Employer s Guide To Health Care Reform

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1 Employer s Guide To Health Care Reform A nonprofit independent licensee of the Blue Cross Blue Shield Association National strength. Local focus. Individual care. SM

2 As part of our commitment to being the trusted advisors you have come to count on for information pertaining to Health Care Reform, we have updated our Resource Guide to include the information you need to stay ahead of changes that impact you and your business. This Resource Guide continues to cover many Frequently Asked Questions (FAQs), including the options you have, information you will need, and questions to consider along the way to ensure you and your company are protected.

3 Table of Contents HCR for Small Group Employers Learn what s new for Small Group Employers in 2015 Page 1 HCR for Large Group Employers Learn about HCR large group employer mandate and what s new in 2015 Page 2 Employer Penalties Page 5 Information about the penalties certain employers face if they do not provide health insurance coverage to employees Reporting and Notifications Page 8 Learn about coverage reporting 6056 for large groups, and 6055 for small groups, including the information reported, and how and when to file reports Future Considerations Page 10 Learn about future changes that will impact your business Background & Common Terms Health Care Reform is now health care - Key components of Page 11 HCR reform such as preventive services and essential health benefits Taxes & Fees - Review the taxes and fees that insurance companies Page 12 and employers may have to pay under Health Care Reform Common Terms - Commonly used words to help you understand Page 13 HCR terminology Health Care Reform Checklist for Small Businesses Page 14 Health Care Reform Checklist for Large Businesses Page 17

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5 2015 HCR for Small Group Employers There are no additional Heath Care Reform regulation changes for Small Group employers in As a reminder, an employer with less than 50 eligible employees is considered a small employer. To verify if you are subject to the Employer Mandate, which requires employers with 50 or more full-time equivalent employees to offer coverage or pay a penalty, calculate the number of full-time equivalent employees as described on page 3. If you have 50 or more full-time equivalent employees based on the calculation, you need to offer affordable, minimum coverage in order to avoid penalties. To help you prepare for upcoming HCR changes, see the 2015 HCR Checklist for Small Group Employers on page 14. Please contact your account consultant for coverage options for those employees who are not eligible for employer coverage. 1

6 2015 HCR Update For Large Group Employers HCR Employer Mandate Health Care Reform s Employer Mandate requires employers with 50 or more full-time equivalent employees to pay a penalty if they don t provide minimum value, affordable health insurance to their full- time employees and dependent children. Under Health Care Reform, full time is defined as an employee who works on average 30 hours or more per week. Those who do not offer coverage must pay a penalty of $2,000 per full-time employee (not including the first 30 employees). If the employer has never offered health insurance to their employees in the past, they will be required to offer insurance or pay the penalty Employees 100+ Employees Penalties apply upon renewal in 2016 Penalties apply upon renewal in 2015 Until 2016, $2,000 per employee if coverage is not offered to at least 70% of full-time employees If an employer of 50 or more full-time equivalent employees does not offer affordable health coverage that provides a minimum level of benefits, they may be subject to a $3,000 penalty for each employee who does not take the employer-sponsored plan and instead applies for coverage on the New York State of Health Exchange and receives financial assistance for purchasing that coverage. Financial assistance is only available if: n Minimum value, affordable coverage is not being offered to them through their employer n They are not qualified for OR currently receiving Medicaid or Medicare, OR n Affordable coverage is not available through their spouse s employer. 2 Employers will not be assessed a penalty if they offer minimum essential coverage to all but 5% or 5 full-time employees, whichever is greater.

