Navigating through all the new information on Healthcare Reform can prove challenging to employers and their employees. At HowardSimon, we continuously support our clients by providing them with important information affecting their business. The Affordable Care Act (ACA) implements changes that will undoubtedly alter how many businesses handle healthcare coverage. We consolidated important points to assist you in understanding the healthcare reform and will diligently update information as changes go into effect.
For more information on healthcare reform and the Affordable Care Act (ACA), visit the Department of Labor
The Affordable Care Act requires reporting the cost of healthcare coverage through an employer's group plan on the W-2s of employees, however does not make the coverage taxable. A transition relief for reporting continues to be in place for eligible employers, including those filing fewer than 250 Forms W-2 for the previous calendar year. The transition relief continues until the IRS publishes additional guidance.
For more information, including a complete list of transition relief eligibilty requirements for employers, visit Employer-Provided Health Coverage Informational Reporting Requirements: Questions and Answers on the IRS.
Tracking employee hours became more essential than ever due to the Affordable Care Act (ACA). Employees working over 30-hours per week or 130-hours per month will qualify for employer-sponsored “affordable” healthcare. Subsequently, failure to properly track employee hours can result in tax penalties/payments or disqualify a business for available tax credits. Employers must validate full-time and full-time equivalent employee counts and employee hours (weekly or monthly) to the IRS. Implementing automated time and attendance systems protects employers and should be put into place immediately (if not already in use). Time and attendance systems offered by HowardSimon can be implemented through the web, or a combination of physical clocks, voice clocks, swipe cards, biometric verification and web access.
Beginning in 2014, the new health insurance marketplace becomes available to small businesses with fewer than 50 employees through the Small Business Health Options Program (SHOP). To reduce the high administrative costs that small businesses incur with health insurance, the SHOP marketplace offers quality coverage at a lower cost than currently available. The SHOP program aims to simplify finding healthcare for small businesses. Eligible employers must offer SHOP coverage to all full-time employees and have an office located in the service area of the SHOP in order to enroll.
Details on the Small Business Health Options Program (SHOP):
The Affordable Care Act (ACA) requires large businesses to adapt to new healthcare reforms. A business with 50 or more full-time or full-time equivalent employees is considered a large business. The most significant provisions directly affecting these businesses involve “Employer Shared Responsibility” and W-2 reporting.
Starting in 2015, employers with 50 or more full-time or full-time equivalent (FTE) employees must provide affordable, adequate health insurance for full-time employees and dependents. The provision defines a full-time employee as an individual employed an average of 30+ hours per week. If at least 1 of their full-time employees is certified to receive a premium tax credit in an individual health insurance marketplace, the employer may be required to pay an assessment. A premium tax credit is available to help individuals or families to afford health coverage purchased through the exchange. Reliable time & attendance systems offer the safest and most efficient way to track employee hours and determine the total number of full-time or full-time equivalent employees. It’s important to note that large employers (over 50 full-time or FTE employees) will be required to report six consecutive months of labor records for 2013 to the IRS.
Employers must determine if they will “pay or play” meaning they will fail to provide adequate coverage to employees as required by the ACA and pay assessments (penalties) or comply with the ACA and provide affordable, quality health insurance coverage to employees. Employers must determine which option is best for the business and its employees. Large employers face assessments for the following:
For More Information on Employer Shared Responsibility Provisions, visit the IRS’ website
W-2 reporting will change for large businesses, by requiring employers to report the cost of coverage under an employer-sponsored group health plan on the W-2 form of each employee. The employer’s excludable contribution to health coverage continues to not be taxable; the information will provide employees with the cost of their health insurance coverage. For more information on W-2 reporting of employer sponsored health coverage, visit http://www.irs.gov/uac/Form-W-2-Reporting-of-Employer-Sponsored-Health-Coverage
Certain small employers that help pay for employee' health insurance or Medicare premiums now face a steep excise tax that could add up to $36,500 a year. The IRS had provided relief from the tax but it ended on June 30, 2015. This article explains who could wind up paying the excise tax, how it's calculated and why one business organization is calling for it to be repealed.
EEOC Proposes Long-Awaited Wellness Program RegulationsThe EEOC has proposed long-awaited regulations on how employer wellness programs may comply with the Americans with Disabilities Act. This article describes the regulations' approach to important issues such as plan design and compliance, incentives, and confidentiality. We also cover several FAQs on wellness programs recently released by other federal agencies.
EEOC Proposes Long-Awaited Wellness Program RegulationsTo help keep employers up-to-date with developments in the Affordable Care Act, these articles cover:
The IRS HHS and DOL have jointly issued FAQ guidance on the required coverage of preventive health services. Under the Affordable Care Act(ACA), nongrandfathered, nonexcepted group health plans must provide coverage for various preventive services delivered by in-network providers without cost-sharing. This article covers highlights of the FAQs.
Reviewing the Final Regulations for the ACA’s SBC RequirementThe IRS DOL and HHS have issued final regulations addressing the Affordable Care Act's summary of benefits and coverage requirement. They generally apply to group health plans for plan years beginning on or after September 1, 2015. This article reviews six highlighted areas of the final regs and takes note of a couple of important points from the preamble.
Can We Deny Coverage to Dependents Eligible Under Another Plan?Question: Our organization offers a grandfathered group health plan. The plan covers dependent children until age 26 — even if they're eligible for coverage under another plan. Aren't grandfathered plans permitted to deny coverage to a dependent child in these circumstances? Read on for the answer.
High-Deductible Health Plans May Be on the Rise AgainWith the "Cadillac" tax coming in 2018 and fresh data now available, many organizations that had previously sat out of the HDHP trend may now begin to stand up and pay attention. This article presents a wealth of recent survey results describing which companies are using HDHPs and how they compare to other plan models. A sidebar addresses average employer/employee costs for various plan types.
Do HIPAA Portability and ACA Rules Apply to Our Dental Benefits?This Q&A addresses whether portability under the Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA) rules apply to dental benefits. The short answer is "no" — but, as the article explains, that is true only if a dental plan qualifies as an "excepted benefit" under both laws.
Health Care Reform: HDHPs, SBC Regs and Dental BenefitsTo keep employers up-to-date with developments in the Affordable Care Act, these articles cover:
This Q&A addresses whether a self-insured health care plan must provide "essential health benefits," as defined and required under the ACA. As this article explains, the answer is generally "no" — though self-insured plans are prohibited from imposing annual or lifetime dollar limits on any essential health benefits they do offer.