Health-Care Reform Employer Shared Responsibility Provisions

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1 Health-Care Reform Employer Shared Responsibility Provisions CPA EDITION... This document provides an overview of the Employer Shared Responsibility provisions of the Affordable Care Act based on guidance provided by the Internal Revenue Service as of December 28, 212.

2 Employer Shared Responsibility Provisions Safe Harbor Qualification TABLE OF CONTENTS... Overview 1 Steps and Examples To Determine Assessable Fees Example 1: Bonnie s Day Care Exempt 2 (2 full-time employees; 6 part-time employees) Example 2: Cool Café Applicable Large Employer Not Subject to Fee 3 (18 full-time employees; 6 part-time employees) Example 3: Widget Manufacturing 3 Scenario A: No MEC offered 4 Scenario B: Coverage not offered at minimum value 4 Scenario C: Unaffordable coverage offered 5 Scenario D: Non-covered employee receives subsidy 7 Example 4: Best Boat Rentals Seasonal Employer 8 Example 5: Essential Enterprises Controlled Group 9 Example 6: Bob s Baked Goods An Employer Planning to Divide Into Multiple Entities 12 Safe Harbor Tests Flowchart 14 Key Terms and Definitions 16 What Employers Need To Do 2 How Paychex Insurance Agency Can Help The information in these materials is based on guidance provided by the IRS as of December 28, 212. It should not be considered legal or accounting advice, and should not substitute for legal, accounting, and other professional advice where the facts and circumstances warrant. These materials are for informational purposes only and may not provide details about every aspect of the Employer Shared Responsibility provisions in their entirety.

3 OVERVIEW The Employer Shared Responsibility (ESR) provisions of the Affordable Care Act outline the responsibility of certain employers to offer qualified and affordable health insurance to their full-time employees (those who average 3 working hours per week or 13 hours per month) and their dependents (employee s children, up to age 26, but not including employee s spouse) and the potential fees the Internal Revenue Service (IRS) may assess the employers for not doing so.. Effective January 1, 214, employers who have 5 or more full-time equivalent (FTE) employees are considered Applicable Large Employers and may be assessed a fee by the IRS if they fail to offer health-insurance coverage that meets the established minimum essential coverage (MEC) requirements. The FTE calculation is based on both full- and part-time employees.. Full-time employees are defined as averaging 3 hours per week or 13 hours per month. Those employees who do not meet the criteria for full-time definition will have their hours aggregated by month (each employee s hours will be capped at 12) and divided by 12 to determine the number of FTEs for that month.. MEC must be offered to all but five percent of full-time employees and their dependents or to all but five full-time employees and their dependents, whichever is greater.. Applicable Large Employers may also be charged a fee if they offer MEC but 1) the coverage is deemed unaffordable or 2) the coverage does not provide minimum value.. A fee cannot be charged until at least one full-time employee receives a federal premium tax credit (premium subsidy) for health insurance through a federal or state government health insurance (marketplace) (formerly called an exchange ).. However, the employer will not be subject to a fee for employees offered coverage if that coverage is considered to provide MEC, meets the minimum value test, and is deemed affordable using one of the safe-harbor methods provided.. Applicable Large Employers may be subject to a fee if they offer qualified and affordable coverage to the required number of full-time employees, but at least one of the full-time employees who are not offered coverage (non-covered employee) receives a premium subsidy through a marketplace.. No fees will be charged to an Applicable Large Employer who has fewer than 3 full-time employees. Even if an Applicable Large Employer is not subject to fees, the business will still be subject to reporting requirements beginning with the 214 plan year.. If an Applicable Large Employer maintains a fiscal year health insurance plan (rather than a calendar-year plan), as of December 27, 212, the company would not be charged a fee for not offering qualified or affordable coverage until the first day of the fiscal year of that plan in Whether an employer is subject to the ESR provisions is based upon the number of employees employed during the previous calendar year. Applicable Large Employers should track employee hours of service in 213 to determine the number of FTE and full-time employees they have in preparation for offering health coverage in

