Advantage Payroll Services Presents. March 24, 2015 Presenter: Jessica Stelfox, MBA, PHR

Transcription

1 (c )A dv an ta ge Pa yr ol l Se rv ic es Advantage Payroll Services Presents March 24, 2015 Presenter: Jessica Stelfox, MBA, PHR

2 We encourage you to benefit from resources and information provided in this webinar to further your own research. Nothing in this webinar is intended to be, nor should be, construed as legal advice. Contact your legal counsel if you have legal questions regarding the subject matter in this webinar. 2

3 Federal health care reform is the result of the March 2010 enactment of the Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act. These two laws are commonly referred to together as ACA or health care reform. This represents the most significant government expansion and regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in

4 All existing health insurance plans must: Prohibit lifetime limits and rescissions Restrict annual limits Have waiting periods of no more than 90 days Offer coverage for non-dependent children up to age 26 Children under 19 may not be excluded due to preexisting conditions. Reasonable Breaks in a private place for nursing mothers for one year after child s birth. Determine whether or not Grandfathered plan status. If not, must follow new plan rules. 4

5 OTC drugs cannot be reimbursed through FSAs, HRAs, or HSAs without prescription. Preventive care is covered at 100%. Insurers must maintain a medical loss ratio of not less than 85% for large groups or 80% for individual and small group markets. Those that do not meet the standard must pay rebates to policyholders. Group prescription insurance plans must send notification before 10/15 each year to covered employees, spouses and dependents who are eligible for Medicare. Notices should indicate whether drug coverage is considered creditable coverage for Medicare Part D. 5

6 Large employers must report health plan cost information on Forms W-2s. Small employers (those filing fewer than 250 W-2s the prior year) do not have to comply until further guidance is issued. New rules for standardized health plan summaries (Summary of Benefits & Coverage as well as a Uniform Glossary of Terms). A fee will be assessed to fund comparative effectiveness research. This fee helps fund the Patient-Centered Outcomes Research Institute. Plans affected: major medical plans, retiree-only plans, HRAs, dental & vision in certain instances, and health flexible spending accounts in certain instances. 6

7 FSAs are capped at $2,500 per employee. Employers no longer permitted to take an income tax deduction for the Medicare Part D retiree drug subsidies they receive. The subsidy will be non-taxable, but will not be deductible. Employees share of the Medicare tax on wages in excess of wage thresholds increases. The Medicare tax rate will increase by 0.9% (2.35%) on wages over $200,000 for single filers, wages over $250,000 for joint filers, and wages over $125,000 for those who are married but filing separately. Employers must provide each employee with a notice about the availability of state health insurance exchanges within 14 days of hire. 7

8 Maximum limits for out of pocket spending for fully/self insured non-grandfathered plans ($6,350 for individual and $12,700 for family). Protecting Access to Medicare Act of Ended limitation on deductibles that were set at $2,000 per individual and $4,000 per family on small group employer sponsored health plans. Plans offering dependent coverage must allow it to continue until the end of plan year which child becomes 26. Each individual is required to obtain health care insurance or face a penalty. Update: 2015 Open Enrollment Extension Special Enrollment Period (SEP) for those that did not have health coverage in 2014 and are subject to paying a fee when they file their taxes. SEP allows those that were unaware of the requirement or didn t understand the requirement to enroll in 2015 health insurance coverage. SEP begins 3/15/15 and runs through 6/30/15. This only pertains to individuals that live in states with a federally facilitated marketplace. 8

9 Employers who offer prescription drug coverage to employees/retirees should provide a notice to plan participants/beneficiaries who are eligible for Medicare part D stating whether the employer prescription drug coverage is creditable coverage. Special rules surrounding HRAs, FSAs, Employer Payment Plans, and Wellness Plans part 4. Update: New Guidance The excise tax under Code 4980D will not be assessed for any failure to satisfy the market reforms by employer payment plans that pay, or reimburse employees for individual health policy premiums: 1) For 2014 for employers that are not ALEs for 2014 and; 2) For January 1, 2015 through June 30, 2015 for employers that are not ALEs for After 6/30/2015 this relief ends. Must have fewer than 50 FT/FTE employees. Note: Subchapter S Corps may pay for or reimburse individual plan premiums for employee shareholders who own at least 2% of the corporation. Payments are included in income but the 2% shareholder can deduct the premiums for tax purposes. Note: Employers are allowed to pay Medicare Part B or D premiums for retired employees in retiree-only plans (those plans are not subject to market reforms). Employers can only pay Medicare premiums for active employees if the employer payment plan is integrated with a group health plan. HIPPA Identifiers for large group health plans but small group health plans have until 11/5/15 to obtain. 9

