Health Reform Updates: Planning for 2013/2014 Compliance Discussion with Colorado AHU June 4, 2013

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1 Health Reform Updates: Planning for 2013/2014 Compliance Discussion with Colorado AHU June 4, 2013 Shelly Winson for Benefits Compliance Link Team Karli Dunkelberger VP Business Development Caitlin Gadel, Benefits Consultant Benefits Compliance Link 2013

2 Agenda What is the value of the right team? Why is compliance more important than ever? What Does Benecomplink Do? Compliance Partner We can train you We can help you Impact Analysis of Employer Mandate 2013 To Do List 2014 To Do List Common Questions Stories Experience Important/Timely Health Reform Topics DISCLAIMER: Today s discussion does not represent legal 2 or tax advice. Benefits Compliance Link 2013

3 The I.R.S. The D.O.L. Health and Human Services Office of Civil Rights Can You Survive An Audit From: Important Note PPACA includes budget dollars to hire additional I.R.S. employees 3

4 Benecomplink Compliance Partner Karli Dunkelberger Introduction A.Please register to receive our periodic 30-second compliance updates B. C.Free calculators for PPACA D.Articles on PPACA requirements E.Impact Analysis/Employer Mandate F.Compliance is our core business G.Indemnify We Indemnify our work Our Work H. Benefits Compliance Link

5 Benecomplink Compliance Partner Shelly K Winson, CBC, REBC, RHU Introduction NAHU 20 Years Certified PPACA Professional Educational Presentation Experience CDHP: HSA, HRA, FSA COBRA, HIPAA, FMLA, ADA True Choice Benefits LLC Chandler, Arizona Benefits Compliance Link

6 Nondiscrimination Testing - $399 Section 105(h) Section 129 Section 79 Comprehensive Section 125 Plan Document Packages - $399 SBCs - $99 POP - $149 Wrap Section 105 Section 125 What Does Benecomplink Do? Benefits Consulting - $399/90 min Seminars - Webinars fees vary 6

7 Do You have the right team to be in compliance? Payroll Partner Insurance Broker CPA Compliance Partner You could be doing the right things and still pay more for penalties Having the Right Team of Resources The right team could minimize Risk and improve the value of dollars spent on health insurance and other benefits 7

8 1. Are you a large employer or a small employer based on PPACA? 2. Decide which Lookback/safe harbor to use -- SOON 3. Determine length of Measurement Periods for 2014 Plan Year-- SOON 4. Decide what you will do with your variable employees - SOON 5. Employer Reporting: 250+ W-2s Jan 2014 plus add l reporting 6. Controlled Groups/Common Ownership 7. SBC communication process 8. SBC for FSA? 2013/2014 Health Reform Compliance Checklist 9. Employer Requirement to Inform Employees of Exchange (delayed to Fall 2013) 10. Plan Document Requirements any updates needed? 11. Nondiscrimination Testing 2010/fully-insured delayed 12. Nondiscrimination Testing FSA, HRA, other self-funded plans, and Life Ins DISCLAIMER: Today s discussion does not represent legal or tax advice. 8 Benefits Compliance Link 2013

9 Compliance Considerations Why important 1) Offer Health Insurance to ALL employees working 30+ hours/week If miss more than 5% of FT employees employer could face same penalty as if NO health insurance (PPACA) 2) Minimum Essential Coverage, Minimum Value 60% - Bronze Level, 9.5% affordability If health insurance does NOT meet all 3, employer can be penalized $3,000/employee that goes to Exchange and receives premium subsidy, up to max of $2,000 x FT ees 30 FTs (PPACA) 3) Timely consistent communication of SBC (all size employers) $1,000/eligible employee (PPACA) 4) Annual nondiscrimination testing (all size employers) Employer could lose tax deduction of entire Plan and need to issue updated W-2s to impacted highly compensated employees who will lose their tax deduction (ERISA) 5) Current Plan Document Package (all size employers) Employer could lose tax deduction of benefits (ERISA) Minimize Risk with the Right Team 6) COBRA Administration (20 or more employees, in general) $100/day/notice for single and $200/day per notice for family from IRS and up to $110/day per notice from DOL + legal and/or court costs (COBRA, OBRA, PPACA) Benefits Compliance Link 2013