4 Notes:. The fees in these examples are annualized and assume no change in employment Employer Shared Responsibility Provisions Steps and Examples to Determine Assessable Fees Step 1: Full-Time Equivalent (FTE) Test: Does business qualify as an Applicable Large Employer with 5 or more FTEs? Step 2: Full-Time Employee Test: Does employer have 3 or more full-time employees? Step 3: Premium Subsidy Test: Has one or more of full-time employees received a premium subsidy from a government health insurance marketplace? Step 4: Minimum Essential Coverage (MEC) Offer Test: Does employer offer MEC to all but five percent or to all but five of full-time employees and their dependents, whichever is greater? Step 5: Minimum Value Test: Does the employer-sponsored plan have an actuarial value that covers at least 6 percent of the cost of medical expenses? Step 6: Affordability Test: Is the employer-sponsored plan deemed affordable based on the approved Safe Harbor methods? Step 7: Non-Covered Employee Test: When the employer offers MEC to the required number of full-time employees, has one of the full-time employees who is not offered coverage received a premium subsidy from a marketplace? structure throughout the year, except as noted in Example 4.. Although no fees will be assessed to employers who have fewer than 3 full-time employees, employers must still calculate FTEs for reporting purposes. Example 1: Bonnie s Day Care. Bonnie s Day Care employs: 2 full-time employees working at least 13 hours per month 6 part-time employees working 6 hours per month Bonnie s Day Care does not offer MEC to any employees.. 1 full-time employees receive a premium subsidy through a marketplace. 2

5 Step 1 FTE Test (6 part-time employees x 6 hours per month/12) + 2 full-time employees = 23 FTEs. Bonnie s Day Care does not qualify as an Applicable Large Employer since the company falls below the threshold of 5 or more FTEs. Result: With fewer than 5 FTEs, Bonnie s Day Care is not subject to the Employer Shared Responsibility requirement for this year. Even though some employees have received a premium subsidy, the employer may not be assessed a fee. Example 2: Cool Café. Cool Café is a non-seasonal business that does not offer MEC to employees.. Cool Café employs: 18 full-time employees working at least 3 hours per week and 13 hours per month 6 part-time employees working fewer than 3 hours per week and an average of 8 hours per month.. Five full-time employees receive a premium subsidy through a marketplace. Step 1: FTE Test (6 part-time employees x 8 hours per month/12) + 18 full-time employees = 58 FTEs. Cool Café qualifies as an Applicable Large Employer with more than 5 FTEs. Go on to Step 2. Step 2: Full-Time Employee Test Cool Café has 18 full-time employees. Result: Since Cool Café has fewer than 3 full-time employees, the business is not subject to any Employer Shared Responsibility fees for this period. Example 3: Widget Manufacturing Company. Widget employs 6 full-time employees and no part-time employees.. Seven of the employees receive a premium subsidy from a marketplace. 3

6 SCENARIO A. Widget does not offer MEC to any full-time employees. Step 1: FTE Test With 6 full-time employees, Widget has more than 5 FTEs, so is an Applicable Large Employer. Go on to Step 2. Step 2: Full-Time Employee Test Widget has more than 3 full-time employees. Go on to Step 3. Step 3: Premium Subsidy Test Widget has seven employees who have received a premium subsidy. Go on to Step 4. Step 4: MEC Offer Test Widget does not offer MEC to any full-time employees.. The assessable fee will be $2, per full-time employee above the first 3. (6 3) x $2, = $6, Result: $6, assessable fee for not offering MEC. Note: Widget does not need to continue to Steps 5 through 7. These steps apply only to employers who offer MEC. SCENARIO B. Widget offers MEC to 55 of the 6 full-time employees and their dependents, but the plan does not provide minimum value (see Minimum Value definition). Step 1: FTE Test See Scenario A. Go on to Step 2. Step 2: Full-Time Employee Test See Scenario A. Go on to Step 3. Step 3: Premium Subsidy Test See Scenario A. Go on to Step 4. 4

