How List-Billing Works with Section 105 Healthcare Reimbursement Plans
Compliance • January 28, 2014 at 11:31 AM • Written by: PeopleKeep Team
Many Section 105 Healthcare Reimbursement Plan (HRP) or health reimbursement arrangement (HRA) providers do not allow the use of list-bill arrangements with HRPs because List-Billing creates potential HIPAA/ERISA violations for the employer.
Some insurance companies allow employers to set up list-billing for their employees. List-billing is a process that allows an employer to facilitate employees' purchase of individual health insurance policies via post-tax payroll deduction.
Under a List-Bill arrangement, a health insurance carrier sends an employer a single bill for each employee's personal health insurance policy.
The employees (not the employer) pay their premium in full, usually through payroll withholding (post-tax), and the employer transmits the payment to the insurance company on behalf of the employees.
Essentially, the employer serves as a facilitator for the premium payments, but under federal law is not permitted to contribute to the premium. Under List-Billing, because the employer does not contribute to the premium, and the individual owns the insurance policy, group policy requirements do not apply. The individual is covered by the terms of their individual policy.
With an HRP (when List-Billing is not involved), employees:
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Purchase their own individual health insurance policy;
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Make payment to the carrier (via ACH transfer, check, or credit card) for their individual health insurance premium;
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Submit a health insurance premium claim to their HRP with proof of payment (e.g. invoice or monthly bill); and
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Receive tax-free reimbursement from their employer via check, payroll addition, or direct deposit.
In a List-Billing scenario with an HRP, the only difference above is #2 - the employee's method of premium payment. The employee must still submit claims for reimbursement of their insurance premium to the HRP.
Rather than paying the carrier directly via ACH transfer, check, or credit card, the employee pays the carrier indirectly (through their employer) via payroll withholding (post-tax). Nothing changes as far as the HRP is concerned.
With an HRP (when List-Billing is involved), employees:
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Purchase their own individual health insurance policy;
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Make payment to the carrier through their employer (via post-tax payroll withholding) for their individual insurance premium;
-
Submit a health insurance premium claim to their HRP with proof of payment (e.g. invoice or monthly bill); and
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Receive tax-free reimbursement from their employer via check, payroll addition, or direct deposit.
To reiterate... List-billing is never recommended with the use of an HRP because it creates potential HIPAA/ERISA violations for the employer. See Why Business Should Never Pay for Individual Health Insurance for more information.