10 Tax Implications of the Individual Mandate Who Will Be Impacted By The Individual Mandate? 1. Individuals and their dependents who do not have health insurance that meets the definition of minimum essential coverage 2. Bronze Plan for Minimum Essential Coverage FREE Calculator Benefits Compliance Link 2013

11 Tax Implications of the Individual Mandate How Much Is the Flat Tax? A. $ B. $ C. $ D cost of living revision E. All of the above Benefits Compliance Link 2013

12 Tax Implications of the Individual Mandate Is the Flat Tax owed on Dependents? A. Yes B. No Benefits Compliance Link 2013

13 Tax Implications of the Individual Mandate How Does Income Impact Tax Rate? A. PPACA establishes a minimum income that triggers requirement to file Federal tax return B. Tax Filing threshold examples A. Single under 65/$9,750 B. Married file jointly under 65/$19,500 C. A Maximum Penalty is defined Bronze Level Benefits Compliance Link 2013

14 Tax Implications of the Individual Mandate Let s Review Some Numbers A B. $95 or $325 or $695 C D. 1% or 2% or 2.5% E. Age 18 F. 3 x Flat Tax Amount G. Tax Penalty is the greater of.. Benefits Compliance Link 2013

15 Tax Penalty/Individual Mandate Single Case Study Example #1: Tax Time for Cassidy Hanson earns wages resulting in $50,000 (MAGI). No children. She does not have Qualified Health Insurance. What is her PPACA tax penalty for not purchasing Health Insurance? 1) $95 2) 1% x $50,000 = $500 3) $4,500 to $5,000 (not firm - Bronze Avg Prem) Benefits Compliance Link 2013

16 Tax Penalty/Individual Mandate Family Case Study Example #1: Tax Time for Tom and Cindy Jones earn wages resulting in $50,000 (MAGI). They file jointly. They have an 8 year old, a 10 year old and a 19 year old. They do not have Qualified Health Insurance? What is their PPACA tax penalty for not purchasing Health Insurance? 1) $95 + $95 + $95 + $ $47.50 = $380 2) 3 x $95 = $285 3) 1% x $50,000 = $500 4) $12,000 to $12,500 (not firm - Bronze Avg Prem)

17 PPACA: Small Employer Tax Credit PPACA Definition of Small Employer Eligible for Tax Credit A. 10 or fewer increasing to 25 or fewer full-time equivalent 40 hours/week B. Average annual wages less than $25,000 increasing to $50,000 C. Contribute to employee s qualified health care coverage a uniform percentage, no less than 50%, of premium cost D. Tax credit is reduced by a percentage for every full-time employee over 10 employees and average income over $25,000 E. - FREE calculator Benefits Compliance Link 2013

18 PPACA: Small Employer Tax Credit When Does a Small Employer Receive the Tax Credit A. Claim the tax credit as part of general business tax credit and use it to offset actual tax liability. B. If no tax liability, may carry tax credit forward or back to offset tax liabilities for other years (may allow refund, if estimated taxes paid) C. When claiming tax credit employer may also deduct insurance expenses on any tax returns minus the amount of the tax credit D. Tax credit may be claimed for up to 20 years ( ) if insurance purchased through EXCHANGE (2014 forward) Benefits Compliance Link 2013

19 PPACA: Small Employer Tax Credit Tax Credit = How Much? (For Profit) A. 35% of employee s annual premiums the employer pays for the years before 2014* ( ) B. 50% 2014 and beyond* NOT-FOR-PROFIT: 25% tax credit, computed same method, actual tax credit will be the lesser of that amount vs. the total amount of the employer s income tax and Medicare tax withholding plus the employer s share of the Medicare tax. *50% of average premium costs for surrounding area. Tax Credit is phased out as additional employees hired, starting with 11 th ee. Also, tax credit decreases as average wage is $25,000+. Benefits Compliance Link 2013