10 Small Business Health Options Programs is where small businesses can buy small group plans. Small businesses are those with no more than 100 EEs although states have the option of limiting pools to companies with 50 or fewer EEs through States will be able to add large group plans to their SHOP beginning Go to for information on the SHOPs. The federal government will run exchanges for the 32 states that chose not to run their own. The Supreme Court expected to rule on whether subsidies are permitted to be granted to participants of federal run state exchanges since the regulation says the subsidies are for state run exchanges. Small Business Healthcare Tax Credit - In order to take advantage of the credit, you must purchase a policy on the exchange. Employers with 25 or fewer FT EEs, averaging $50,000 or less annually, may be eligible for a tax credit of up to 50% of the premium costs of providing EE health coverage as long as the employer contribution is at least 50% of the EE-only premium cost and the plan was purchased through SHOP. This credit is good for 2 years. 10

11 The employer mandate requires employers with 100 or more FT employees (50+ for 2016) to offer health insurance (minimum essential coverage) to their FT/FTE employees or pay a penalty. Grandfathered plans are excluded. For 2015, relief (100 employees instead of 50) is only given to employers who meet certain criteria: 1) didn t decrease workforce size to avoid mandate; 2) didn t change health coverage significantly since 2/9/2014. Reporting Requirements under Section requires reporting by insurers, self-insuring employers, and other parties that provide health coverage. Reporting Requirements under Section 6056 required reporting by certain employers concerning the health coverage they offer to their full-time and full-time equivalent employees. Auto Enrollment for employees of employers with more than 200 FT employees. (Delayed) 11

12 Employers with 100+ FTE employees must offer affordable and adequate coverage to at least 70% of FT Employees. Effective 1/1/2016, employers with 50+ FTE employees must offer affordable and adequate coverage to at least 95% of FT employees. Affordable costing no more than 9.5% of employee s household income. There are safe harbors in place to make this determination. Because employers do not have information regarding household income, you can use employee s W-2 wages for that year; or If the cost of coverage for a month is not more than 9.5% of an amount equal to 130 hours multiplied by the employee s hourly rate of pay; or If insurance costs are less than 9.5% of the federal poverty level for one person for one month. Adequate plan s actuarial value is at least 60%. (aka minimum essential coverage or MEC) The HHS and IRS have an online calculator employers can use to determine this: Employers with non-calendar year plans can begin compliance at the start of their plan year in In order for this relief to apply: The plan must be in effect as of December 27, The employer must not have modified its plan year since December 27, The employer must offer affordable coverage providing minimum value to at least 70% of its FT employees (and their dependents) on the first day of its 2015 plan year. 12

13 Full-Time (FT): 30 or more hours worked per week. The monthly equivalency of 30 hours per week is 130 hours per month. may change to 40 Hours of service: include each hour for which the EE is paid or entitled to payment for work and each hour for which an EE is paid or entitled to payment by the employer on account of a period of time during which no duties are performed due to vacation, holiday, illness, incapacity, layoff, jury duty, military duty, or leave of absence. Seasonal Employee: works less than 120 days per year still need to test until clearer guidance is issued. Use good faith evaluation to avoid penalty. On Call Employees: Employers must use a reasonable method of crediting hours of service for employees who are on-call, which include crediting one hour of service for every on-call hour for which the employee is compensated. Sole proprietors, partners in a partnership, 2-percent S corporation shareholders, certain real estate agents and direct sellers, and individuals who meet the technical definition of leased employee in the Code are not treated as employees for any purpose of the employer mandate including determining whether coverage is provided to at least 95% of an employer s full-time employees. Breaks in service the length of the break in service for a returning employee to be considered a new employee is reduced from 26 weeks to 13 weeks 13