7 Step 4: MEC Offer Test Widget offers MEC to 55 of 6 full-time employees and dependents, or all but five of full-time employees and dependents. As five percent of 6 full-time employees are equal to three employees, Widget may offer to all but five employees and still comply with the MEC required-coverage level (See Minimum Essential Coverage definition). Widget passes the MEC Offer test. Go on to Step 5. Step 5: Minimum Value Test. The Widget plan does not provide health insurance at the minimum value.. Widget will be charged a fee of $3, for each of the seven full-time employees who received a premium subsidy: $3, x 7 = $21,. The fee cannot exceed the $6, that would have been assessed for not offering coverage at all. Result: $21, assessable fee Note: Widget does not need to go through steps 6 and 7 since the business failed the minimum value test. Failing this test affects all covered employees, and the employer must pay the fee for all the full-time employees who receive a premium subsidy. SCENARIO C. Widget offers MEC to 55 of 6 full-time employees and their dependents at the minimum value.. The coverage is deemed unaffordable (see Affordable Coverage definition) for five of the seven full-time employees who have received a premium subsidy from a marketplace. Step 1: FTE Test See Scenario A. Go on to Step 2. Step 2: Full-Time Employee Test See Scenario A. Go on to Step 3. Step 3: Premium Subsidy Test See Scenario A. Go on to Step 4. 5

8 Step 4: MEC Offer Test See Scenario B. Go on to Step 5. Step 5: Minimum Value Test Pass. Go on to Step 6. Step 6: Affordability Test. Coverage is deemed unaffordable for five of the seven employees who have received a premium subsidy. Widget will be charged a fee of $3, for each full-time employee receiving a subsidy whose coverage is deemed unaffordable. $3, x 5 employees = $15, This is less than the assessable fee for not offering MEC ($6, see Scenario A); therefore, the fee is $15,. Go on to Step 7. Step 7: Non-Covered Employee Test Widget reviewed the employees who received subsidies and determined that this group did not include any non-covered full-time employees. Widget will not be charged a fee for non-covered employees. Result: Widget will be charged a fee totaling $15, for the full-time employees who received subsidies for unaffordable coverage. 6

9 SCENARIO D. Widget offers MEC at the minimum value to 55 of the 6 full-time employees and their dependents.. Coverage is not deemed affordable for five of the seven employees who receive a premium subsidy from a marketplace.. Two of the five non-covered full-time employees receive a premium subsidy from a marketplace. Step 1: FTE Test See Scenario A. Go on to Step 2. Step 2: Full-Time Employee Test See Scenario A. Go on to Step 3. Step 3: Premium Subsidy Test See Scenario A. Go on to Step 4. Step 4: MEC Offer Test Pass. Go on to Step 5. Step 5: Minimum Value Test Pass. Go on to Step 6. Step 6: Affordability Test See Scenario C. Subtotal fee for unaffordable coverage $3, x 5 = $15,. Go on to Step 7. Step 7: Non-Covered Employee Test Widget will be charged a fee of $3, for each full-time non-covered employee who receives a premium subsidy. Subtotal assessable fee for non-covered employees: $3, x 2 = $6, 7

10 Result: The total assessable fee for unaffordable coverage and for non-covered employees receiving subsidy is $21,. $15, + $6, = $21, Note: The total fee cannot exceed the $6, that would have been charged for not offering coverage at all. Example 4: Best Boat Rentals Best Boat is a seasonal business in a resort area. Best Boat employs 22 full-time employees each month (January - December).. The part-time workforce and number of FTEs is broken down as follows: MONTH January Non-Seasonal Part-Time EE Roster per Month HOURS 1,28 FTE Calculation FTEs 1.7 HOURS Seasonal Hours FTE Calculation FTEs Subtotal FTEs (Part-Time Employees) 1.7 Total FTEs (Part-Time & Full-Time) 32.7 February March 1, April 2, May 2, June 2, , July 3, , August 3, , September 3, 25. 2, October 2, November 1, December 2, Total

11 Step 1: FTE Test 29 average monthly FTEs based on part-time workers (348.9 FTEs/12 = 29.1) + 22 full-time employees = 51 total FTEs (including seasonal workers) Best Boat would appear to be an Applicable Large Employer with 51 FTEs; however, Best Boat exceeds 5 FTEs for no more than four calendar months (June, July, August, and September) due to its seasonal employees. Since Best Boat exceeds 5 FTEs during only four months, the business can exclude seasonal employees from its FTE calculation. When removing the seasonal employees from the calculation, non-seasonal part-time FTEs remain, for a total of 41 FTEs 19 FTE employees based on part-time non-seasonal workers (229.8 FTEs/12) + 22 full-time employees = 41 FTEs Result: Best Boat is not considered an Applicable Large Employer since it has fewer than 5 FTEs and is not subject to the Employer Shared Responsibility provisions for this year. Example 5: Essential Enterprises A Controlled Group Essential Enterprises owns and controls three different businesses with a total of 18 full-time employees. 1. Fabulous Flooring employs 3 full-time employees and 24 part-time employees working 1,92 hours per month for a total of 46 FTEs. 3 + (1,92/12) = 46 FTEs 2. Simply Signs employs 6 full-time employees and 9 part-time workers with a total of 84 hours per month for a total of 67 FTEs. 6 + (84/12) = 67 FTEs 3. Fran s Fabrics employs 9 full-time employees and 34 part-time employees working 2,88 hours per month for a total of 114 FTE employees. 9 + (2,88/12) = 114 FTEs 9

