Reminder: Affordable Care Act 2016 Changes

Under the Affordable Care Act, there are several changes for large employers (100+ full time equivalent employees) and mid-sized employers (50-99 full time equivalent employees) coming in 2016. Here are the major ones to be aware of: Employer Mandate Reporting Begins (Section 6056 Reporting) – Beginning in the 2015 tax year, all mid-sized and large employers are required to perform Section 6056 reporting. Just like W-2s, copies of the forms must be provided to employees by January 31st and filed with the IRS by February 28th (paper) or by March 31st (electronic). The first reporting will take place early in 2016. Mid-Sized Employer Transitional Relief Expires – In 2015, there was some transitional relief that exempted most mid-sized employers from being subjected to employer mandate penalties. This transitional relief expires in 2016, so both mid-sized and large employers will be subject to employer mandate penalties attributable to 2016. Most mid-sized employers will enjoy reprieve until their plan renews in 2016. Counting Employee Transitional Relief Expires – In 2015, employers were permitted to determine their total number of full-time equivalent employees by averaging any consecutive 6-month period in 2014. However, in 2016, the employer will be required to average their FTEs for all 12 months in 2015 to determine if they are required to comply with the mandate. (Note: It is possible that this transitional relief may be extended.) Employer Mandate Margin of Error Shrinks – In 2015, large employers could fail to offer coverage to up to 30% of their full-time employees and still not face employer mandate penalties. In 2016, the margin of error shrinks to 5%. So in 2016 and beyond, both large and mid-sized employers will be required to offer coverage to 95% of their full-time employees or face a penalty. Employer Mandate Penalty Calculation Changes – In 2015, when calculating the "A" or "no coverage" penalty, large employers could subtract out their first 80 full-time employees. In 2016 and beyond, both mid-sized and large employers may subtract out only their first 30 full-time employees when calculating the "A" penalty.

More Companies Increased Contributions to Help Employees Pay Premiums

Companies are more likely to have added or increased contributions to their employees’ premiums this year compared to the last two years, according to a study by the Transamerica Center for Health Studies (TCHS). The study of 1,500 employers was conducted by the Harris Poll from August 14 to September 3. Forty-four percent of companies expect their healthcare costs to increase in the next 24 to 36 months.

Most employers are trying to keep constant their contribution to employees’ premiums (57%), deductibles (60%), and co-pays/coinsurance (58%). Thirty percent want to maximize their contributions to employees’ premiums to help manage health insurance costs. TCHS Executive Director Hector De La Torre said, “The anticipated increase in healthcare costs correlates to improved quality for many employers.” Forty percent expect the quality of health insurance they offer employees to improve in the next 12 to 36 months while only 10% expect the quality to decline. Companies are most concerned about managing healthcare costs related to cancer (71%), drug expenses (69%), and diabetes and obesity (68%).

Sixty-one percent of employers offer wellness programs. Forty-nine percent of employers that have had a wellness program in the past 12 months say that saving money was the motivation. Eighty-two percent of companies say their wellness program improved workers’ health; 80% say it improved productivity and performance, and 71% say it reduced healthcare costs. De La Torre said, “Providing the best healthcare benefit package possible remains the top healthcare-related priority for employers. Interestingly, employers that offer healthcare benefits are more likely to anticipate profitability, hiring and wage increases in the next two years.”

Navigating the employer mandate for 2016

 

Employer Mandate

IN THIS GUIDE:

How Do I Know if the Employer Mandate Applies to Our Organization?

When Did the Employer Mandate Begin?

How Do I Immunize My Organization from Employer Mandate Penalties?

Do I Have to Offer Coverage to Part-time, Seasonal and Variable Hour Employees?

How Are Employer Mandate Penalties Calculated?

What Employer Mandate Reporting is Required?

 

Navigating the Employer Mandate  (send for a free copy to;

 

info@amsisure.com

subject line: guideline to health care reform 2016 

 

2-Minute HR

Our 2-Minute HR trainings serve up important HR topics in segments that you can watch in less time than it takes to drink a cup of coffee. So take a couple of minutes to learn some great HR basics, tips, and best practices.  Browse our most recent trainings below, or filter them according to the HR topic you're most interested in.

 

FREE HR SUPPORT; HR Demo Video

 

 

 

 

 

 

 

 

 

 

 

  

• Health Plans Expect Group Premium Increase of 7.2% in 2016, 10.8% for Individual Plans

• Health Plans Expect Group Premium Increase of 7.2% in 2016, 10.8% for Individual Plans

You can check for the plans and relates of all companies in privacy, then contact us to assist you.

