Labor and the Department
of Health and Human Services, which, along with the IRS,
share responsibility for the COBRA requirements.
Q: Can an employer reduce its payroll deposits
during the quarter by the amount of the COBRA subsidy it
provides during the quarter without incurring a Failure to
Deposit penalty?
A: The amount of the COBRA subsidy the employer provides
during the quarter (based on the 35 percent premium payments
received from assistance eligible individuals during the
quarter) will be treated as having been deposited on the
first day of the quarter and applied against the employer’s
deposit requirements. Therefore, timely deposits up to the
amount of the subsidy will be deemed to have been made
during the quarter, regardless of the otherwise applicable
due dates for deposits. However, in some cases, the amount
of the subsidy the employer provides during the quarter will
be less than the total amount of the employer’s required
deposits during the quarter. In that case, the employer
will be required to make timely deposits during the
remainder of the quarter to make up the difference.
Example 1: Employer’s required payroll deposits for the
second quarter of 2009 total $10,000, determined without
regard to the COBRA premium subsidy provided by Employer
during the quarter. Employer provides assistance eligible
individuals with a total COBRA subsidy of $12,000 during the
quarter, based on the 35 percent premium payments received
from the individuals during the quarter, and reports the
$12,000 subsidy on Line 12a of its
Form 941 for
the quarter. Employer will be treated as having made a
$12,000 payroll tax deposit on the first day of the quarter
and thus will not be subject to a Failure to Deposit penalty
for the quarter even if it reduces its deposits during the
quarter by the amount of the subsidy. Alternatively,
Employer may make some or all of its required deposits
during the quarter, determined without regard to the COBRA
premium subsidy provided by Employer during the quarter,
rather than reducing its total deposits by the subsidy.
Example 2: Employer’s required payroll deposits for the
second quarter of 2009 total $10,000, determined without
regard to the COBRA premium subsidy provided by Employer
during the quarter. Employer provides assistance eligible
individuals with a total COBRA subsidy of $8,000 during the
quarter, based on the 35% premium payments received from the
individuals during the quarter, and reports the $8,000
subsidy on Line 12a of its Form 941 for the quarter.
Employer will be treated as having made an $8,000 payroll
tax deposit on the first day of the quarter and thus will
not be subject to a Failure to Deposit penalty for the
quarter, provided that, once the total of its required
deposits exceeds $8,000, it makes its regularly required
deposits for the remainder of the quarter.
Q: Will the credit amount taken impact an
employer’s current “assigned” deposit frequency or future
deposit frequencies?
A: Frequency of deposits and look back periods are
computed from Line 8 of
Form 941,
before taking into account any credits, including the COBRA
credit. Therefore the COBRA credit will not affect future
deposit frequency computations.
Q: If the 35 percent premiums are paid and the
subsidy is provided at a point in the quarter where there
are no additional federal tax deposits due for the quarter,
should the employer claim the credit on the current quarter
or the subsequent quarter?
A: Although an employer may reduce its payroll tax
deposits during a quarter by the amount of subsidy provided
during the quarter, claiming the credit on Form 941 for the
quarter is not dependent on reducing deposits during the
quarter. Therefore, even if no additional deposits are due
for the quarter, the employer can claim credit for the full
amount of the subsidy provided during the quarter on its
Form 941 for the quarter. If the amount of the subsidy
entered on Form 941 exceeds the employer’s tax liabilities
for the quarter, the employer can choose to have the excess
either refunded or applied to the next quarter.
Q: If the employer chooses to have the excess
refunded, will the IRS send a notice before refunding the
credit?
A: If the full amount of the excess is to be refunded to
the employer, the IRS will not send a notice before making
the refund.
Q: The questions and anwers refer to the
employer. Is it always the employer that provides the
subsidy and takes the credit on its Form 941?