12 Step 1: FTE Test. Determine if Controlled Group qualifies as an Applicable Large Employer. Essential Enterprises has 227 FTEs ( = 227). Essential Enterprises is considered an Applicable Large Employer with greater than 5 FTEs. Go on to Step 2. Step 2: Full-Time Employee Test Essential Enterprises has a combined total of 18 full-time employees = 18 Essential Enterprises has a combined total of more than 3 full-time employees. Go on to Steps 3 through 7 to determine if fees are assessable for each member business. Business 1 Fabulous Flooring offers affordable MEC to all full-time employees at minimum value. One of the full-time employees receives a premium subsidy. Step 3: Premium Subsidy Test One full-time employee has received a premium subsidy. Go on to Step 4. Step 4: MEC Offer Test Fabulous Flooring offers MEC to all full-time employees and dependents. Go on to Step 5. Step 5: Minimum Value Test The Fabulous Flooring plan meets the minimum value requirements. Go on to Step 6. Step 6: Affordability Test The coverage offered to the employee who received a subsidy is deemed affordable. Go on to Step 7. Step 7: Non-Covered Employee Test All full-time employees are offered MEC coverage by the employer. Fabulous Flooring passes the Non-Covered-Employee Test. Result: Fabulous Flooring passes all the tests and will not be assessed any Employer Shared Responsibility fees for this period. 1

13 Business 2 Simply Signs offers MEC to all full-time employees at a minimum value, but coverage is deemed unaffordable for some employees. 1 full-time employees receive a premium subsidy. Step 3: Premium Subsidy Test 1 full-time employees have received a premium subsidy. Go on to Step 4. Step 4: MEC Offer Test Simply Signs offers MEC to all full-time employees and dependents. Go on to Step 5. Step 5: Minimum Value Test The Simply Signs plan meets the minimum value requirements. Go on to Step 6. Step 6: Affordability Test The employer has determined that coverage is deemed unaffordable to eight of the ten full-time employees who have received a premium subsidy. Note: The employer is only assessed a fee for unaffordability based on the Safe Harbor methods provided, even if other employees receive a premium subsidy from a marketplace. The fee is calculated as $3, multiplied by the number of full-time employees receiving a subsidy whose coverage is deemed unaffordable. $3, x 8 = $24, fee Go on to Step 7. Step 7: Non-Covered Employee Test All the full-time employees are offered MEC. Simply Signs passes the Non-Covered Employee Test. Result: Simply Signs will be assessed a total fee of $24, based on unaffordable coverage. 11

14 Business 3 Fran s Fabrics does not offer MEC to any employees. One full-time employee receives a premium subsidy from a marketplace. Step 3: Premium Subsidy Test One full-time employee has received a premium subsidy. Go on to Step 4. Step 4: MEC Offer Test Since Fran s Fabrics does not offer MEC to any employees, the business may be assessed a fee. For a company that is not a Controlled Group, the fee would be $2, per full-time employee above the first 3 full-time employees. For Controlled Groups, the fee is based on the percentage of full-time employees an individual entity has within the Controlled Group. Fran s Fabrics has 9 full-time employees, or one half of Essential Enterprises total full- time employees (18). Fran s Fabrics subtracts one half of the 3 full-time employees Essential Enterprises can deduct before being charged a fee from its number of full-time employees. One half of 3 = = 75 Result: Fran s Fabrics will be assessed $2, per full-time employee minus the first 15 full-time employees for a total of $15,. $2, x (9 15) = $15, assessable fee to Fran s Fabrics Example 6: Bob s Baked Goods Bob s Baked Goods has 15 full-time employees and does not offer MEC to any employees. Two employees have received a premium subsidy from a marketplace. In its current form, Bob s Baked Goods is considered an Applicable Large Employer and may be charged a fee of $15, for not offering MEC. (15 full-time employees 3) x $2, = $15, 12

