Affordable Care Act Update

Transcription

1 Affordable Care Act Update

2 Presented by: Jill Brooking, Vice President, Benefits Compliance National Financial Partners Corp. and its subsidiaries do not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances

3 Agenda: Health Care Reform Employer Mandate Strategies for Compliance Fees and Taxes Reporting Private Exchanges

4 Employer Mandate

5 Employer Mandate One Year Delay for Employers with 50 to 99 Employees Must not reduce its workforce or overall hours of service for employees during 2014 Exception for bona fide business reasons- sale of a division, terminations of employment for poor performance Continue the same employer contribution through the end of the 2015 plan year (as compared to Feb. 9, 2014) At least 95% of the employer s dollar contribution The same or higher percentage of cost Files a certification that will be submitted with 6056 reporting

6 Employer Mandate: Effective Date Is the employer subject to the employer mandate on Jan. 1 or plan year? Transition relief for non-calendar year plans Non-calendar year plan must have been in place on Dec. 27, 2012 and could not have subsequently changed plan year to a later calendar date Those who changed to a Dec. 1, 2013 plan year (early renewal strategy) will not qualify for transition relief. Must comply Jan. 1, 2015 Must offer minimum value coverage on the first day of the 2015 plan year Must meet one of the following criteria: Offered coverage to at least 33% of all employees (or 50% of FT employees) during the most recent open enrollment period prior to Feb. 9, 2014; OR Covered at least 25% of all employees (or 33% of FT employees) on any day between Feb. 10, 2013 and Feb. 9, 2014 Additional relief- no penalty due for an employee who was eligible under the terms of the plan on Feb. 9, 2014

7 Penalty A Must offer coverage to substantially all full-time employees (30+ hours per week) and children or pay a $2,000 penalty per FT employee If employer does not currently offer coverage to dependents, but is taking steps to do so, will not pay a penalty for failure Offer coverage to No penalty on % of FT EE s First 80 FT EE s 2016 and subsequent year 95% of FT EE s First 30 FT EE s

8 How does an employer identify a full time employee? Must calculate formula to determine hours worked by non-traditional employees- commissioned, sales, etc. Temporary employees- If they are not variable hour or seasonal AND they regularly work 30 hours or more per week, they are a FT employee Independent Contractors- Conduct analysis to determine if the contractor is correctly classified. If so, they are not an employee, and don t offer coverage. Union- If they are an employee of the employer, then include in employer s EE count to determine size. If they are FT, should offer coverage under ER plan or union plan. Staffing company employees- Conduct analysis to determine common law employer (relationship, behavioral control, financial control). Common law employer would be responsible under employer mandate. Leased- Somewhat counterintuitive, is employee of recipient employer for first year. Employee of leasing company thereafter. Seasonal- If 6 months or less, may use a look-back period to measure their hours to determine status

9 Reminder regarding measurement periods New Employees Initial Measurement Period Initial Stability Period Initial Administrative Period (optional) 3 to 12 months Same as standard measurement period or 6 months, whichever is greater Up to 90 days, but when combined with initial measurement, stability cannot start more than 13 months (and days until first of next month) from start date Ongoing Employees Standard Measurement Period Standard Stability Period Standard Administrative Period (optional) 3 to 12 months Same as standard measurement period or 6 months, whichever is greater Up to 90 days

10 Measurement Period: Example ABC Company Plan Year: June 1 to May 31 Measurement Period: 05/01/ /30/2015 Admin Period: 05/01/ /31/2015 Stability Period: 06/01/ /31/2015

11 Penalty B Affordable Minimum value If not, pay a penalty of $3,000 per FT employee who receives a premium tax credit. No change in final regulations

12 How do wellness programs interact with the affordability requirement? Wellness rewards are disregarded for affordability purposes, unless they are tobacco related. Premium Cost Wellness Reward EE Contribution w/ reward EE Contribution w/o reward $500 $150 $100 $250 $250 Premium Cost Wellness Reward Non-tobacco related Tobacco related EE Contribution w/ reward EE Contribution w/o reward $500 $250 $100 $350 $100 EE Cost for Affordability Purposes EE Cost for Affordability Purposes