A: In some cases, a person other than the employer is the
proper party to provide the subsidy and take the credit on
its Form 941. For example, under the legislation, if the
COBRA coverage is provided by a multiemployer plan, the plan
provides the subsidy and is reimbursed by taking a credit on
Form 941.
Q: Will there be a means other than a quarterly
Form 941 for employers (or other person if applicable) to
claim credit for the COBRA subsidy provided to assistance
eligible individuals? There is some information out there
saying the credit can be claimed on a more frequent basis
(e.g., weekly).
A: As discussed above, an employer may reduce its payroll
tax deposits during a quarter by the amount of subsidy
provided during the quarter. However, in all cases, credit
for the subsidy must be claimed on the employer’s payroll
tax return, whether the quarterly filed Form 941 or the
annually filed Form 943 or 944. A payroll tax return is the
only means to claim credit and be reimbursed for the COBRA
subsidy.
Q: Will Schedule B continue to reflect the total
payroll tax liabilities for the quarter, or will the
liabilities reported be reduced by the COBRA subsidy
credits?
A: Schedule B is used to report an employer’s payroll tax
liability for each payroll period, not the amount of the
employer's payroll tax deposits. Therefore, when the
employer reduces a deposit by the amount of the COBRA
subsidy, this has no affect on the liabilities the employer
reports on Form 941, Schedule B (or the monthly totals in
Part 2 of Form 941). The employer should still reflect on
Schedule B (or in Part 2, Form 941) the total liabilities
for all wages reported on Form 941.
Example: Employer is a semi-weekly schedule depositor
with a total liability of $75,000 for the payroll period
ended on Feb. 27, 2009. Employer's regular deposit of
$75,000 would be due on March 4, 2009. Because of a COBRA
subsidy obligation of $5,000, Employer is allowed to reduce
the deposit amount to $70,000, so Employer makes a timely
deposit of $70,000 by March 4, 2009. When Employer completes
Schedule B of Form 941 for the first quarter of 2009,
Employer must enter the total liability, $75,000, on Day 27
of Month 2. As always, the total liability reported on
Schedule B must equal the total taxes reported on Line 10 of
Form 941. Employer will reflect the total COBRA subsidy for
the quarter on Line 12a of Form 941.
Q: Is the employer required to claim the credit
on Form 941 for the quarter during which the COBRA subsidy
is provided to assistance eligible individuals?
A: No. Instead of claiming the credit on Form 941 for the
quarter during which the COBRA subsidy is provided, the
employer may generally choose to claim the credit on Form
941 for a later quarter in the same calendar year.
Alternatively, if the employer has not claimed the credit
on the original Form 941 for the quarter during which the
COBRA subsidy was provided, the employer can file Form 941X
for that quarter. In all cases, however, if an employer
chooses to reduce its payroll tax deposits during a quarter
by the amount of subsidy provided during the quarter (or
during a previous quarter), it must claim the credit for
that subsidy amount on Form 941 for the quarter during which
its payroll tax deposits were reduced. In addition, of
course, an employer may not claim credit for the same
subsidy amount on Forms 941 for more than one quarter.
Q: Is there a specific date when employers can no
longer take this credit?
A: An individual can be eligible for the COBRA subsidy
based on an involuntary termination of employment that
occurs as late as Dec. 31, 2009 (the qualifying event), and
the subsidy can apply for up to nine months of COBRA
coverage, which generally begins shortly after the
qualifying event. It is therefore expected that eligibility
for the subsidy will be exhausted by the end of 2010 and
Form 941 for the fourth quarter of 2010 will be the last
time to take the subsidy credit.
Q:Will there be anything that Payroll Service
Providers will have to provide to employers and/or IRS?
A: Payroll Service Providers need to communicate with
their clients and ensure their clients maintain proper
supporting documentation for the credit claimed. Such
documentation includes, but is not limited to:
-
Information on the receipt, including dates and amounts,
of the assistance eligible individuals’ 35 percent share
of the premium.