7 What 50+ employees means under Health Care Reform The graphic below illustrates how you can calculate the employer s company size. Company Size Calculator Complete the form below to calculate the employer s company size. Total number of monthly hours worked by parttime employees (those working less than 30 hours per week) Number of employees working more than 30 hours per week Total is 50 or more = Large Employer = Total is less than 50 = Small Employer What is Affordable coverage? n Affordability refers to the amount an employee has to pay for the insurance plan if they were to buy coverage for themselves only. n If an employee has to pay more than 9.5% of their annual household income for the company s health insurance, the coverage is not considered affordable. In general, there are three ways employers can determine affordability. Employers can use any or all of these methods: 1. The employee s share of self-only coverage does not exceed wages reported on Box 1 of IRS Form W-2 2. The employee s share of self-only coverage does not exceed 9.5% of the employee s rate of pay multiplied by 130 hours 3. The employee s share of self-only coverage does not exceed 9.5% of the Federal poverty line (FPL) for one person. Insurance would not be considered affordable if: Employee annual earnings: $30,000 $50,000 Insurance plan: More than $238 per month $396 per month IMPORTANT NOTE: When an employer offers multiple plans to choose from, the affordability test applies to the lowest-cost plan option available to the employee. Minimum Value Requirements If an employer has coverage for their employees today, it is important to ensure that coverage meets the minimum amount of benefits. Minimum Value (MV) is the amount the Health Plan expects to pay versus the amount that the member would pay for things like deductibles and coinsurance. The employer s plan must have an MV of at least 60%, which means the plan covers at least 60% of the total allowed cost of benefits that are expected to be incurred under the plan. 3

8 Look-Back to count variable hour employees Employers may have workers who are not hired as full-time, but who work a variable number of hours throughout a month. An employer may not offer coverage to these employees. But if an employee worked an average of 30 hours or more per week, they should have been offered coverage just like a full-time employee. There is a safeguard in place for employers who aren t sure if their employees should be offered coverage. The look back process helps determine if variable hour employees averaged 30 hours or more per week: Choose measurement period: Select a time period of 3-12 months to measure the actual number of hours the employee worked 10/15/ /14/2016 1/1/ /31/2017 Measurement Period Look back 12 months Administrative Period Figure out average house Offer Coverage To employees who averaged 30+ hours/week Calculate employee hours: Employers have up to 90 days after the measurement period to determine the employees who averaged more than 30 hours per week Determine mandatory insurance requirements: If an employee averaged 30 hours per week or more, they must be offered health insurance coverage for 6 months, or the length of the measurement period. Please contact your account consultant for coverage options for those employees who are not eligible for employer coverage. 4

9 Employer Penalties WHAT IS THE PENALTY? The penalty for not offering coverage is $2,000 a year for each full-time employee. The first 30 full-time employees are not counted. This means that if an employer has 100 employees, the penalty of $2,000 would apply to 70 employees (totaling $140,000 in penalties) The penalty for offering coverage that an employee cannot afford (meaning it does not meet the minimum affordability guidelines) or that does not provide minimum value is $3,000 for each employee that receives assistance for New York State of Health coverage. Penalties are determined on a monthly basis and calculated based on the number of months coverage was not offered or did not meet the minimum requirements. For example, if an employer offers the necessary coverage for five months out of the year, the penalty would only apply to the seven months when the employer did not offer coverage. Penalty Triggers Employers will learn that they owe a penalty if at least one of their full-time employees purchases insurance from the New York State of Health and is eligible for help paying their monthly premiums (a premium tax credit ). The premium tax credit is available for individuals who fall below certain income thresholds. Once this occurs, the employer will receive notification and have an opportunity to respond to the Internal Revenue Service (IRS) before they have to pay the penalty. If an employee declines employer-sponsored coverage and enrolls in a health plan on the New York State of Health, the employer would only be charged a penalty if that employee becomes eligible for help paying for the New York State of Health insurance. Therefore, as long as the employer offers affordable coverage that meets the guidelines, the employee would not be able to receive a premium tax credit on the New York State of Health, and therefore the employer would not pay a penalty. 5

