Implementing Helthcare Reform

The Patient Protection and Affordable Care Act

Provisions Impacting Self-Funded Employers and their Employees
 

EMPLOYER RESPONSIBILITY

Automatic Enrollment

Employers with over 200 full-time employees that offer at least one health benefits plan are required to automatically enroll new full-time employees and re-enroll current employees. Employers can wait up to 90 days to enroll employees.

Employers must provide adequate notice to their employees of their enrollment.

Employers must allow their employees the opportunity to opt-out of any coverage they were automatically enrolled in.

Effective date – TBD by agency guidance

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Disclosure of Coverage Options

Employers are required to disclose the following to each employee at the time of their hire:

  • Informing the employee of the existence of their State’s insurance exchange, including a description of the services provided by such exchange and the manner in which the employee may contact the exchange to request assistance
  • If the employer’s share of the total allowed costs of benefits provided is less than 60% of such costs, that the employee may be eligible for a premium tax credit and a cost-sharing reduction if the employee purchases a Qualified Health Plan through the exchange
  • If the employee (who is not eligible for a “free choice” voucher) purchases a Qualified Health Plan through the exchange, the employee will lose the employer contribution (if any) for its health plan and that all or a portion of such contribution may be excludable from Federal income tax

Effective date – 3/1/13

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Employers Not Offering Coverage

Employers with over 50 employees will be penalized if:

  • They do not offer minimum essential coverage; and
  • In any month have at least one employee receiving and using a premium assistance tax credit to purchase coverage through an exchange

Penalties equal:

  • 2014 - A monthly fee of (1/12th of $2,000) per full-time employee employed in such month - Employers may disregard first 30 employees from penalty calculations
  • Subsequent years - the monthly fee will be 1/12th of (the previous year’s annual penalty amount plus the increase in the premium adjustment percentage)

All employers required to pay the penalty are also required to report the following information to HHS as well as a personalized copy to each employee:

  • The employer’s name and employer identification number
  • A certification of whether the employer offer’s minimum essential coverage
  • If the employer certifies that it did offer minimum essential coverage, it must report:
    • The length of any enrollment waiting period
    • All of the months coverage was available
    • The monthly premium of the lowest cost option in each enrollment category (if applicable)
    • The employer’s share of total allowed costs of benefits
  • The number of full-time employees for each month during the calendar year
  • The name, address and TIN of each full-time employee during the calendar year and the months during which such employee (and any dependents) were covered

Effective date – 1/1/14

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Employers Offering Coverage

Employers with over 50 employees will be penalized if:

  • They do offer minimum essential coverage; and
  • In any month have at least one employee receiving and using a premium assistance tax credit to purchase coverage through an exchange

Penalties equal:

  • 2014 - A monthly fee of (1/12th of $3,000) per full-time employee receiving the premium assistance credit - Employers may disregard first 30 such employees from penalty calculations
  • Subsequent years - the monthly fee will be 1/12th of (the previous year’s annual penalty amount plus the increase in the premium adjustment percentage)
  • Penalties are capped at $2,000 (in years after 2014, the previous year’s amount plus the increase in the premium adjustment percentage) times the number of full-time equivalent employees.

All employers required to pay the penalty are also required to report the following information to HHS as well as a personalized copy to each employee:

  • The employer’s name and employer identification number
  • A certification of whether the employer offer’s minimum essential coverage
  • If the employer certifies that it did offer minimum essential coverage, it must report:
    • The length of any enrollment waiting period
    • All of the months coverage was available
    • The monthly premium of the lowest cost option in each enrollment category (if applicable)
    • The employer’s share of total allowed costs of benefits
  • The number of full-time employees for each month during the calendar year
  • The name, address and TIN of each full-time employee during the calendar year and the months during which such employee (and any dependents) were covered

Effective date – 1/1/14

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Reporting of Employees’ Coverage Status

All employers who provide minimum essential coverage are required to report the following information on each covered life:

  • Name & Address
  • TIN
  • Dates of coverage
  • Whether the coverage is through a Qualified Health Plan offered through an insurance exchange, and if so, must report:
    • Advance payment of any cost-sharing reduction
    • Any premium tax credit

Effective date – 1/1/14

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Reporting of the Cost of Coverage

Employers who offer minimum essential coverage are required to include the aggregate value of coverage for each employee (and any dependents) on the employees W-2 form.

Effective date – 2011

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(Please note: This document was produced by the Self-Insurance Institute of America to provide an overview of the Patient Protection and Affordable Care Act, as modified by the Health Care and Education Reconciliation Act. It does not cover every aspect of the legislation, and certain provisions of the law may change or be modified by additional rules and regulations. This document does not constitute legal or tax advice.)