13 Strategies

14 Pros Strategy #1: Spousal Carve Out An employer may exclude spouses without penalty Eligibility for a premium tax credit is based on the affordability of EE only coverage. If the EE s coverage is affordable, the spouse will be ineligible for a premium tax credit. By excluding the spouse from coverage, the spouse s eligibility for a premium tax credit is preserved. Cost savings Cons Household income is unknown. Spouse may still be ineligible for premium tax credit. Difficult to communicate. Employees see as a reduction in benefits. Not permissible in some states

15 Strategy #2: Offer a skinny plan Pros Would qualify as minimum essential coverage (MEC) for covered individuals to avoid individual mandate Would avoid Penalty A of employer mandate Cost savings Cons Not available for fully insured plans because of state mandates Employer subject to Penalty B of employer mandate

16 Strategy #3: Cut hours of full-time employees Possible interaction with ERISA 510 Unlawful for any person to discharge or otherwise discriminate against a plan participant or beneficiary: for exercising a right the participant or beneficiary is entitled to under ERISA or under an employee benefit plan (i.e., retaliation for the past exercise of protected rights); or for the purpose of interfering with any right the participant or beneficiary may become entitled to under ERISA or under an employee benefit plan.

17 Strategy #4: Terminate group plan and assist employees in purchase of individual coverage Cannot be on a tax advantaged basis Section 125 regulations prohibit an employee for paying for individual exchange coverage through the cafeteria plan IRS Notice prohibits a stand alone HRA and the reimbursement of individual policy premiums on a pre-tax basis Premiums are not a qualified medical expenses under a health FSA An HSA can only reimburse premiums for an individual on COBRA, receiving unemployment compensation, or aged 65 and older

18 What does an employer need to do? Determine size and whether they are subject to the employer mandate in 2015 Calculate average number of full-time equivalent employees in 2014 A. FT EE s (30+hrs/wk) B. Add up monthly hours of EE s with <30 hrs/wk and divide by 120 C. Total of A +B Amend eligibility to offer coverage to employees working 30 hours or more per week If employer has variable hour or seasonal employees, implement measurement and admin periods so that they end prior to Jan. 1 and full-time employees are identified and offered coverage. Determine employee premium contributions and affordability strategy

19 Fees and Taxes

20 Fees Description PCOR Reinsurance Health Insurance Tax (HIT) What & When Annual fee on plans from year annual fee on plans ( ) Permanent annual fee on health insurers Purpose Fund outcomes-based research for clinical effectiveness Fund reinsurance program for state exchanges Help fund federal and state exchanges and PPACA implementation Who Pays Fully Insured: Insurer Self-insured: Employer Fully Insured: Insurer Self-insured: Employer Insurers How Much $2 per covered life ($1 per covered life 1st year $63 per covered life in 2014 (decreases for 2015 and 2016) $8 billion apportioned among insurers (Increases each year) How Paid Self-reported on IRS Form 720 Report filed Nov. 14 Payment due Jan. 15 Report on IRS Form 8963 Paid after IRS Assessment Tax Treatment Tax deductible Tax deductible Not tax deductible Types of Plans Major medical, continuation coverage, retiree-only, HRA, non-excepted FSA, prescription Major medical, continuation coverage, retiree-only, nonexcepted FSA, non-integrated HRA Major medical, stand-alone dental/vision, retiree-only coverage Notable Plan Type Exclusions Stand-alone dental/vision, excepted FSA, HSA Stand-alone dental/vision, HRA, HSA, integrated HRA, prescription drug Voluntary, fixed-indemnity, supplemental, specified disease/illness, stop-loss

21 PCOR Funds the Patient Centered Outcomes Research Institute Applies for plan years ending after 9/30/12 until 9/30/19 $2 times the average number of covered lives ($1 for plan years ending before Oct.1, 2013) Payable by the insurance carrier for fully insured plans. Permitted to pass through cost to consumers. Employer responsible for self-funded plans. An employer who sponsors an HRA is responsible for paying and reporting the PCOR- even if it is paired with a fully insured plan.