January 2016 rates now available.

 

Group Health Plans

 

Small Business (2-50 Employees)

Individual / Family Health Plans

• Standard Health Insurance

info@amsinsure.com

Employers plagued by ACA administrative burdens

By Nick Otto
November 3, 2015

As employers face growing challenges trying to balance employees’ well-being with containing benefits-related company costs, many are seeking guidance on how to manage the administrative and compliance requirements of the Affordable Care Act.

And as the health care law continues to evolve, be it through Congressional bills or Supreme Court rulings, employers are battling a number of reforms and regulations, and 60% of employers say they need help managing the ACA landscape, according to the Guardian Workplace Benefits Study.

Also see: “The long regulatory road trip for benefits professionals.”

“As employers adapt to the ACA, we’re seeing greater adoption of private exchanges and self-funded medical plans paired with stop-loss insurance, so employers can deliver the workplace benefits their employees rely on while addressing the challenges they are facing,” says Ray Marra, Guardian’s senior vice president, group products.

As companies reassess their approach to benefits, the report notes, three trends are gaining momentum: increased outsourcing, interest in private exchanges, and consideration of self-insurance.

“The ACA has intensified challenges for a majority of employers,” Marra says. “They must deal with administrative and compliance requirements, trying to offer employees wider benefits choices and an effective enrollment experience and controlling costs.”

The study notes one in three employers expects to outsource more aspects of their benefits program as a direct result of the ACA. Nearly 70% of employers expect greater compliance and administrative burdens because of the law.

Also see: “Boosting benefits enrollment with technology.”

And the market for benefits outsourcing appears to have considerable room for expansion, according to the report. Only 16% of all employers are engaged in a “high level” of outsourcing (where all administration tasks are outsourced to a vendor), while at the other end of the spectrum, just 15% report doing no outsourcing.

Companies with fewer than 1,000 employees are more likely than larger companies to outsource their benefits administration to a single third-party administrator (36% versus 22%), according to the report. Nearly half (47%) of employers that outsource all of their administration and enrollment tend to use a single vendor compared to 25% of those doing just a little to no outsourcing.

Also see: “Budget reconciliation sought for ACA repeal.”

“It’s important for brokers to provide guidance on emerging options for funding and delivering employee benefits which can help employers respond,” says Marra.

In addition, some other key findings from the report include:

• About 20% of employers expect to offer benefits on a private exchange in the next year. Top reasons are to increase employee choice and to improve the employee experience. Seven in ten employers say it is highly important to offer benefits that meet their employees’ personal needs and help them make better benefits choices.
• Of those thinking of self-insuring, 58% say the ACA is the impetus and half of those planning to self-insure expect to carry stop-loss insurance. Self-insuring medical plans is a less common funding option for smaller firms but is receiving increased attention due to the ACA. Seventy-eight percent of employers expect benefit cost increases due to the ACA, impacting an employer’s health benefits offering.
• A tailored benefits and communication approach is becoming increasingly critical to address employees’ financial needs at different points in their work stages.

 

Federal repeal of small group expansion won't impact California

On October 8, 2015, the federal government repealed the decision to redefine customers with 51 to 100 employees as small groups. That means these customers will continue to be defined as large groups and must purchase health coverage in the large group market. The federal legislation still allows individual states the option to expand the definition of small group from 1 to 100 employees in 2016, which is the definition currently set by the California legislature. Unless further guidance is issued by the state, we are moving forward with the transition of groups with 51 to 100 employees in California to small business at their 2016 renewals. We'll keep you updated should more information become available. If you have questions, please contact your Kaiser Permanente representative.

Focus on Nonqualified Deferred Compensation Plans

If certain executives are critical to the success of your business, providing them with a nonqualified deferred compensation (NQDC) plan could be an effective retention strategy. Such a plan represents an agreement whereby one person (or legal entity) promises to pay compensation at some time in the future. The plan is a contractual agreement between the employer and an employee, which specifies when and how future compensation will be paid.
When the plan is properly arranged, the employee defers taxation until benefits are actually paid. Because these plans are not governed by Federal pension laws, they are considered "nonqualified," and they can be extremely flexible. Their very flexibility—and the associated risks—means that professional guidance from tax, legal, and financial professionals is required. From a business standpoint, it is important to establish an informal funding mechanism to help ensure the benefits are available when the employee is entitled to them. From a tax standpoint, it is important to ensure that the employee's benefits are taxed upon receipt, and not before. Professional advice is advised to ensure compliance with all tax issues related to NQDC plans, including the Internal Revenue Service's "constructive receipt doctrine" and IRC Section 409A, the latter of which prescribes rules regarding the timing of deferral elections,
acceleration of benefits, and distribution of deferred amounts.