14 Full Time Equivalent Employees (FTEs) are calculated using the following formula: Part time employee equivalents (formula is total monthly part-time hours/120) + Full time employees (30 hours per week or more) - owners (sole proprietors, partners in a partnership, members of LLCs taxed as a partnership, and shareholders) = full time equivalent employees 14

15 Measurement Period = 3-12 months Stability Period = follows measurement period. Cannot be shorter than 6 months or, if longer, the length of the measurement period. ACA calls for 12 months 6 months is the 2015 safe harbor). 6 months may only be used if the period begins no later than 7/1/2014 and ends no earlier than 90 days before the first day of the first plan year beginning on or after 1/1/2015. Administrative Period = can be scheduled at the end of the measurement period to allow the employer to process the measurement period numbers and offer coverage to FT employees. Common Practice 12 month measurement period and 12 month stability period. If you sponsor a calendar year plan, you will need to complete your measurement period before your open enrollment period for the coming plan year. New Employers: Standing based on if reasonably expect at the time the business starts to have at least 50 (100 in 2015) FTE employees. Newly Large Employers: For the first year that the employer is a large employer, an employer will have until April 1 of the first year to offer affordable coverage without being liable for the $2,000 employer mandate penalty. This rule does not apply if the employer was subject to the employer mandate for any preceding year. 15

16 Employers are permitted to use a look-back measurement period for determining status of new or seasonal employees. The result depends on the employer s reasonable expectations of the status of the EE at their start date. Factors to consider include: Whether the EE is replacing an EE who was or was not FT. The extent to which EEs in the same or comparable positions are or are not FT. Whether the job was advertised as requiring 30+ hours per week. New Employee Reasonably expected to work FT: Employer must offer health coverage by the first day of the month immediately following the EE s initial 3 full calendar months of employment to avoid a penalty. New Variable Hour Employee: An employer may determine whether a new EE is FT using an initial measurement period. The stability period for these EEs must be the same length as for ongoing EEs. The employer must retest a new variable hour EE once he or she has been employed for an entire standard measurement period. 16

17 Companies that have common ownership or are otherwise related are combined together for the purposes of determining whether or not they employ at least 50 full-time or fulltime equivalent employees (100 for 2015). This determination is made using Section 414 of the Internal Revenue Code. If the combined total of employees meets the threshold then each separate company is subject to the Employer Mandate even if the separate companies do not individually have enough employees to meet the threshold. Determination of Offering of Coverage: Even if separate business entities are aggregated for purposes of determining whether the businesses are subject to the employer mandate, each business entity is analyzed separately in determining whether the business entity offers coverage to its employees. For example, each separate business must offer coverage to at least 95% of its FT EEs, without regard to whether the aggregated business entities offer coverage to at least 95% of their aggregated FT EEs. The aggregation rules are not applied to companies for the purpose of determining potential liability and the payment amount under the employer mandate. Ex: If determining the amount of the penalty for failure to offer coverage, the 30 FT EE reduction (80 EE reduction in 2015) is allocated ratably among the business entities that are aggregated based on the number of FT EEs employed by each entity. You should consult the appropriate advisor for assistance in determining common ownership. 17

18 Includes labor union and Taft-Hartley plans. Employers required to contribute to multiemployer plans are generally protected from a penalty for a specific employee based on the following: The employer is required to contribute to a multiemployer on behalf of an employee pursuant to a CBA or participation agreement. Coverage is offered under the multiemployer plan to employees (and the employees children under age 26) who meet the plan s eligibility rules. Final rule allows a one year good faith period for plan sponsors to add dependent / adult child coverage to the plan if the plan does not currently cover them. The coverage offered by the plan qualifies as affordable and provides minimum value. An employer will not be subject to penalties under the employer mandate for union employees regardless of whether they qualify for coverage under the multiemployer plan as long as the employer makes the required contributions to the plan and the plan is otherwise compliant. Some employers have both employees that are covered under a CBA or participation agreement and other employees that are not. Remember to follow the rules for those employees not covered under a CBA or participation agreement. 18