22 Transitional Reinsurance Program The purpose is to help stabilize premiums for coverage in the individual health insurance market during the first 3 years of the exchange ( ) $63 per covered life (2014); $44 in 2015 Fully Insured plans: The health insurance company will pay the fee to the reinsurance program (will be passed back to the employer) Self Funded plans: The plan sponsor will pay the fee to HHS (the TPA may be used to make the payment at the plan s direction). Self funded, self-administered plans: Exempt for 2015 and

23 Health Insurance Tax (HIT) Applies to all insured plans- including medical, dental, and vision. Does not apply to self-funded Purpose is to help fund federal and state exchanges and PPACA implementation An annual target amount is divided among carriers based on market share target amount is $8 billion Increased premiums 3-5%

24 Tax on High Cost Plans ( Cadillac Tax) 40% tax on Cadillac Plans imposed on insurers and administrators of self funded plans Aggregate value cannot exceed $10,200 for single and $27,500 for family Total Aggregate value includes reimbursements for FSA or HRA, Contributions to HSA Threshold may be adjusted if health care costs increase more than expected Effective 2018

25 May an employer pass through fees to participants? Yes, with two exceptions. A self-funded plan may not pass through the PCOR fee to participants because the fee is imposed on the plan sponsor, not the plan. If the carrier bills the plan sponsor for the fee separate from the premium, it is not clear as to whether this is an acceptable expense to be paid with ERISA plan assets.

26 Employer Informational Reporting

27 Informational Reporting under Section 6055 Applies to employers of all sizes. Fully insured plans- carrier is responsible Self-funded- employer is responsible Purpose to implement individual mandate penalty (shared responsibility payment) and premium tax credits Due To taxpayers/employees by Jan. 31, 2016 To IRS by Feb. 28, 2016 (March 31 if electronically)

28 Informational Reporting 6055 Required content Name, address, and EIN of employer plan sponsor (if group coverage) Name, address, and TIN (i.e. SSN#) of the responsible individual and of each other individual obtaining coverage under the policy or plan Months when the individual was covered during the calendar year For insured minimal essential coverage, information regarding whether or not the coverage is a qualified health plan offered through an Exchange and, in the case of a qualified health plan, the amount (if any) of the advance payment of any cost-sharing reduction, or of any premium tax credit with respect to such coverage If the health insurance is a qualified health plan in the small group market offered through an Exchange, such other information as the IRS may require for administering the tax credit for employee health insurance expenses of small employers With respect to all individual and group insurance (whether sold inside or outside of an exchange), as well as self-funded plans

29 Informational Reporting under Section 6056 Applies to large employers Fully insured and self funded- employer plan sponsor is responsible Association is responsible for MEWA Purpose to implement employer mandate penalty, affordability and minimum value Due To IRS by Feb. 28, 2016 (March 31 if electronically)

30 Informational Reporting under Section 6056 Required Content Name and EIN of the applicable large employer Certifications as to whether the applicable large employer offers its full-time employees (and their children up to age 26) the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan and, if so: The duration of any waiting period with respect to such coverage The months during the calendar year when eligible for coverage The monthly premium for the lowest cost option for self-only coverage Whether the coverage offered meets minimum value The number of full-time employees for each month of the calendar year For each full-time employee, the name, address, and TIN of the employee The months (if any) during which the full-time employee were covered under the eligible employer-sponsored plan

31 Private Exchanges

32 Public Exchange Marketplace for individual or small group coverage SHOP- 50 EE s or fewer. (100 or fewer in 2017) State Run CA, CO,CT, DC, HI, KY, MD, MA, MN, MS, NV, NM, NY, OR, RI, UT, VT Federally Facilitated AL, AK, AZ, AR, DE, FL, GA, IL, IN, IA, KS, LA, ME, MI, MO, MT, NE, NH, NJ, NC, ND, OH, PA, SC, SD, TN, TX, UT, VA, WV, WI, WY Most states allow small employers to purchase coverage outside of the exchange Not Vermont or DC The Small Business Health Care Tax Credit only available through public exchange Currently no employee choice in federally facilitated

33 What is a Private Exchange? Marketplace for group coverage Employee Choice Multiple carriers Multiple metal tiers Multiple benefit designs Defined contribution Online enrollment Customer service Call center Reporting Compliance Support

34 Challenges Carrier participation Regionalization Electronic data interchange Interest in only larger groups For smaller groups Precludes an employer from the Small Business Health Care Tax Credit Group plan compliance ERISA- Summary Plan Descriptions (SPD) PPACA Reporting Medicare Part D Disclosure Notification to CMS COBRA

35 Questions?