ACA Spurring Interest in Self-Insurance

Self-insurance can create risk exposures that most smaller employers don’t want to take. Still, 15 percent of smaller employers (1-199 employees) find the benefits outweigh the risks. Read on for details.

How to Survive the Surge with the expanding world of ACA Audit & Penalty Enforcement

While there have been audits since 2012, it is now growing as we move into the need for revenue generation from the various forms of penalty noncompliance.  With more agencies now doing audits; Department of Labor, Department of Health and Human Services, and the big gun Internal Revenue Service your chances are growing of having an audit.

Agencies are making it easier for people to file complaints with agencies on line, and with all the forms being reviewed it is making it easier to be an audit target.  There are significant penalties for both small and large businesses.  Self-reporting on the various forms is making it difficult for employers and giving the agencies an opportunity to have information to look at doing an audit.  Also cross fertilization from one agency to another can lead to audit  uncovering a problem covered by different agency.

KNOW the ENFORCEMENT ZONES

DOL

·         ACA

·         Erisa including Form 550, Plan documents, and summary plan descriptions

·         HIPPA

HHS

·         Summary of benefits coverage

·         HIPPA privacy, security, and breach of notification rules

·         Medicare secondary payer through CMS

IRS

·         ACA including reporting

·         Misclassification of employees as independent contractors

·         COBA

·         Employee benefit related tax issues, such as group term life insurance, valuation.  Cafeteria plan operations, and discrimination testing duties

Equal Employment Opportunity Commission (EEOC)

·         Americans with Disabilities Act

·         Age Discrimination in Employment Act

Genetic Information

How important are your key employees.

Your  key employees need their wages. Have you talked to them about getting their income covered - with Disability Income Insurance?

 

 

We want to provide you with something that is of value to you as an employer and your key employees.  Its easy to provide a benefit at a low cost unlike other benefits. Contact us for a no obligation quote.

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Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act

On Feb. 10, 2014, the IRS and Treasury issued final regulations on the Employer Shared Responsibility provisions under section 4980H of the Internal Revenue Code. More information is available on the employer shared responsibility page. The following questions and answers provide helpful information about the guidance:

• Basics of the Employer Shared Responsibility Provisions: Questions 1-3
• Which Employers are Subject to the Employer Shared Responsibility Provisions: Questions 4-14
• Identification of Full-Time Employees: Questions 15-17
• Liability for the Employer Shared Responsibility Payment: Questions 18-23
• Calculation of the Employer Shared Responsibility Payment:Questions 24-26
• Making an Employer Shared Responsibility Payment: Questions 27-28
• Transition Relief: Questions 29-39
• Basics for Small Employers: Questions 40-42
• Related Provisions: Questions 43-47
• Additional Information: Questions 48-56

Basics of the Employer Shared Responsibility Provisions

1. What are the Employer Shared Responsibility provisions?
For 2015 and after, employers employing at least a certain number of employees (generally 50 full-time employees or a combination of full-time and part-time employees that is equivalent to 50 full-time employees) will be subject to the Employer Shared Responsibility provisions under section 4980H of the Internal Revenue Code (added to the Code by the Affordable Care Act). As defined by the statute, a full-time employee is an individual employed on average at least 30 hours of service per week. An employer that meets the 50 full-time employee threshold is referred to as an applicable large employer.
Under the Employer Shared Responsibility provisions, if these employers do not offer affordable health coverage that provides a minimum level of coverage to their full-time employees (and their dependents), the employer may be subject to an Employer Shared Responsibility payment if at least one of its full-time employees receives a premium tax credit for purchasing individual coverage on one of the new Affordable Insurance Exchanges, also called a Health Insurance Marketplace (Marketplace).

Workers missing out on billions in unclaimed 401(k) matches

by Andrea Davis

MAY 13, 2015
11:39am ET

 

While the majority of employers offer a company match on their 401(k) plan, employees are not taking advantage of the benefit, passing up the chance to potentially receive thousands of dollars every year.