19 The Expatriate Health Coverage Clarification Act of 2014 (EHCCA) states that expatriate health plans that are issued or renewed on or after July 1, 2015 are exempt from certain ACA provisions. Section 3(a) Some provisions do not apply to expatriate health plans, employers that sponsor those plans, and expatriate health insurance issuers (with respect to the expatriate coverage). The EHCCA does NOT provide an exemption from the Sections 6055 and 6056 reporting requirements. The EHCCA does NOT exempt sponsors from the excise tax on high cost employer sponsored coverage in IRC section 4980I. You must qualify for this exemption. Your plan must meet the definition of an expatriate plan and your coverage must meet certain requirements. 19

20 MEC Employer sponsored self-insured coverage active, retired, or terminated employees Individual or employer sponsored group health insurance (including coverage bought on an exchange) Medicare Part A or Medicare Advantage Coverage recognized as MEC by the Dept. of Health and Human Services (i.e. coverage provided by a foreign government or coverage provided to certain self-employed individuals) provided that the sponsor complies with notice and reporting requirements. Most Tricare coverage Most Medicaid or CHIP coverage Certain self-insured student health coverage Not MEC Excepted benefits (i.e.: stand alone dental and vision, fixed indemnity plans, critical illness coverage, on-site medical clinics, most health flexible spending arrangements, EAPs that do not provide significant medical benefits Health Reimbursement Arrangements integrated with group health coverage Health Savings Accounts MEC that supplements a primary plan of the same plan sponsor, or that supplements Medicare or other government sponsored coverage 20

21 Employers with 100+ FT employees face penalties if: 1 2 No coverage or offered less than 70% Penalties only apply if EE receives gov t subsidy MEC offered to at least 70% of FT employees $2,000 per employee if one gets a subsidy (excluding 80 EEs) Greater Penalty (30 EEs after 2015) Costs more than 9.5% of wages Covers less than 60% of allowed costs No Coverage Penalty $3,000 per employee that receives a subsidy - Lesser Penalty 21

22 No employer payment is owed for non-coverage of parttime employees even if they receive a premium tax credit. If employer offers affordable coverage that provides minimum value to a full-time employee who declines it, no employer payment is owed for that employee. No payment is owed if an employee obtains coverage through means other than the individual Marketplace (i.e., spouse s family coverage). To avoid a payment, employers that offer coverage to fulltime employees must also offer coverage to the dependents of those full-time employees who are children under age 26 (coverage need not be offered to spouses). 22

23 Effective in 2012, employers with more than 250 W-2s the prior year are required to report the aggregate value of medical, dental, vision, and supplemental insurance benefits coverage on W-2s. Those employers that have less than 250 W-2s the prior year, do not have to report this information on W-2s. This transitional relief for smaller employers is indefinite until the IRS releases further guidance. 23

24 Employers subject to the ACA shared responsibility mandate will be required to file forms with the IRS in order to show that the health coverage they offer employees is compliant with ACA requirements. Although mid-size employers (50-99 FT or FTE employees) have one year transition relief from the employer mandate, they still must comply with the reporting requirements. If qualified for transitional relief, must certify to IRS that meet the requirements on Form 1094-C. First period required to report: Calendar year When Reporting Begins: January 2016 to employees and March 2016 to the IRS. Filing is on a calendar year basis regardless of the type of year which the plan is administered. If your plan operates on a non-calendar year basis, the IRS will allow you to defer compliance with the reporting until the first day of the plan s plan year. IRS released new brochure Affordable Care Act Reporting Requirements for Applicable Large Employers. It discussed getting ready for monthly tracking and preparing to fill out new forms in

25 Form 1095-C used to report information under Section 6056 Form 1094-C used to transmit the 1095-C return to the IRS Form 1095-B used to report information under Section 6055 Form 1094-B used to transmit the 1095-B return to IRS The IRS has released instructions relating to these forms. Forms 1094-B and 1095-B Forms 1094-C and 1095-C Reasons for Reporting: Enable the agency to enforce the employer mandate and issue penalties. Help IRS compare what individuals report on their tax returns to what their employers report. Allow IRS to double-check whether people who have received subsidies to buy insurance on the exchange were actually entitled to the subsidies. 25