-
In the case of an insured plan, copy of invoice or other
supporting statement from the insurance carrier and
proof of timely payment of the full premium to the
insurance carrier required under COBRA.
-
In the case of a self-insured plan, proof of the premium
amount and proof of the coverage provided to the
assistance eligible individuals.
-
Attestation of involuntary termination, including the
date of the involuntary termination (which must be
during the period from Sept. 1, 2008, to Dec. 31, 2009),
for each covered employee whose involuntary termination
is the basis for eligibility for the subsidy.
-
Proof of each assistance eligible individual’s
eligibility for COBRA coverage at any time during the
period from Sept. 1, 2008, to Dec. 31, 2009, and
election of COBRA coverage.
-
A record of the SSN’s of all covered employees, the
amount of the subsidy reimbursed with respect to each
covered employee, and whether the subsidy was for one
individual or two or more individuals.
-
Other documents necessary to verify the correct amount
of reimbursement.
This documentation must be maintained, but will not be
required to be submitted to the IRS with Form 941.
Q: It might be difficult to make the April 30,
2009 deadline for filing the new Form 941. Who should we
contact if we want to request an extension of time to file?
A: No extensions are available for filing of employment
tax returns.
Q: In order to be an assistance eligible
individual, must the individual actually have coverage under
the group health plan at the time of the involuntary
termination of employment?
A: Yes. The individual must have actual group coverage at
the time of the qualifying event, i.e., the involuntary
termination of employment. The qualifying event must occur
between Sept. 1, 2008, and Dec. 31, 2009, and the individual
must be eligible for COBRA coverage at any time during that
period.
Q: Is the COBRA benefit based on the former
employee’s insurance coverage?
A: In general, COBRA coverage is based on the same
coverage that the individual had at the time of the
qualifying event. However, under the COBRA subsidy
provision, an employer may offer an assistance eligible
individual the option of choosing other coverage that is
also offered to active employees and that does not have
higher premiums than the coverage the individual had at the
time of the qualifying event.
Q: Is the assistance eligible individual’s share
of the premium always 35 percent, or are there other
elections the individual can make?
A: The assistance eligible individual is required to pay
35 percent of the amount of the total premium for the
coverage the individual elects. This percentage is fixed by
statute.
Visit the
Department of Labor Web site for information related to
COBRA eligibility and the subsidy. Benefits Advisors are
also available to assist you at 1-866-444-3272.
|
|
Return
to Top of page |
|
ARRA COBRA Subsidy
Frequently Asked Questions for Employers
- 1 -
This FAQ document represents our interpretation based
on the information
available at the time of its creation. However, it
should not be construed as legal
advice or counsel. Modifications may be made as
additional clarifications and
guidance become available.
1. EFFECTIVE DATE
What is the effective date?
The American Recovery and Reinvestment Act (ARRA) was
effective February 17,
2009, and measures many of its timeframes from that
date. For instance, the COBRA
subsidy provisions are effective for a plan as of the
plan’s first billing period on or after
that date (so March 1, 2009, for most plans).
2. OVERVIEW
What do the major COBRA subsidy provisions do?
• Provide a 65%
subsidy for COBRA and qualifying state continuation premiums for up
to 9 months for “assistance-eligible individuals.” The
subsidy is “fronted” by the
employer, multiemployer plan, or insurer and recovered
from the federal government
via a payroll tax credit.
• Provide a special
COBRA election period for individuals involuntarily terminated from
employment between September 1, 2008, and February 16,
2009, who didn’t elect
COBRA or elected it but no longer had it on February
17, 2009. Furthermore, some
states have adopted or are considering adopting
corresponding special election
periods with regard to their state continuations.
• Require new and
revised notices related to the subsidy and special election period.
3. DEFINITIONS
Which plans are affected?