 

A new research report from Financial Engines, an investment advising company, estimates that Americans leave $24 billion in unclaimed 401(k) company matches on the table each year.
Financial Engines examined the saving records of 4.4 million retirement plan participants at 553 companies, and found that one-in-four employees (25%) miss out on receiving the full company 401(k) match by not saving enough. The typical employee failing to receive the full match leaves $1,336 of potential “free money” on the table each year, which equates to an extra 2.4% of annual income not received. With compounding, this could amount to as much as $42,855 over 20 years.

Disability Month; learn how to protect your income!

Now is a great time to learn about protecting your most valuable asset – your income. Watch this video to find out what you need to know. Watch the video now!

Employers report limited premium increases in wake of ACA

Health care in the U.S. is a hot button issue but the early consensus is that the Affordable Care Act has been integrated well by employers.

“One of the big concerns [about the ACA] is this is going to drive up our premiums and the cost of healthcare,” says Christopher Ryan, vice president, Strategic Advisory Services at ADP.
But, he adds, this has not materialized as originally thought. “I give credit do business,” he adds, “I think business looked very carefully at their current practices and … has been well managed.”

A new study suggests that premiums for employees and headaches for employers have been minimal. The 2015 ADP Annual Health Benefits Report says that for companies with more than 1,000 employees, insurance premiums have risen 9.4% since 2011 – and only 2.6% from 2014 to 2015.

Care in terminating an employee?

Question about Terminations We have an employee who was expected to return from FMLA yesterday. She has not returned and we haven't heard from her. Can we terminate her employment?

Answer from Rebecca, one of our HR Pros Communication from both the employer and the employee is critical to the success of leave that is protected under the Family Medical Leave Act (FMLA). This is especially true if the employee’s expected return date is before her full FMLA allowance would be used. In that situation, it is possible that the continued absence would be protected FMLA leave, so you should make every practical effort to contact the employee, by phone, email, and certified mail. All efforts to contact the employee should be documented You should also consider whether the employee may be protected under the Americans with Disabilities Act (ADA), even if all FMLA protected leave has been taken. FMLA issues can often prompt an ADA analysis. If you think there is any possibility that the employee would be considered disabled under the ADA based on your objective knowledge (and especially the reasons given for the initial FMLA leave) you should also be reaching out in an effort to start the ADA interactive process to determine if she is disabled and if there are any reasonable accommodations that can be made. You may be able to sever the employment relationship if the employee is completely unresponsive within a reasonable period of time. However, prior to termination we recommend that you make written attempts to reach the employee via certified mail, return receipt requested, and document those attempts in her personnel file. While the “reasonable period of time” may be dependent on the particular situation, generally two weeks from the confirmed date of receipt of the certified letter would be an acceptable amount of time to wait before proceeding with a termination for job abandonment. You should also ensure that no contract, state specific regulation, or other protection (such as workers’ compensation) would require additional allowed absence or a different termination procedure. Following this procedure shows "good faith" on your end. Acting in good faith and documenting your good faith efforts may provide you with protection should you ever be challenged with regard to your decision to terminate this employee. Even if the FMLA protected leave is exhausted and no ADA protections are available to the returning employee, you may choose not to treat the failure to return from FMLA leave in exactly the same way as other job abandonment is treated. By giving the employee who has failed to return from leave a week or two to explain the absence, you can ensure that all parties are in agreement about the expected return date and that additional protected leave is not required. However, if you do decide to apply your regular job abandonment policy in this situation, you should make sure that you are giving the non-returning employee the same number of missed work days and attempts at communication before termination that you would give to any other employee, or have given to other employees in the past.

Penalties & Reporting for Violations of ACA Requirements

 

March 26, 2015

If you are a private employer (non-governmental) who has failed to comply with the various portability, access and renewability requirements imposed on your single employer group health plan by the Affordable Care Act (ACA) (such provisions are found in Chapter 100 of the Internal Revenue Code and include prohibitions against annual or lifetime limits, pre-existing condition limitations and waiting periods in excess of 90 days, as well as a requirement to provide no-cost preventive services and other requirements), you must timely report your violation and pay the related excise tax under Section 4980D of the Internal Revenue Code. This includes employers who sponsor medical reimbursement plans or health reimbursement arrangements that have improperly reimbursed premiums for individual health insurance, another employer’s health plan, TRICARE or Medicare, or medical expenses that do not fit within a limited exception from the ACA limits (please see our recent alert on these arrangements here).