15 The owner is planning to split his business into three separate entities, with 35 employees each and three different federal employer identification numbers. He does not know if he would still be considered an Applicable Large Employer under the new arrangement since each individual company would have fewer than 5 FTEs. Doing research, he finds that his three companies are considered a Controlled Group under IRS Code Section 414. Step 1: FTE Test Determine if the Controlled Group qualifies as an Applicable Large Employer: Bob s Baked Goods has 15 FTEs ( = 15). Bob s Baked Goods is considered an Applicable Large Employer with greater than 5 FTEs. Go on to Step 2. Step 2: Full-Time Employee Test Bob s Baked Goods has a combined total of 15 full-time employees = 15 Bob s Baked Goods has a combined total of more than 3 full-time employees. Result: For the purposes of fee assessment, each business is looked upon as a stand-alone entity. Each company may be assessed a fee of up to $5,. (35 full-time employees 1) x $2, = $5, The owner may have to pay up to $15, for all three businesses. See Example 5 for details on how fees are calculated for a Controlled Group. The fee assessed for each member company could vary depending on how each individual member company complies with the Employer Shared Responsibility provisions and whether any employee receives a premium subsidy. 13

16 Employer Shared Responsibility Safe Harbor Tests Paychex Client 2. For each full-time employee, does employer offer minimum essential coverage?* Fewer than 1. 5 FTEs FTE Test 5 or more FTEs NO Employer Shared Responsibility does not apply Employer fails test If one or more full-time employees enrolls in a government marketplace and receives a government subsidy (premium credit) *Minimum essential coverage must be offered to all but five percent of full-time employees and their dependents or to all but five full-time employees and their dependents, whichever is greater. Employer penalty is $2, per full-time employee after the first 3 full-time employees 14

17 YES Does coverage provide minimum actuarial value? YES For each full-time employee, does coverage meet at least one of the affordability requirements? Annual employee contribution for lowest cost single plan 9.5% of annual wages in W-2 Box 1? Monthly employee contribution for lowest cost single plan 9.5% of monthly wages (hourly rate x 13 hours)? Annual employee contribution for lowest cost single plan 9.5% of FPL for a single individual? NO Employer fails test NO If one or more full-time employees who are not offered minimum essential coverage purchases insurance through a government marketplace and receives a government subsidy (premium credit) If one or more full-time employees enrolls in a government marketplace and receives a government subsidy (premium credit) YES Employer in Safe Harbor Employer penalty is the lesser of $3, for each affected full- time employee OR $2, per full-time employee after the first 3 full-time employees 17

18 Employer Shared Responsibility Provisions Key Terms and Definitions AFFORDABLE COVERAGE APPLICABLE LARGE EMPLOYER. An employee s required contribution for self-only coverage to the lowest cost plan that offers minimum essential coverage (MEC) cannot exceed 9.5 percent of their modified adjusted gross household income. Employers may not be able to determine an employee s gross household income. However, they may use one of three affordability safe harbor methods to assist them in determining whether the coverage they are providing is deemed affordable: a) Form W-2 Safe Harbor: Use employee s Form W-2 wages shown in Box 1. b) Rate of Pay Safe Harbor: Multiply an employee s hourly rate by 13 to determine monthly wages or use a salaried employee s monthly pay. Note: This method may only be used if the employer did not reduce the employee s rate of pay during the year. c) Federal Poverty Line Safe Harbor: Use the federal poverty line for a single individual. A business entity that employs 5 or more full-time equivalent employees (FTEs).. All member entities within a Controlled Group under Code Section 414(b), (c), (m), and (o) are taken into account when determining if an employer is an Applicable Large Employer.. Each member entity within a Controlled Group will be looked at separately when determining fees that may apply. Fees will be charged only to the member entities within the Controlled Group that do not meet the requirements. DEPENDENT. A child of an employee who has not yet attained age 26. This does not include the spouse of an employee. FEES. There are two types of fees for Applicable Large Employers for not complying with the ESR provisions, depending on whether the employers do or do not meet the minimum essential coverage (MEC) offer test: - When an employer does not meet the MEC offer test and at least one full-time employee receives a premium subsidy through a federal or state government health insurance marketplace, the annualized fee will be:. The number of full-time employees minus 3 x $2,. - When an employer does meet the MEC offer test, but 1) does not offer coverage that meets the minimum value, 2) does not offer affordable coverage to at least one full-time employee, or 3) there is at least one full-time employee who is not offered coverage and who obtains a subsidy through a marketplace, the annualized fee will be: 16