26 SSNs of employees, spouses, and dependents. Names and EINs of other employers within the reporting employer s controlled group of corporations for each month of the calendar year. Number of FT and FTE employees for each calendar month. Section 4980H transition relief indictors for each calendar month. Employees share of the lowest-cost monthly premium for self-only, minimum value coverage for each calendar month. Applicable Section 4980H safe harbor for each calendar month. 26

27 Applies to insurance companies and employers that sponsor selfinsured group health plans. This reporting is required for enforcement of the individual mandate. Individuals will be able to verify they had appropriate coverage to avoid a tax penalty. Issuers and Self Insured employers providing MEC (regardless of size) must report about the MEC they provide. Provided to IRS and individuals. Must be reported on IRS Form 1095-B with the 1094-B transmittal form. Self-insured employers will be able to file a combined form for 6055 and 6056 reporting. Will need: Information about the entity providing coverage, including contact information. Which individuals are enrolled in coverage, with identifying information and the months for which they were covered. 27

28 Name, Address, EIN of insurer or self-insured plan sponsor Name, Address and TIN (SSN) of the insured or employee For each covered individual, the months for which they were covered at least one day The reports must be filed with the IRS. The reports must be given to the covered individuals. The reports do not have to go to every family member; only to the primary insured. Form 1095-B filed with IRS and provided to tax payers by insurers and self-insured employers to verify that individuals have minimum essential coverage that complies with the individual coverage requirements. Name, Address, EIN of the employer sponsoring the plan when an insurer is reporting on an employer-sponsored group health plan, and whether the plan is enrolled through the SHOP Name and TIN of each individual covered Any other information required by the form and instructions Form 1094-B is the transmittal form that insurers and self-insured employers must use to transmit the individual Forms 1095-B to the IRS. Insurers and self-insured health plans will provide Form 1095-B to each enrollee and members and file these forms together with Form 1094-B to the IRS. 28

29 Large employers (50+) must separately report information about FT employees and the coverage they offer for the 2015 year. Employers between FT or FTE employees, that did not meet the employer shared responsibility mandate for 2015, must certify that they met the requirements for 2015 transition relief on reporting form. Report on Forms 1095-C and 1094-C: Form 1095-C to verify compliance with the employer shared responsibility mandate. This form will also be used to establish employee eligibility for premium tax credits if the employer does not offer affordable and adequate coverage. Form 1094-C is the transmittal form that employers must use to transmit the individual 1095-Cs to the IRS. Employers are permitted to file multiple Forms 1094-C (such as to cover different divisions), but must designate one authoritative form that includes complete information for the reporting ALE member. An ALE member has to report the names and EINs of the other members of its controlled group. If you have not identified or track all of the members of your group, you should start doing that now. If an employer has a non-calendar year plan, the certification will have to be made again on the 2016 filings with respect to any months during 2016 that fall within the 2015 plan year. 29

30 With respect to each FT employee, the following must be reported: Name, Address and EIN of Employer Calendar year for which report is provided Number of FT employees for each month during the year For each FT employee: The months during the calendar year for which MES was available to the FT employee The employee s name, address, and TIN and the months covered under the plan Name and Telephone of a Contact Person MEC offered to FT and dependents? by calendar month The employee s share of the lowest cost monthly premium for self-only coverage providing minimum value offered to the FT employee by month Other information required on the form 30

31 Large employers must provide Form 1095-C to each employee and send these together with Form 1094-C to the IRS. Individuals also must receive a copy of the 1095-B or C that relates to them, or a substitute statement that includes all the relevant information. Reports to individuals are due by 1/31 the year following the calendar year in which MEC was provided. Can provide electronically if the individual has given electronic or written consent to receive the form electronically. Reports are due to the IRS on or before 2/28 (3/31 if filed electronically). The forms must be filed electronically if the reporting entity is required to file at least 250 Forms 1095-B or C. 31