20 Plan Document Package Master Plan Document Summary Plan Description (SPD) Board Resolution/Adoption Agreement Information Form Fully-Insured Ask your insurance carrier for these documents to have on file 20

21 Summary of Benefits and Coverage (SBC) Quiz The SBC is only provided after an employee enrolls. A. False B. True Distribution of SBCs occurs upon application for enrollment for participants, no more than 30 days prior to the election process for the plan anniversary, upon request, and in a few other unique circumstances. Benefits Compliance Link

22 $1,000/failure Failure is defined as each person A shorter, new summary document Summary of Benefits and Coverage (SBC) Intended to help people easily compare one benefit plan to another A four-page, two-sided document with very specific layout and information format is provided by the Dept. of Labor Must be provided to each participant or beneficiary for each benefit package offered that the participant or beneficiary is eligible. HRAs, FSAs*, may require a separate SBC *What if the FSA is an excepted benefit? 22

23 Nondiscrimination Testing The Plans The following plans are subject to section 105(h) testing: Health Flexible Spending Arrangements (FSA s) Self-insured major medical, dental and vision Health Reimbursement Arrangements (HRA s) Applicable benefits provided by Voluntary Employee Benefit Associations (VEBA s) Retirement Medical Savings Accounts (RMSA s) Fully-insured medical and dental* *Testing for fully insured plans is not being enforced yet. The IRS should be issuing more guidance on the matter in the near future.

24 Self-insured Plans: FSA, HRA included Penalty falls on Highly Compensated Employees, must report excess benefits in their taxable income Fully-insured Plans: Penalty falls on employer - excise tax of $100/day/individual discriminated against per day the plan does not comply with 105(h) $100/day/individual civil penalties Cap (on excise tax penalty) of lesser of $500,000 or 10% of previous year s health care costs Penalties Nondiscrimination Testing 24

25 Pay or Play Articles & Calculator on Benecomplink website Employers need the right team to make the best decisions with their health insurance Payroll Partner Insurance Broker CPA Measurement Periods + PPACA Stabilization Periods Compliance Partner 25

26 Play v. Pay The Numbers 50 FTEs (30+ hrs/week) 30 hours/week = full time When do penalties apply? What is the total risk? Who do you, as an Employer, want to offer benefits to, and Why??? The Solutions Offer benefits Manage hours 26

27 Controlled Groups Common ownership It is important to note that a group of employers that are treated as a single employer under I.R.C. Section 414(b), (c), (m), or (o) are also treated as a single employer for the purposes of the Pay or Play provision; thus all employees must be taken into consideration when determining if the employer is a large employer. Click here to learn more. Read Will Employer Pay or Plan Part I 27

28 Play v. Pay Quiz Pay v. Play applies to Large Employers. How does Health Reform (PPACA) define a Large Employer : A. 50 or more full-time employees B. 50 or more full-time equivalent employees C. 30 or more employees D. 50 or more full-time employees Benefits Compliance Link

29 Play v. Pay Premium v. Penalty Penalty consists of: Monthly penalty for employers who do not provide insurance is: (1/12) x $2000 x (number of full-time employees 30) Monthly penalty for employers who provide coverage but it is not considered minimal essential coverage, minimum value and 9.5% affordability is the lesser of: (1/12) x $3,000 x each full-time employee who receives a premium credit, or (1/12) x $2,000 x (number of full-time employees 30) Benefits Compliance Link

30 PPACA: Employee Definitions Seasonal Employees less than 120 days/year* Variable Employees don t know work hours or may flex based on business need Full-time Employees 30+/week** Part-time Employees less than 30/week Disclaimer: Proposed rules, waiting for final determination. These are the rules for plan sponsors to rely on for 2014 *Our opinion based on other regulations **Every hour an employee entitled to payment jury duty, PTO, etc. **Monthly equivalent is 130+ hours/month Benefits Compliance Link

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