PENALTIES, MANDATES & REPORTING REQUIREMENTS UNDER THE ACA

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1 Sub-nomenclature MARCH 2014 EMPLOYEE BENEFITS STRATEGY FOR 2015 PENALTIES, MANDATES & REPORTING REQUIREMENTS UNDER THE ACA CONTENT: 2 PLAY OR PAY 3 MOVING THE GOALPOSTS 3 DETERMINING ELIGIBILE EMPLOYEES 4 ADDITIONAL STEPS

2 EMPLOYEE BENEFITS STRATEGY FOR 2015 AS REFORMS TAKE EFFECT, NOW IS THE TIME TO PLAN Planning a health benefit strategy for the next few years is a daunting task: employers say they are being overwhelmed by requirements of Affordable Care Act (ACA) and the ongoing changes to deadlines and regulations. Even as some mandates are delayed, others remain on track, and changes to definitions and reporting requirements add to the confusion. Employers need to plan now for the reshaped health benefits landscape that businesses will see in the next few years. Under these rules, to avoid the pay side of the equation, employers must play. In our first look at planning for 2015 (see Employee Benefits Strategy for 2015: Understanding Play Design Options Under the ACA), we discussed the various models of health plans available to employers and how the health care reform law has affected them. This article will dig deeper into the health reform changes by looking at things such as play-or-pay penalties, how to count eligible employees, and IRS reporting requirements. Some of these elements will require more work than others, but all are important to consider as health care reform rolls on. PLAY OR PAY Few aspects of the ACA have generated more discussion among employers than the play-orpay rules that are part of the reform law s employer mandate. With this rule, known officially as Employer Shared Responsibility, companies who do not offer health insurance to workers can be subject to penalties. Play or Pay penalties can be assessed for either not offering health insurance or not offering coverage deemed affordable and adequate under the law. Under these rules, to avoid the pay side of the equation, employers must play. This means offering coverage to full-time staff (defined as those who work 30+ hours per week), with coverage meeting minimum value requirements, and being deemed affordable. When fully implemented, penalties in this area are broken into two parts: First, if a company does not offer an insurance plan and one of its employees goes to an ACA exchange and qualifies for a subsidy, the company is penalized $2,000 for every fulltime employee in the company, minus the first 30 employees. Second, companies that provide coverage that does not meet affordability or minimumvalue (i.e., doesn t cover enough medical conditions) thresholds will be charged $3,000 for every full-time employee who turns to an ACA exchange for coverage and is subsidized. 2

3 PENALTIES, MANDATES & REPORTING REQUIREMENTS UNDER THE ACA The complexity of these arrangements is a great illustration of the amount of detail employers must now be aware of when planning their health benefit strategy. Which employees would be eligible for subsidies, if a company chooses not to provide coverage? Who is considered a full-time employee? What about contract, seasonal, or short-term workers? All of these questions could affect how much an employer pays in tax penalties, and could obviously factor into an employer s decision on who will be covered under the company plan. These are things that need to be evaluated and discussed with qualified professionals who understand the law as well as the employer s current position and long-term goals.. MOVING THE GOALPOSTS With the various glitches and problems that the ACA rollout has seen, federal regulators have been changing the rules on the fly. The employer mandate for companies with between 50 and 99 employees, requiring them to offer coverage, was recently changed. Instead of going into effect for 2015, regulators have pushed that deadline back to Also for 2015, employers with 100 or more workers will be required to offer coverage to 70 percent of fulltime employees, rather than 95 percent as originally required. The 95-percent-coverage threshold will go into effect on Jan. 1, (On the other hand, the requirement for employer-sponsored health plans to be affordable and meet minimum value thresholds, and the $3,000 penalty for not doing so, remains applicable in 2015.). DETERMINING ELIGIBLE EMPLOYEES Employers should already be tracking their employees work status to make sure they can accurately report which workers are eligible for health insurance in Things to keep in mind include the fact that the ACA define full time as working 30 hours or more a week. Also, employers should be aware of the special rules for seasonal workers, contract workers and new hires. With the various glitches and problems that the ACA rollout has seen, federal regulators have been changing the rules on the fly. While many mandates and requirements of the ACA have been pushed back to 2016, the requirement for employer-sponsored health plans to meet affordable and adequate remain in effect for Despite some high-profile cases of employers dropping part-time employees from coverage because of the ACA, it s unlikely that most employers will significantly change their approach to covering part-time employees. However, the ACA redefinition of full time could cause problems. Keeping track of who meets this threshold will be a new challenge for employers. To help employers with this, regulators are allowing some flexibility in classifying employees, but again, a thorough knowledge of the law is helpful. Most surveys show employers are not re-classifying workers (from full-time to part-time, for example) in significant numbers. And it s important to remember that the ACA regulations discourage employers from reducing hours of workers just to escape the Employer Shared Responsibility requirements. The ACA includes special rules for seasonal and contract workers as well as new hires when tracking employee work status. Marsh & McLennan Agency 3