ARRA covers most health plans that are subject to
COBRA or similar continuation
coverage laws. This includes: insured and self-funded
plans; state and municipal plans
that are subject to continuation under the Public
Health Service Act; plans under the
Federal Employee Health Benefits Program; and plans
subject to state continuation laws
similar to COBRA. Medical plans (including dental,
vision, and/or prescription only plans)
are eligible for subsidy, but flexible spending
arrangements are not.
Which state continuation laws are qualified for the
subsidy?
A definition has not been provided, but Oregon state
continuation under ORS 743.610
and Utah mini-COBRA under UCA §§31A-22-722 and 722.5
are likely similar to COBRA.
Washington and Idaho do not have subsidy-qualifying
state continuation laws.
ARRA COBRA Subsidy
Frequently Asked Questions for Employers
- 2 -
What defines an “assistance-eligible individual?”
To be an assistance-eligible individual (AEI), an
individual must be either:
(a) an employee involuntarily terminated from
employment between September
1, 2008, and December 31, 2009, and eligible for COBRA
or similar state
continuation during that period, or
(b) such an employee’s spouse or child who was
enrolled through him or her on
the day before the involuntary termination.
An individual who is eligible for another group health
plan or Medicare is not an AEI. If a
child is born to or placed for adoption with a former
employee AEI after the involuntary
termination qualifying event, that child is also a
qualified beneficiary and an AEI. Some
employees, though entitled to receive the subsidy,
will have to refund some or all of it on
their next year’s federal income taxes because their
adjusted gross income is over
certain levels ($250,000 for joint filers; $125,000
for others). Employers are not required
to track or calculate this. AEIs can waive the
subsidy, but any waiver is irrevocable.
What about domestic partners?
The subsidy is not available for domestic partners,
even if they can be included on
COBRA or state continuation coverage. This may
complicate recovering the subsidy
from the federal government.
What does “involuntarily terminated” mean?
No definition has been provided to date, but a little
guidance exists. Layoff, firing, and
other involuntary discharges are likely included.
According to new U.S. Department of
Labor (DOL) FAQs, this includes “being told not to
come back to work until further
notice.” A reduction of hours or furlough under which
an employment relationship
remains does not appear to be an involuntary
termination. Further, if you do not to offer
COBRA to employees terminated for “gross misconduct,”
the new law does not appear
to change that. You must make any decision not to
offer COBRA because of a
termination for gross misconduct.
4. THE SUBSIDY
When does the subsidy begin?
The subsidy begins as of the plan’s first billing
period on or after February 17, 2009
(usually March 1, 2009), whether the recipient is
already enrolled as an AEI on that date
or enrolls during the special election period
described later in these FAQs. There is no
subsidy available for premiums related to coverage
before that date.
When does the subsidy end?
The subsidy will apply for a maximum of 9 months
(though unsubsidized continuation
coverage may be available beyond that). It will end
earlier if:
(a) the AEI becomes eligible for (not necessarily
enrolled in) another group health
plan or Medicare; or
(b) COBRA or state continuation ends for any reason
(e.g., the maximum
continuation period is exhausted, premium is not paid
timely, etc.).
ARRA COBRA Subsidy
Frequently Asked Questions for Employers
- 3 -
AEIs have the obligation to notify you of their
eligibility for other coverage and are
subject to a penalty of 110% of the subsidy amount if
they fail to do so.
How does the subsidy work?
For a period of up to 9 months, AEIs who pay the 35%
of their share of the COBRA or
state continuation premium will be entitled to the
continued coverage. For continued
coverage before or after that time, the usual premium
amounts apply. Alternatively, any
person or entity, except the AEI’s employer, may pay
on the AEI’s behalf. Usually, the
AEI’s premium is calculated from 102% of the “active”
premium (so 35% would be 35.7%
of that active premium). The entity “fronting” the
remainder of the premium is permitted
to take a credit in the amount of the remaining 65%
against its federal payroll tax (Form
941). If the credit amount is greater than the taxes
due or no taxes are due, the
Department of the Treasury will directly reimburse the
entity as if taxes had been
overpaid.