19 FEES CONTINUED. $3, for each applicable full-time employee (see above conditions) who receives a premium subsidy through a marketplace. Note: The fee cannot exceed the payment for not having offered health insurance (number of full-time employees minus 3 x $2,).. When a full-time employee receives a premium subsidy from a marketplace, the employer may not necessarily be subject to a fee if the employer-sponsored coverage is considered to offer MEC, meets the minimum value test, and is deemed affordable using one of the Safe Harbor methods provided. Under these circumstances, the employer would only be charged a fee for any full-time employees who are not offered MEC and who receive a premium subsidy.. Applicable Large Employers who do not offer dependent coverage, but take reasonable steps to do so in 214 will not be assessed a fee for the 214 plan year. There will be no exceptions for Applicable Large Employers in No fees will be charged to Applicable Large Employers who have fewer than 3 full-time employees.. The determination of Applicable Large Employer is made on a Controlled Group basis; the liability calculation is made on a member-company-by-member-company basis. The 3-employee reduction when determining the liability for non-coverage, however, must be allocated pro rata among the members of the Controlled Group. This is based upon the number of full-time employees employed by each member (if a member s allocation is less than one, but more than zero, round up to one fulltime employee). The following equations use Example 5, Essential Enterprises, to illustrate: - Total full-time employees member company/total full-time employees Controlled Group = Percent of full-time employees 9/18 = 5% - Percent of full-time employees x 3 = Number of employees to deduct before paying fee 5% x 3 = 15 - (Number of full-time employees Number of employees to deduct) x $2, = Assessable fee (9 15) x $2, = $15, total assessable fee FULL-TIME EMPLOYEE. An employed person who averages 3 or more hours of service per week or 13 hours per month. This definition of employee is based on the commonlaw standard. It does not include individuals such as a leased employee, a sole proprietor, a partner in a partnership, or a two-percent S-Corp shareholder. 17

20 Employer Shared Responsibility Provisions Key Terms and Definitions FULL-TIME EQUIVALENT EMPLOYEE (FTE) HOURS OF SERVICE CALCULATION HOUSEHOLD INCOME REPORTING. The number of full-time equivalent employees is determined by adding the number of full-time employees plus total hours worked by part-time employees in a given month (this number is capped at 12 for each employee), divided by 12: - Total number of full-time employees + (Total hours per month of part-time employees/12) = total FTEs. The following methods are used to calculate hours of service for hourly and non-hourly employees: a) Hourly employees - Use actual hours of service from records of hours worked and hours for which payment is made or due. b) Non-hourly employees - Use one of the following methods: i. Actual hours of service from records of hours worked and hours for which payment is made or due. ii. Days-worked equivalency - The employee is credited with eight hours of service for each day in which the employer would be required to be credited with at least one hour of service. iii. Weeks-worked equivalency - The employee is credited with 4 hours of service for each week in which the employer would be required to be credited with at least one hour of service.. The employer is not required to use the same method for all non-hourly employees and may apply different methods for different classifications of nonhourly employees as long as the classifications are reasonable and consistent.. The equivalency methods are not permitted to be used if they would substantially understate an employee s hours of service.. Hours of service generally do not include hours of service worked outside the United States. Employees working overseas generally will not have hours of service and will not qualify as full-time employees. However, all hours of service for which an individual receives U.S. source income are counted as hours of service for these provisions.. As the employer has no way of knowing the total family income of the employee, the IRS has provided additional affordability safe harbor methods to determine affordability (see Affordable Coverage). However, the IRS is still requiring the employee to use household income when determining eligibility if a subsidy is requested. When the employee s taxes are filed, the cost of insurance compared to income will be determined. 18