10 Companies Under Common Law Ownership A company is considered a large employer when any one company under common ownership exceeds 50 fulltime equivalent employees. For example, if there are 50 or more total full-time equivalent employees within any one common law company, that company may be subject to the Employer Mandate and pay a penalty. If there are 50 or more total full-time equivalent employees within all companies under a common owner combined, each company would be subject to the Employer Mandate, although each of those companies would be assessed a penalty on its own. For example, if the John Smith Corporation owns Employer A and Employer B, and the number of employees under the John Smith Corporation totals 75, each organization will be subject to the employer responsibility provision. If Employer A offers health insurance coverage that meets federal requirements, but Employer B does not, only Employer B will be subject to the penalty. When calculating the penalty, the reduction of the first 30 full-time equivalent employees will be divided among all companies under common ownership that do not offer health insurance coverage, based on their total number of employees. Corporation X 132 employees Corporation X owns A Co. and B Co. A Co. 100 employees B Co. 32 employees All employer members must offer coverage or pay a penalty if 100+ total employees B Co. is not exempt because they are part of Corporation X ANSWERS TO COMMON QUESTIONS Do employers have to offer insurance to part-time or contract (1099) employees? No. Employers who have to provide insurance due to the Employer Mandate are only required to offer insurance to their fulltime employees and their dependent children, not spouses, part-time, seasonal or contract (1099) employees. However, the employer must keep track of an employee s hours worked and if they work 30 or more hours per week, the employer will be required to offer them coverage on a go forward basis or pay a penalty. This is called the Employer Look Back Process (see above). Do employers pay a penalty if the employee starts a new job and is not eligible for coverage until 90 days after they are hired? The employer will not have to pay a penalty as long as they offer minimum affordable coverage after the 90-day waiting period. In addition, the employee will not have to pay a penalty as long as they maintain insurance for the rest of the year. Does affordability also apply to prescription drug coverage or just medical coverage? The affordability guidelines apply to the combined medical and prescription drug coverage, regardless of whether the employer has one or more insurance companies or managed care organizations offering those plans. 6

11 How does an employer calculate affordability with full-time employees who work variable hours? For hourly employees, the 9.5% contribution is based on the actual hours worked. For example, an employer can look at the actual number of hours worked within a month and determine the employee s income versus the employee s premium contribution to determine if the contribution is less than 9.5% of the employee s income. There are a few methods for determining hours if the employee is not paid hourly: 1) they can count actual hours worked, 2) they can consider the employee to have worked eight hours for each day they work at least one hour, or 3) they can consider the employee to have worked 40 hours per week for each week worked. What if I offer coverage to part-time employees that isn t affordable? Penalties are only applied to full-time employees. You will not have to pay a penalty for coverage offered to part-time employees. 7

12 Reporting and Notifications Coverage Reporting 6055 and 6056 reports n Large Employer Coverage Reporting ( Section 6056 Returns ) Employers with 50+ FTEs must file returns to the IRS beginning in 2016 for calendar year These returns provide information to the IRS to show whether the employer is or is not providing coverage to employees and that coverage meets minimum value and affordability levels. These returns will show if employers are compliant with the Employer Mandate. In addition to the returns, employers must also send a statement to each employee. These statements are similar to W-2 forms. They give employees information they will need when they file their taxes, only these statements are used to determine if they were eligible for a premium tax credit. Who s Responsible for Filing: Large employers with 50+ FTEs using the Employer Mandate company size calculation (see page 3) Information Reported How are reports filed? Filing Due Dates n Name, address, and employer identification number (EIN) n Name and phone number of the employer s contact person n Calendar year of information being reporting n Certification of whether or not full-time employees and dependents were offered coverage n Number of full-time employees each month of the year n For each full-time employee, months in which coverage was available n For each full-time employee, employee contribution to the premium of the lowest cost minimum value plan (self-only) each month n Name, address, and taxpayer identification number ( TIN ) for each full-time employee who was covered, and which months they were covered under the employer s plan n Name, address, and EIN of the employer n All information filed on the return that applies to the employee Returns: Form 1095-C Transmittal Forms: Form 1094-C Statements to Employees Copy of Form 1095-C Electronic Statements can be used If filing electronically*: March 31st of the year following the coverage year If filing by paper: February 28th of the year following the coverage year The first returns are due March 31st, 2016 If filing electronically*: March 31st, 2016 If filing by paper: February 28th, 2016 *Employers that file more than 250 forms must file electronically Statements to employees are due January 31st of the calendar year following the year included in the return. The first statements are due to employees January 31st,