Note that an entity that was already subsidizing
continuation premiums before ARRA
would not be able to take a credit for the amount of
that subsidy, but rather only for 65%
of the amount that was actually being charged to AEIs.
For instance: if full COBRA premium is $1,000, but you
already were paying
half, the subsidy would be based on the half that the
qualified beneficiary
was being charged. The AEI would have to pay only $175
(35% of $500)
and you would have to pay the $825 balance, but only
$325 (65% of $500)
could be recovered through the payroll tax credit.
If you provide a non-ARRA subsidy for state
continuation coverage, you will need to
inform Regence and pay Regence the amount of that
unrecoverable subsidy. Refer to
section 7 for additional information.
Who pays the subsidy?
In a multiemployer group health plan, the
multiemployer plan pays the subsidy and
claims the payroll tax credit. In a COBRA-eligible
group health plan or a self-funded plan
(whether or not COBRA-eligible), the employer pays the
subsidy and claims a payroll tax
credit. In both cases, Regence will require timely
payment of the full premium from the
plan or employer. In an insured plan that is not a
multiemployer plan and is subject to
state continuation, Regence will front the subsidy
amount and claim the payroll tax
credit. In this last type of plan, Regence will be
claiming the credit and, in addition to the
usual information, you will need to provide:
• Attestation of
the involuntary termination of the employee, including the date of
termination
• Employee Social
Security Number
What if I’ve received full premium payments from AEIs
already?
During the first two months after the effective date
of the subsidy program, if full
payments are received, you may refund the “overpaid”
65%. Alternatively, if it is (and
remains) reasonable to believe that amount would be
exhausted within 180 days, you
may provide an AEI a credit of the overpaid amount
against future premiums. After the
first two months, the subsidy must be fully
implemented.
ARRA COBRA Subsidy
Frequently Asked Questions for Employers
- 4 -
5. SPECIAL ELECTION PERIOD
What is the special election period and how does it
work?
Employees involuntarily terminated from employment
between September 1, 2008, and
February 16, 2009, who didn’t elect COBRA, or elected
it but no longer had it on
February 17, 2009 (and their spouses and dependent
children covered the day before
the involuntary termination), are given a second
chance to elect COBRA. The special
election period began February 17, 2009, and will last
until 60 days after you provide
notice of it. Under ARRA, the special election period
applies only to COBRA, but some
states have taken or are considering action to extend
it to their state continuations. If
special election is made, COBRA coverage is effective
as of the first billing period on or
after February 17, 2009 (usually March 1, 2009). The
period between the original
COBRA qualifying event and the effective date of
special election is not part of a
significant break in coverage for purposes of applying
a pre-existing condition waiting
period to an AEI. Eligible individuals using the
special election period must start COBRA
as of March 1, 2009, and pay the corresponding
premiums.
6. NOTICES
Are new or revised notices required?
Yes. Because the subsidy is a temporary provision, you
may prefer to create separate
supplemental notices, rather than amending existing
ones, and that is permissible.
COBRA requires a general notice to be sent to
qualified beneficiaries upon the
occurrence of a qualifying event. You must send a
revised general notice to all
individuals experiencing a qualifying event between
September 1, 2008, and December
31, 2009, with one exception. A revised general notice
does not have to be sent to a
qualified beneficiary whose qualifying event occurred
between September 1, 2008 and
February 16, 2009 if the qualifying event was not an
involuntary termination of
employment and you provided a general notice that was
compliant with the law at that
time. The revised general notice must provide
information about the subsidy and include
related forms. Department of Labor model notices are
available at
http://www.dol.gov/ebsa/COBRAgeneralnoticefullversion.doc
and
http://www.dol.gov/ebsa/COBRAgeneralnoticeabbreviatedversion.doc.
The models
include a full version and an abbreviated version.