32 Part I of Form 1095-C includes EE information and ER information. Part II Line 14 - You must enter the proper Code Series 1 indicator code to specify the type of coverage offered to the EE each month. This list is located on page 2 of the form. Part II Line 15 Complete only if code 1B, 1C, 1D, or 1E is entered anywhere on line 14. Enter the amount of the EE share of the lowest-cost monthly premium for self-only MEC providing minimum value that is offered to the EE. Part II Line 16 Enter code from Code Series 2 if applicable special EE scenarios See IRS instructions for details and code names. 32

33 Complete Part III only if offer employer-sponsored self-insured health coverage in which the employee or other individual enrolled. For this purpose, employersponsored self-insured health coverage does not include coverage under a multiemployer plan. 33

34 Section I of 1094-C details employer information. Section II details ALE Member information. (c )A dv an ta ge Pa yr ol l Se rv ic es Only one 1094-C per employer even if member of controlled group 34

35 B. ER must have made a QO for one or more months of 2015 to at least 95% of its FT EEs Do not complete Part II, line 15 for any month QO applies on Form 1095-C instead insert code 1A on line 14 for any month QO was made and QI for any month it was not. (c )A dv an ta ge Pa yr ol l Se rv ic es 22A. ER must have made Qualifying Offer (QO) to one or more FT EEs for all months EE was FT Do not complete Part II, line 15 on Form 1095-C instead insert code 1A on line C. ER is between 50 and 99 FT/FTE EEs and is not complying with the employer shared responsibility mandate or ER has 100+ FT/FTE EEs and utilized the 2015 Transition Relief for Calculation of Assessable Payments under Section 4980H(a). Must also complete Form 1094-C, Part III, column (e). 22D. ER offered affordable MEC coverage to at least 98% to employees and dependents all 12 months. Do not complete Full Time Employee Count Part III, column (b) on Form 1094-C. 35

36 Column (a) Enter X for each month that offered MEC to at least 95% of FT/FTE EEs or where ER was eligible for transition relief. Column (d) Must complete if checked Yes on line 21 indicating that ER was a member of an aggregated group for any month during the year. Enter an X in the box for each month a member or the box for all months if applicable. Column (e) If ER selects box C on line 22 certifying that it is eligible for Section 4980H Transition Relief and is eligible for the 50 to 99 Relief, enter code A. If the ER selects box C on line 22 certifying that it is eligible for Section 4980H Transition Relief and is eligible for the 100 or More Relief, enter code B. You cannot be eligible for both. Part IV of Form 1094-C is where you list the other members of your controlled or affiliated service group (Aggregated ALE Group) 36

37 The penalties for not reporting will be the same as the penalties for late or incorrect reporting Forms W-2 and transmittals to the IRS. The penalty is generally $100 per return, with a maximum of $1.5 million. The penalties apply separately to reporting under Sections 6055 (MEC) and 6056 (ALEs). IRS said that penalties will not be enforced for 2015 reporting for any issuer or employer that has made a good faith effort to comply, but has provided incorrect or incomplete information such as TINs or dates of birth. 37

38 MEC Reporting: Forms 1094-B and 1095-B Name, address, and EIN of reporting entity Name, address, and SSN (or TIN) of the responsible individual (i.e. the employee) Name and SSN (or birthdate of no TIN obtainable) of each covered individual (i.e. the employee s covered dependents) Months of MEC for each covered individual ALE Reporting: Forms 1094-C and 1095-C Employer identifying and contact information Employer certification of MEC offer to FTEs and dependents FTE information: months coverage was available, employee s share of lowest cost self-only minimum value option, number of FTEs each month Name, address, TIN of each FTE and months in which the employee was covered Additional information will be required to be reported using indicator codes (i.e. utilization of transition relief) 38

39 MEC Reporting: Forms 1094-B and 1095-B All individuals receiving minimum essential coverage, including employee, pre- Medicare retirees, COBRA beneficiaries, and covered dependents. Separate statements not required for enrolled family members they are to be listed on report to responsible individual. The reporting is filed with the IRS. ALE Reporting: Forms 1094-C and 1095-C All full-time employees (FTEs). The reporting is filed with the IRS. 39