13 Minimum Essential Coverage Reporting ( Section 6055 Returns ) Insurance providers, including self-funded groups, must file returns to the IRS beginning in 2016 for calendar year These returns provide information to the IRS to verify if and when individuals were enrolled in minimum essential coverage. Self-funded plan sponsors can use a combined form to file both coverage reporting returns. In addition to the returns, employers must also send a statement to each employee. These statements are similar to W-2 forms. They give employees information they will need when they file their taxes - only these statements are used to determine if they will have to pay the Individual Mandate penalty for not having health insurance. Who s Responsible For Filing: Self-funded plan sponsors, health insurance companies What Information Is Reported? How Are They Filed? When Are They Due? n Name, address, Employer Identification Number (EIN) n Name address, tax identification number ( TIN ) (or date of birth if TIN unavailable) of the subscriber/ beneficiary n Employer must make reasonable attempts to collect TINs: n Initial request upon enrollment n Two consecutive annual requests n Name and TIN (or date of birth if TIN unavailable) of each individual covered under the subscriber s policy n Months in which each individual was covered for at least one day n Any other information required by the IRS n Contact phone number of entity filing the return n Policy number n All information filed on the return that applies to the employee Returns: Form 1095-C (combined form for self-funded plan sponsors) Form 1095-B (form for health insurance plans) Transmittal Forms: Form 1094-C (combined form for self-funded plan sponsors) Form 1094-B (form for health insurance plans) Statements to Employees Copy of Form 1095-C or 1095-C Electronic Statements can be used If filing electronically*: March 31st of the year following the coverage year If filing by paper: February 28th of the year following the coverage year The first returns are due March 31st, 2016 If filing electronically*: March 31st, 2016 If filing by paper: February 28th, 2016 *Employers that file more than 250 forms must file electronically Statements to employees are due January 31st of the calendar year following the year included in the return. The first statements are due to employees January 31st, Notifying your employees Notification about the NY State of Health marketplace must be sent to all new hires. Want to see an example notice? Go to: Health Plan Identifier (HPID) A Health Plan Identifier (HPID) is a 10-digit ID that will be used to identify a health plan in HIPAA standard transactions. The HPID was created to eliminate the need for multiple identifiers and streamline HIPAA standard transactions, such as enrollment and eligibility transactions. Controlling health plans are required to obtain and use a HPID. A controlling health plan is one that controls its business activities, actions and policies. Self-funded plans are considered health plans and are required to use HPIDs. If you self-fund you are likely considered a controlling health plan. 9

14 Subhealth plans may, but are not required to, obtain a HPID. A subhealth plan is a plan whose activities, actions or policies are directed by a controlling health plan. As your TPA, Excellus BCBS is not permitted to obtain the HPID on your behalf. Here s what you should do: HPID Timeline November 5, 2014 November 5, 2015 November 7, 2016 Deadline to apply for a HPID if your annual receipts are more than $5 million. Go here for instructions on how to get your HPID: HIPAA-Administrative-Simplification/Affordable-Care -Act/Health-Plan-Identifier.html Deadline to apply for a HPID if your annual receipts are less than $5 million. Begin using your HPID in all HIPAA transactions. ANSWERS TO COMMON QUESTIONS I have a fully insured plan. Do I need an HPID? No. Only controlling health plans will need an HPID. It looks like a lot of the same information is included in the two coverage reports. Can they be combined? If you self-fund, you are responsible for filing both reports. They can be filed together using Form 1095-C. If you offer a fully insured plan, Excellus BCBS is responsible for filing Section 6055 reports. Is there a penalty if I don t file coverage reports? Yes. The penalty is $100 per incorrect or missing return, up to $1,500,000 a year. My plan renews in April. Do I file coverage reports for the plan year or calendar year? The returns should account for coverage during the calendar year. The information filed on the return is broken down by calendar month. Do I need to file reports for employees who are covered by a multi-employer plan? The administrator of the multi-employer plan can file the returns for participating employees. Keep in mind that you will be liable for any penalties if incomplete or incorrect returns are filed. Future Considerations 2014 If you self-fund, obtain a Health Plan Identifier by November 5th (Nov. 5th, 2015 for (see above for more info ) 2015 Employer Responsibility penalties for groups 100+ Coverage Reporting for groups Groups of shift to community rating Employer Responsibility penalties begin for groups States can choose to open the exchange to large groups 2018 Cadillac Tax for plans with higher premiums TBD Non-discrimination rules about highly paid employee 10

15 Background & Definitions Health Care Reform is now health care n Provisions implemented between 2010 and 2014 are now a part of everyday health care n Preventive Services n Essential Health Benefits Prescription Drugs Ambulatory Patient Services Hospital Visits Laboratory Services 10 Essential Health Benefits Rehabilitative & Habilative Services & Devices Emergency Service Maternity & Newborn Care Mental Health & Substance Use Disorder Services Pediatric Services; Dental & Vision Preventative & Wellness Services; Chronic Disease Management n Community Rated products fall into one of four metal levels PLATINUM GOLD SILVER BRONZE Plan Pays: 90% 80% 70% 60% Members Pays: 10% 20% 30% 40% n Dependents covered up to age 26 n Individuals and small businesses can buy health insurance on NY State of Health 11