The full version must be used for all qualified
beneficiaries with any qualifying event from
September 1, 2008, through December 31, 2009, if
either:
o they haven’t been
provided a general COBRA notice yet, or
o they were
provided one after February 16, 2009, that did not address the
subsidy.
The abbreviated version can be used as an alternative
to the full version, but only for
qualified beneficiaries who already elected and have
retained COBRA coverage in
connection with a qualifying event on or after
September 1, 2008. The abbreviated
version provides only the subsidy information.
ARRA COBRA Subsidy
Frequently Asked Questions for Employers
- 5 -
These notices must be mailed no later than April 18,
2009. The full version is also to be
used as your general COBRA notice hereafter for
qualifying events occurring until
January 1, 2010.
You also must send notice of the available special
election period to individuals who had
an involuntary termination of employment qualifying
event between September 1, 2008,
and February 16, 2009, and either did not elect COBRA,
or elected it but no longer had it
on February 17, 2009. A Department of Labor model of
this notice is available at
http://www.dol.gov/ebsa/COBRAextendedelectionperiodnotice.doc.
This notice
approximates the full general COBRA notice, providing
information about the special
election opportunity, as well as the subsidy and
related forms.
In addition to these notices, you may want to consider
updating or supplementing the
initial COBRA notice that you provide to individuals
upon enrollment in your plan to
disclose the availability of the subsidy, though doing
so is not required. Because the
subsidy is temporary, Regence’s benefit booklets and
certificates of creditable coverage
will not be changed at this time.
7. ADMINISTRATION, COMMUNICATION, AND COOPERATION
What information must you provide to Regence?
If your group is subject to COBRA, you will continue
to use the same COBRA application
form you have always sent to Regence. You need to note
on the form whether or not
the qualified beneficiary is eligible for the subsidy.
Failure to do so may result in
processing delays.
If your group is subject to state continuation, you
will continue to use the same form you
have always sent to Regence. You need to note on the
form whether or not the
qualified
beneficiary had an involuntary termination of
employment that makes the qualified
beneficiary eligible for the subsidy. This information
will be required in order to process
the form when the reason is termination of employment.
These forms can be downloaded, as before, from our
employer website at:
www.or.regence.com/employer/forms/.
If your employee count has varied above and below the
20-employee mark from
calendar year to calendar year, it is imperative you
ensure that Regence has accurate
information about whether COBRA or state continuation
applies to your plan.
REMINDER: If you provide a non-ARRA subsidy for state
continuation coverage, you will
need to inform Regence and pay Regence the amount of
that unrecoverable subsidy.
This will prevent the payroll tax credit from being
inappropriately claimed.
You must notify Regence, when you are notified, that
an AEI has become eligible for
Medicare or other group coverage.
ARRA COBRA Subsidy
Frequently Asked Questions for Employers
- 6 -
8. COVERAGE CHANGES
Can AEIs change from one of our health plan options to
another?
COBRA qualified beneficiaries have long been able to
change among health plan
options at the same times that active employees may,
generally at annual renewal.
ARRA permits, but does not require, groups to allow an
AEI to enroll in an option that is
different than the coverage he had at the time of his
qualifying event as long as that
other coverage is: (a) no more expensive; (b) is also
offered to active employees; and (c)
is not limited to only dental, vision, or counseling
coverage (or any combination of those
coverages), a flexible spending arrangement, or an
on-site medical clinic.
The group contract between you and Regence, however,
precludes your permitting such
coverage changes without renegotiation of that
contract. If such changes were allowed,
they would be expected to increase claims experience
and therefore premium rates, as
well as add to administrative tasks.
9. APPEALS
What if an individual thinks he or she has been
wrongly denied subsidy?
If you are a private employer subject to COBRA, the
individual can appeal to the U.S.
Department of Labor. If you are a public employer, or
private employer subject to state
continuation, the individual can appeal to the U.S.