40 Employers that can certify that a qualifying offer was made to FT employees for the entire year may provide a simplified employee statement and transmittal with respect to those FT employees. A qualifying offer is an offer of MEC providing minimum value at an employee cost for employee-only coverage not exceeding 9.5% of the federal poverty line. For 2015 only This method may be used even for employees not receiving a QO for all 12 months if the ER certifies that it made a QO to at least 95% of FT employees and their spouse and dependents. Can use code rather than dollar amount of the employee contribution for lowest cost employee-only coverage providing minimum value. 40

41 This alternative allows employers to report without identifying all FT employees if it offers MEC that was affordable to at least 98% of all employees (and their dependents) regardless of whether the employee is FT. You can use any of the affordability safe harbors permitted under the regulations. You do not have to identify or give a count of FT employees for each month. 41

42 Learn about the reporting requirements and review the forms. Develop a procedure/process for determining and recording FT/PT status by month. Develop procedure/process for recording offers of health coverage and health plan enrollment by month. Review ownership structures to see if common ownership applies (Controlled Group Members). Determine how you will provide statements to employees mailed or send electronically? In order to send electronically, you will need consent from the employee. 42

43 As of 1/1/2017, states may allow large employers to participate in exchanges. 40% Tax on Cadillac or high cost plans valued at more than $10,200 Single / $27,500 Family will become effective 1/1/2018 (imposed on plan administrator, not participant). 43

44 Effective 1/1/2018, insurers of fully insured plans and plan administrators of selfinsured plans will be subject to a non-deductible excise tax on high-cost health plans. Excise tax is on 40% of the amount the premium is over the thresholds: $10,200 for individuals and $27,500 for family or any dependents. The thresholds for retirees and high-risk jobs are $11,800 for individual and $30,950 for family. Multiemployer union plans have more lenient rules, including a $27,500 threshold for any coverage, whether family or single. Coverage that is subject to this tax include the value of the total premium for employer-provided accident and health coverage, employer and employee contributions to health flexible savings account (FSA), and employer and employee salary reduction contributions to health savings account (HSA). Annual increases in the excise tax thresholds are not based on health care cost inflation, but instead on the Consumer Price Index. Goal of the tax is to help fund the expansion of health care coverage under the ACA. Recent guidance released in IRS Notice Many proposed changes looming. 44

45 NY State of Health customer service: or nystateofhealth.ny.gov. (NY Employers Only)

46 This report gives you a monthly breakdown for each EE where the average hours each EE works for a 12 month period of time is shown. This will assist with determining whether or not you are a large employer under the ACA and if so, who you have to over coverage to. For each EE with pay information within the data range being examined, the report will show a record with EE number and name, indicate if the EE is hourly or salary, as well as provide a breakdown per month of total hours, number of weeks worked, and average weekly hours. The EE s status will be calculated from this data. EEs with 30+ in the AVG WEEKLY HRS field will be counted as FT for the month. PT EEs who are active during the data range will have their hours added to help determine the FTE count for the month. If a pay period crosses months, the program apportions the number of hours and weeks worked based on the ratio of the number of pay period days in each month. 46

47 Status Full-Time Part-Time New Hire Term d Seasonal Explanation Employee was active during the entire date range and averaged 30 or more weekly hours worked. Employee was active during the entire date range and averaged fewer than 30 weekly hours worked. Employee was hired after the start of the date range and cannot be measured for the entire period. Employee was terminated prior to the end of the date range and cannot be measured for the entire period. Employees that are designated as Seasonal The report will not make the determination of whether or not the seasonal employee exemption applies. 47

48 The report also calculates how many FT or FTE employees you have each month the report captures. This will easily allow you to determine whether or not you need to offer health insurance and to whom. This will also assist you with the ACA reporting requirements. 48

49 Advantage ACA Report Improvements Are Here! Detailed instructions on what to do for the ACA. Detailed instructions on what to do with the information contained in the reports. Information on the small business health care tax credit. Information on how to determine if your coverage is affordable for each employee. All questions about the presentation or the reports are to be ed to Jessica Stelfox at 49