It's difficult to keep up with the new regulations and requirements associated with the Affordable Care Act. More importantly, it's not easy to decipher what specific provisions pertain to your business. 

  • Are you subject to the employer mandate? Beginning January 1, 2015 (delayed from January 1, 2014), employers with 50 or more full-time equivalent employees must offer minimum essential coverage that is affordable and provides minimum value to their full-time employees (those working on average 30 or more hours/week) and dependents, or be subject to Affordable Care Act penalties. All employees (including part-time and, in most cases, seasonal employees) must be counted in order to determine if you have 50 or more full-time equivalent employees. Also, if you are a member of a controlled group of companies, all employees in the controlled group must be counted for purposes of the 50 or more threshold.
  • Will new health plan fees affect you? Two major fees that will affect most health plans are the Patient-Centered Outcomes Research Institute (PCORI) fee and transitional reinsurance fee. Employers with self-insured plans must pay these fees directly. The insurance carrier pays these fees for insured plans, but employers will most likely see these fees passed along in the cost of coverage. The PCORI fee is $1 in 2013 and $2 in 2014/covered life/year (and expected to be more in future years). It will be assessed for seven years and the first payment was due by July 31, 2013, for calendar year plans. The transitional reinsurance fee is expected to be $63/covered life/year and will be assessed for three years (beginning in 2014).
  • Are you withholding the additional .9% Medicare tax on employees to whom you pay wages in excess of $200,000? This provision went into effect on January 1, 2013.
  • Are you ready to provide the marketplace (exchange) notice to all employees by October 1, 2013?Most employers will be required to provide this notice, even employers who do not offer group health plans to their employees. The notice informs employees of health coverage options and includes a description of services provided by the marketplace. The Department of Labor has posted model notices on its website.
  • Does your wellness program comply with the new regulations? By January 1, 2014, wellness programs associated with group health plans must meet the nondiscrimination requirements described in recently published regulations, including limiting the size of the reward to 30% (50% for smoking cessation) of the cost of employee-only coverage under the plan and making the reward available to all similarly situated individuals. The new regulations require employers to offer any employee who cannot meet a health standard a reasonable alternative standard for obtaining the reward for the entire year, a more generous position than had been required under prior regulations.