4 EMPLOYEE BENEFITS STRATEGY FOR 2015 No one knows what the future holds, of course, but planning with a trusted expert who can provide a bigpicture analysis of benefit design is still the safest bet. In general, different industries have different labor needs, and different approaches to the mix of full-time and part-time workers. There are tools available to employers to help them find the best balance, and health benefits are just one factor in that equation. A more interesting question will be the coverage of contract workers. Although companies who employ a significant number of contract or temporary workers might think the staffing company providing the labor is responsible for insurance coverage, under common law rule the employer who directs workers on a daily basis is considered the responsible employer, with other factors in play. In general, this is something that an employer should clarify upfront before bringing contract or temporary workers onsite.. ADDITIONAL STEPS Besides the play-or-pay penalties, employers who do not comply with the ACA rules could find themselves paying $100 per day, per participant. So the time is now to take action as you prepare your health plan strategy for Your to-do list should include: Determine if your company will be a 1-49, 50-99, or 100+ FTE employer, under the ACA definitions. This will allow you to see which mandates you will be subject to. Tools such as employee calculators are available to help with this task. Run a play-or-pay analysis. MMA s Health Care Reform Modeling Tool is available to help employers evaluate various plan change scenarios based on decisions the employer can make, and provides cost/savings implications. Key To-Dos: Understand your employee count Model your Play-or-Pay options Classify EEs accurately Update health plan documents Find access to information and updates Classify employees appropriately (i.e., determine if they are contract workers, seasonal help, etc.). Employers should then set up a tracking system if they have seasonal/variable hour employees. Update health plan documents, so employees understand the changes being brought about by the ACA. While employers will have to deal with the added complexity in figuring their health care costs, the recent changes do give companies more flexibility and breathing room as they prepare for the future. Although some companies may see the extension of ACA deadlines as an opportunity to take a wait-and-see approach to complying with health reform rules, there is little reason to expect the deadlines to be extended forever. No one knows what the future holds, of course, but planning with a trusted expert who can provide a big-picture analysis of benefit design is still the safest bet. At the same time, employers should keep an eye on insurance premium rates as they are announced for With enrollment in ACA exchanges coming in below projections so far, insurance carriers may adjust premiums higher to cover the difference. As employers structure their benefit plans with an eye to these potentially higher costs, they will need a wide variety of tools to help analyze a group s ACA risk, and a reliable knowledge base to help design creative, flexible solutions to mitigate the ever-changing benefit world. 4

5 PENALTIES, MANDATES & REPORTING REQUIREMENTS UNDER THE ACA In addition, with MMA as your partner, you benefit from timely compliance updates, articles, and seminars. Don t hesitate to ask for help from any of our qualified and experienced professionals as you seek to comply with ACA changes. NOTES Marsh & McLennan Agency 5

6 For further information, please contact your local Marsh & McLennan Agency office or visit our website at MARSH & MCLENNAN AGENCY 2725 S. Moorland Rd. New Berlin, WI Fax Evergreen Dr., Suite 100 Appleton, WI Fax For informational purposes only. Copyright 2014 Marsh & McLennan Agency LLC. All rights reserved.

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