16 Taxes & Fees Health Care Reform introduced a number of taxes and fees that affect the cost of premiums. How these taxes and fees impact your business is based on factors like how many employees you have and what coverage you offer. For Health Insurance Companies For Employers Amount Excise tax $8 billion (2014) - $14.3 billion (2018) Transitional Reinsurance Fee Risk Adjustment Fee Exchange User Fee PCORI Fee Cadillac Tax Transitional Reinsurance Fee (for self-funded plans) PCORI Fee (for Self-Funded, HRA and HSA Plans only) $5.25 per person enrolled per month $1 per person enrolled per year (estimated) Exact amount to be determined Calculated as the average number of lives covered during the plan year multiplied by the applicable dollar amount for the year: $1 ( ), $2 ( ) and $2+ inflation after 2014 Exact amount to be determined $5.25 per person enrolled per month Calculated as the average number of lives covered during the plan year multiplied by the applicable dollar amount for the year: $1 ( ), $2 ( ) and $2+ inflation after 2014 What it pays Helps fund premium tax credits for individuals and families Helps stabilize the health insurance industry during the first years of Health Care Reform Helps stabilize individual, family and small business health insurance markets during the first year of Health Care Reform Allows the Health Plan to offer their products on the Exchange Helps fund research to improve health care decisions and delivery Tax on employers who offer high cost health insurance beginning in 2018 Helps stabilize the health insurance industry during the first years of Health Care Reform Helps fund research to improve health care decisions and delivery For Individuals Medicare Surcharge 0.9% gross income Supports the Medicare program and only applies to those earning more than $200,000 (single) and $250,000 (married) 12 Not all fees are permanent: n Reinsurance Fee will end after 2016 n PCORI Fee will end after 2019

17 Common Terms Affordable Coverage: Coverage is considered affordable if an employee pays no more than 9.5% of their income toward the premium for self-only coverage. Controlling Health Plan: A controlling health plan is a health plan that controls its own business activities, actions, or policies, OR is controlled by a business that is not a health plan. Employer Mandate/Employer Responsibility: Beginning in 2015, employers with 100 or more full-time equivalent employees are required to offer minimum essential health benefit packages or pay a penalty. The mandate applies to employers with employees in Full Time Employee: Under Health Care Reform, full time is defined as anyone working an average of 30 or more hours per week. Health Plan Identifier (HPID): The Health Plan Identifier is a ten-digit sequence that identifies a health plan, including most self-funded health plans, in electronic HIPAA transactions. The purpose of the HPID is to streamline electronic transactions. Minimum Value: A product has Minimum Value if the health plan pays, on average, at least 60% of covered benefits. Section 6055 Returns: Section 6055 returns provide information to the IRS to verify if and when individuals were enrolled in minimum essential coverage. These returns are filed by health plans and self-funded plan sponsors. Section 6056 Returns: Section 6056 returns provide information to the IRS to show whether an employer is or is not providing coverage to employees and that coverage meets minimum value and affordability requirements. These returns are filed by employers with 50 or more full-time employees. 13

