It's easy to figure out why employers like the idea of clinics at the office. They help keep a lid on health care costs by making it easier for employees to stay healthy.
And it's easy to figure out what workers like about them, too. The convenient clinics treat sniffles and scrapes in addition to providing checkups, vaccines and some drugs free or at reduced cost.
But there's a hitch. Some employers have concluded that employees enrolled in high-deductible health plans that are linked to a health savings account can't be given the same price break on workplace clinic services that their coworkers in regular PPOs and HMOs receive. Unless they charge workers in high-deductible plans the full market value of services, these employers worry, they risk running afoul of IRS rules.
HSAs are tax-exempt savings accounts that people can use to cover health care expenses. They must be paired with a health plan with a deductible of at least $1,200 for individuals and $2,400 for families, among other requirements. Since their introduction in 2004, HSA-qualified plans have grown rapidly, and now cover some 10 million people, according to America's Health Insurance Plans, a trade group.
However, in order for the accounts to keep their tax-favored status, people must pay the full market value of nearly all health care services they receive until they meet the health plan's deductible. The only exception is for preventive services such as physicals and mammograms.
To avoid a potential tax misstep, some employers charge different fees for employees enrolled in high-deductible HSA plans, according to a research brief on workplace clinics published in December by the Center for Studying Health System Change.
Other employers are taking a less stringent stance, saying that as long as clinic practitioners discuss the employee's health risk assessment (a questionaire about health habits and conditions that many employees are given by employers) at every clinic visit, the preventive care requirements will be satisfied.
"Many experts considered this to be a risky, overly broad interpretation of the safe harbor—one that may ultimately jeopardize the tax-exempt status of employes' HSAs," study authors concluded in the brief.