Department of Health and Human
Services. The relevant Department’s decision is due
within 15 business days.
10. Health Coverage Tax Credit (HCTC)
How does this COBRA subsidy work with the subsidy
under the HCTC?
The two do not work together; a choice must be made
between them. The HCTC under
the Trade Adjustment Act is complex but, in general
terms, includes a premium subsidy
available to a small category of individuals who have
lost employment due to foreign
competition. HCTC-eligible individuals are notified
from the IRS. The ARRA increases
the HCTC premium subsidy such that an individual may
be better off taking it than the
COBRA subsidy that is the subject of these FAQs.
11. OREGON STATE CONTINUATION
What special provisions related to Oregon continuation
are not mentioned above?
At the time this FAQ was composed, changes had not
been made to Oregon
continuation. Oregon’s insurance regulator, however,
has proposed both: (a) increasing
the maximum period that Oregon continuation is
available to 9 months (from 6); and (b)
adding a special election right comparable to ARRA’s
special election right for COBRA,
including a notice requirement. It appears that
federal regulations also may add a notice
requirement for state continuations when they are
issued. If any or all these changes
should occur, you will be required to provide Regence
the information it needs to
comply.
ARRA COBRA Subsidy
Frequently Asked Questions for Employers
- 7 -
12. ADDITIONAL INFORMATION
Where can I get more information?
Official guidance is available at
www.dol.gov/COBRA.
For updated information from Regence, including
details and changes in processes and
forms related to COBRA, state continuations, and the
ARRA subsidy, visit
www.regence.com/cobra. |
| Return
to Top of page |
|
May 15, 2009
Lifewise of Oregon
State Continuation Coverage and ARRA Subsidy
On April 28, 2009, Governor Ted Kulongoski signed
legislation modifying the state’s existing
continuation of coverage laws, which affect employer
groups with fewer than 20 employees.
The Department of Consumer and Business Services and
Division of Insurance have recently
adopted rules regarding the application of the federal
subsidy for state continuation of health
benefit plans. LifeWise Health Plan of Oregon is
actively monitoring the activities. You can
access general information on Oregon’s implementation
at:
http://www.cbs.state.or.us/ins/consumer/consumer-issues/federal-stimulus-info/federal-stimulusinfo.
html
LifeWise is in the process of notifying all employer
groups with fewer than 20 employees plus
their former employees who may qualify for the
subsidy. You are receiving this bulletin because
our records indicate you are the agent of record for
one or more employer groups with fewer
than 20 employees. Copies of both letters are attached
for your reference. While the employer
letter outlines some of the employer requirements,
LifeWise is not providing and is not able to
provide legal advice. Employers should contact their
legal counsel for specific obligations under
this law.
LifeWise will administer the federal subsidy for the
state continuation of coverage program
through the following process:
• Request from employer
group, as necessary, subsidy eligibility for members currently
enrolled in state continuation to identify who was
involuntarily terminated.
• Send notifications to
former employees who may be eligible for the subsidy informing
them of the new law, including subsidy information and
extended election period.
• Accommodate special open
enrollment provisions allowing a member (with employer
approval) to elect a different plan with the same or
less expensive premium (if available
to active employees).
• Bill the employer group
for 35 percent of the payment for the subsidy-eligible former
employees. Non-eligible former employees will continue
to be billed for 100 percent of the
continuation of coverage payment.
• Pay the remaining 65
percent and recover the subsidy via payroll tax credit.
• Refund overpayments to
members.
If you have additional questions, please contact your LifeWise
small group sales team.
Return
to Top of page |
|
HealthNet of Oregon, ARRA Assistance As you know, President
Obama signed the American Recovery & Reinvestment Act of 2009 (ARRA)
on Feb. 17, 2009. The law provides “Assistance Eligible Individuals (AEIs)
a 65 percent subsidy for COBRA and/or state-specific COBRA
continuation coverage premiums for qualified beneficiaries
involuntarily terminated from employment in the period from Sept.1,
2008 through Dec. 31, 2009, for up to nine months.