21 HOUSEHOLD INCOME REPORTING CONTINUED MINIMUM ESSENTIAL COVERAGE MINIMUM VALUE PART-TIME EMPLOYEE SEASONAL EMPLOYEE EXCEPTION. The IRS will use a modified adjusted gross income (MAGI) when determining if a household is eligible for a subsidy. This includes both spouses wages and the wages of any eligible dependent, even though they may file separately.. Health insurance coverage that meets the minimum benefits standard of the small- or large-group market within the state is considered to offer minimum essential coverage (MEC). This includes most broad-based medical coverage typically provided by employers. It would not include certain specific coverage, such as accident or disability income, stand-alone dental or vision coverage, or workers compensation insurance.. To avoid a potential fee, an employer must provide MEC to all but five percent of full-time employees and their dependents or to all but five full-time employees and their dependents, whichever is greater. The employers that meet this standard would be considered to have met the MEC offer test which subjects them to a different fee structure. See Fees section for the assessable fees.. A health insurance plan that has an actuarial value that covering at least 6 percent of the cost of medical expenses is considered to provide minimum value.. An employed person who averages fewer than 3 hours of service per week or 13 hours per month.. If an employer s workforce exceeds 5 FTEs for 12 or fewer days (four months) during a calendar year, and the employees in excess of 5 during that period are seasonal workers, the employer would not be considered an Applicable Large Employer. The four months/12 days need not be consecutive. Seasonal employees are not limited to agricultural or retail workers. 19

22 What Employers Need to Do Your clients can start to prepare for Employer Shared Responsibility provisions. In 213, they should track monthly hours to determine if their business will qualify as an applicable large employer and, if so, which employees will qualify for health-insurance coverage in Time for which an employee is paid, or entitled to payment, for the performance of duties for the employer.. Time that is paid, but for which the employee may not work, such as paid vacation time, sick time, disability, jury duty, military duty, and leaves of absence. An employee s hours of service include: Your clients must use the actual hours of service for hourly employees. They can use one of three different methods to calculate hours of service for non-hourly (salaried) employees: 1. Counting actual hours of service from records of hours worked and hours for which payment is made or due (as noted above). 2. Using a days-worked equivalency method, they would credit the employee with eight hours of service for each day of service. 3. Using a weeks-worked equivalency method, they would credit the employee with at least 4 hours of service for each week of service. Your clients cannot use the days-worked or weeks-worked equivalency method if it would substantially understate an employee s hours of service and cause a full-time employee to be classified as a part-time employee. Your clients are not required to use the same method for all non-hourly employees and may apply different methods for different classifications of non-hourly employees as long as the classifications are reasonable and consistent. Note: The IRS and Department of Health and Human Services (HHS) have not yet issued final requirements for how hours will be reported. Your clients can also: Review the type of plan they re offering.. Determine if they offer coverage to all their full-time employees.. Calculate what 9.5% of their lowest paid full-time employee s salary is and whether that matches or exceeds the employee contribution for their plan.. Talk to their insurance carrier about: - The actuarial value of their health plan. - Using the tool available on the HHS Health-Care Reform site (www.healthcare.gov) to calculate actuarial value. - Whether their plan meets the MEC standard. 2

23 How Paychex Insurance Agency Can Help Paychex Insurance Agency is uniquely positioned to help with Employer Shared Responsibility because we coordinate with the payroll services offered through our parent company, Paychex, Inc., and have access to employee hours, salary, and health-insurance information, including:. Monthly reports of employee hours.. Data for calculation of number of full-time employees and full-time equivalents.. Data to assess actuarial value and determine minimum essential coverage. Our experienced insurance professionals can help guide employers through available plan options to find solution for any business. With access to legislative and regulatory specialists in Washington, D.C., and expert, in-house sources of legal and compliance guidance, Paychex Insurance Agency is a key source for help on Employer Shared Responsibility and many other Health-Care Reform provisions. Whether you re looking for help with Health-Care Reform or for another category of insurance, Paychex Insurance Agency offers flexible, scalable solutions for businesses. To learn more, call or visit us on the Web at 21

24 Paychex Insurance Agency, Inc., 15 Sawgrass Drive, Rochester, NY California license #C /13 UPP

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