18 Health Care Reform Checklist for Businesses with 2-49 Employees Most requirements of the health care reform law are already effective, but other aspects will still be phased in over the next few years. This checklist can help you prepare for changes this year and in As always, you should consult your tax advisor and legal counsel to determine the best approach for your business. This guide will be updated frequently as more information becomes available. Please contact your account consultant for the most current version or visit: ExcellusBCBS.com/HealthReform Date(s) Requirement Details Prepare Your Company Date Completed NY State of Health 11/15/2014 to 2/15/2015 New York State of Health open enrollment for individuals Coverage is effective beginning 1/1/15 Help employees who aren t eligible for your health insurance plan to enroll on the NY State of Health. Remember, federal financial assistance is available to individuals who qualify based on household income. 1. Contact us for more information on coverage available for individuals not eligible under your plan. 2. Want to offer coverage to more employees? Talk to your account consultant about affordable plan options. Beginning 11/2/14 Open enrollment begins on the Small Business Health Options (SHOP) exchange Small employers can join the SHOP any time during the year. Small businesses are not required to participate on the SHOP and can continue to purchase or renew health insurance directly through Excellus BlueCross BlueShield or through their broker. Talk to your account consultant or broker about your options for the 2015 plan year. Small Business Tax Credit 4/1/15 for the 2014 tax year This tax credit ends in 2016 Determine if you qualify for the Small Business Tax Credit The Small Business Tax Credit is available today to small employers who meet the requirements set by the IRS. Starting in 2014, however, the credit will only be available to employers who purchase coverage through the SHOP exchange. 1. Do you meet the requirements for the Small Business Tax Credit? 25 or fewer employees Average annual wages are less than $50,000 per FTE Offer health insurance to employees Pay at least 50% of the cost of self-only coverage After 2014, coverage is offered through the SHOP exchange If yes, go to Step Talk to your tax advisor to see if you qualify for the tax credit and how much you can claim. Updated September 2014 This information is to help you prepare. You should consult your tax advisor and legal counsel to determine how your company must comply with the legislation. 14

19 This guide will be updated frequently as more information becomes available. Please contact your account consultant for the most current version or visit: ExcellusBCBS.com/HealthReform Date(s) Requirement Details Prepare Your Company Date Completed Employer Responsibility ( Pay or Play ) Now and ongoing Begin reviewing data to determine if you have 50 or more full-time equivalent employees under Health Care Reform Using the formula provided by the IRS, determine the size of your group. 1. Include the # of full-time employees, which means anyone who worked an average of 30 hours or more per week. plus 2. Add the # of full-time equivalent (FTE) employees. This is calculated on a monthly basis for all employees not considered full-time. Take all hours paid per employee (including paid vacation, illness, and holiday time) and then divide the number by Consult with your legal counsel for situations specific to your business. 2. Determine the size of your group on an annual basis using the entire calendar year for the calculation. 3. If you have 50 or more FTEs, you may be subject to additional coverage and reporting requirements. Ask your broker or account consultant for our Large Business Checklist. Coming Soon Non-Discrimination Compliance TBD delayed until further notice No discrimination in favor of highly compensated employees Employers are required to offer the same level of tax-free coverage to all classes of employees. If any employer offers additional benefits only to highly compensated employees, those benefits will be taxed. Employers that don t comply with this rule will be subject to a penalty of $100/day. We ll keep you informed when we have more information about when and how you need to comply. In the meantime, you can continue to monitor the IRS for new rules and regulations Reporting 1/31/15 for the 2014 tax year Report the cost of health insurance on employees W-2 forms Employers who filed more than 250 W-2 forms in 2013 are required to report the cost of employer-sponsored health insurance coverage in Box 12 of W-2 forms. Reported costs should include those paid by the employer and contributions from the employee. We anticipate that all employers will be required to report this information in 2015 for the 2014 tax year. See our fact sheet for more information. 1. For more details on required and optional reporting, see the IRS W-2 form instructions. 2. Follow up with your payroll company to verify compliance. The penalty for non-compliance is $200 per W-2 form, capped at $3 million. Updated September 2014 This information is to help you prepare. You should consult your tax advisor and legal counsel to determine how your company must comply with the legislation. 15

20 This guide will be updated frequently as more information becomes available. Please contact your account consultant for the most current version or visit: ExcellusBCBS.com/HealthReform Your Action Plan At A Glance Action Effective Date Mandatory? Create Your Action Plan Employer Responsibility ( Pay or Play ) Determine if you have 50 or more full-time equivalent employees under Health Care Reform Begin reviewing data in 2014 to determine your group size. Yes Non-discrimination Compliance No discrimination in favor of highly compensated employees TBD pending further guidance Yes NY State of Health Notify new employees about the NY State of Health Upon hire Yes Open enrollment begins on the Small Business Health Options (SHOP) exchange Open enrollment No Reporting Report the cost of health insurance on employees W-2 forms Anticipated compliance date for all employers is 1/31/16 Yes Small Business Tax Credit Determine if you qualify for the Small Business Tax Credit File by 4/1/15 for the 2014 tax year No Updated September 2014 This information is to help you prepare. You should consult your tax advisor and legal counsel to determine how your company must comply with the legislation. 16

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