We want to help guide you through the COBRA/state continuation
process and provide you with some sample forms and letters that we use
at Health Net.
Subsidies of 65 percent of COBRA or state-specific premium will be
available for up to nine months to workers who are involuntarily
terminated from employment between Sept. 1, 2008 and Dec. 31, 2009.
The law requires employers to pay the amount of the COBRA premium
assistance subsidy and to deduct the amounts from their payroll taxes.
The Act requires that all federal COBRA subsidies be administered
and recovered by the employer group. It is the group’s responsibility
to identify AEIs, meet the notice requirements and administer the
ongoing eligibility and premium remittance requirements of the Act.
- Health Net will not send group or member notifications regarding
the ARRA premium assistance for federal COBRA groups.
- Health Net will continue to bill these groups for the entire
COBRA premium.
- For Health Net's Group Pay COBRA application and attestation
form, click on the attachment, Application & Attestation Form.
Oregon State Continuation Plans for Small Groups Not
Subject to Federal COBRA
Recognizing the need for changes to state law to allow Oregonians to
obtain the full advantage of the federal subsidy, the Oregon
legislature enacted HB 2433. HB 2433 and follow-up rule-making by the
Oregon Department of Consumer Business Services (DCBS) achieves the
following:
- Extends the amount of time former employees can continue
coverage through the state continuation program from six months to
nine months. This gives eligible Oregonians the opportunity to
receive the full nine months of premium assistance.
- Allows an independent election of coverage by each qualified
beneficiary.
- Creates a second election opportunity for state continuation
coverage for AEIs who experienced a qualifying event on or after
Sept. 1, 2008 and before the effective date of HB 2433 and either
did not elect or whose continuation coverage ended, e.g., lapse due
to nonpayment, and/or expiration of six month coverage period.
- Specifies that enrollees who take advantage of the second
election opportunity be treated as having continuous coverage for
purposes of calculating creditable coverage.
- Insurers subject to continuation of coverage provisions are now
required to provide a notice explaining state continuation of
benefits directly to individuals losing group coverage, for any
reason other than replacement of their group coverage, within ten
days following the date of any administrative action taken by an
insurer to initiate or document the loss of coverage.
ARRA Notification Mailings to Identified Members & Groups
On April 17, 2009, Health Net distributed a mailing to all members not
subject to federal COBRA that had terminated coverage between Sept. 1,
2008 and March 16, 2009. This mailing included the following
documents:
- Member-specific ARRA (American Recovery and Reinvestment Act)
and Oregon State Continuation Subsidy notice/letter.
- Summary of the Continuation Coverage Premium Reduction
Provisions under ARRA.
- State Continuation Election/Premium Subsidy Attestation
Application Form.
To view the above documents, click on the attachment, Sample
Member Notice.
In addition, to assist employers not subject to federal COBRA, a
separate mailing was distributed to groups who were identified as
having terminated coverage for individuals Sept. 1, 2008 through March
16, 2009. This mailing included the following documents:
- Employer-specific ARRA (American Recovery and Reinvestment Act)
and Oregon State Continuation Subsidy notice/letter.
- Sample copy of member-specific ARRA (American Recovery and
Reinvestment Act) and Oregon State Continuation Subsidy
notice/letter.
- Summary of the Continuation Coverage Premium Reduction
Provisions under ARRA.
- State Continuation Election/Premium Subsidy Attestation
Application Form.
To view the above documents, click on the attachment, Subsidy
Employer Notice.
Members on IFP, Portability and Medicare Supplemental plans are not
eligible for the subsidy.
For more information on the New COBRA Subsidy Guidelines, please
visit the Health Net web site,
www.healthnet.com.
|
| Return
to Top of page |
| |
| |
| |
| |
| |
|
|