You should periodically check your compliance from time to time, since quick corrective action could save you significant dollars.

Penalties & Exceptions

The excise tax is $100 per day of noncompliance for each individual to whom the ACA failure relates. In most cases, this means the excise tax is calculated based upon the number of your full-time employees. The noncompliance period begins on the date of the first failure and ends on the date of correction.

However, it is important to note that certain exceptions and limits to the excise tax are available:

1. if you can demonstrate that you did not know (and, in exercising reasonable diligence, would not have known) that there was a compliance failure, no tax is due.
2. if you can demonstrate that the failure was due to reasonable cause rather than willful neglect and was corrected within 30 days after you first knew (or, in exercising reasonable diligence, should have known) that the failure existed, no tax is due (note that church plans may have a longer correction period).
3. if you can demonstrate that the failure was due to reasonable cause and not willful neglect, your tax is reduced to the lesser of 10% of the amount that you paid during the preceding tax year for group health plans, or $500,000.
4. if you can demonstrate that the failure was due to reasonable cause and not willful neglect, the IRS also has the power to waive part or all of the tax, to the extent the payment would be excessive relative to the failure involved.

Additionally, even if you meet an exception from the excise tax, it is important that you promptly take correction steps because a minimum excise tax will apply for compliance failures that occurred or continued during a taxable year if they are not corrected before you are notified by the IRS of an audit of that taxable year. The minimum excise tax is the lesser of the excise tax that would have been owed without applying the exceptions above or $2,500 per individual,but it is increased to $15,000 per individual if violations are "more than de minimis."

A failure is treated as “corrected” if it is retroactively undone to the extent possible and affected employees are placed in a financial position as good as they would have been in had the failure not occurred.

Reporting

If you have committed a violation, you must self-report the violation on IRS Form 8928 (Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code). It is unclear whether employers can avoid this filing requirement if they feel they clearly satisfy one of the first two exceptions above that exempts the employer from all taxes and does not otherwise contemplate IRS action to actually waive the taxes. However, since your qualification for these first two exceptions will be based on the facts and circumstances, it appears that you will only achieve certainty by filing the IRS Form 8928 and indicating that $0 is due.

You must file the IRS Form 8928 and pay any excise tax by the due date for filing your company’s income tax return for the taxable year in which the failure occurred (or continued). If your failure spans more than one taxable year, you will need to allocate and report the noncompliance periods to the proper taxable year. No deadline extension is available if you extend the date to file your company’s income tax return, but you may obtain an automatic 6-month extension by filing IRS Form 7004 on or before the deadline for the IRS Form 8928. However, obtaining this extension does not extend the time for you to pay any excise taxes due (so you will need to estimate taxes and may potentially owe interest on late payments), and the IRS has the right to terminate an automatic extension upon written notice to you.

Employer Actions

Since the ACA requirements have not been in effect for very long, it is unknown how strictly the IRS will enforce them. Many experts believe that the IRS is likely to audit compliance in this area because of the significant penalties involved and the overall need to fund other ACA costs.

Given the magnitude of the potential excise taxes that could become due under Code Section 4980D, and the possibility of a complete waiver if errors are quickly addressed, you should:

• quickly determine whether you have any issues with the portability, access and renewability requirements imposed by the ACA on your single employer group health plan(s), especially any medical reimbursement programs or health reimbursement accounts (HRAs), and
• periodically review your compliance with these requirements to make sure that problems are promptly identified, corrected and reported (if required).

With a team of professionals who are highly experienced in the employee benefits field, MLA can provide answers to questions and assistance in complying with these requirements. For assistance, please contact Ann Murray (404-527-4940) or any of our MLA benefits attorneys.
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ACA News: Final IRS forms for employer mandate and minimum essential coverage reporting

 

March 19, 2015
Employer mandate reporting
The employer mandate provision of the Affordable Care Act (ACA or health care reform law) says “applicable large employers,” which are companies with 50 or more full-time workers, have to offer minimum value, affordable health coverage to their full-time workers or face a penalty.
To check if employers are offering minimum value, affordable coverage to their full-time workers, the Internal Revenue Service (IRS) needs reports to be sent by applicable large employers. This is called Employer Mandate Reporting, or IRS Code Section 6056 Reporting.
The IRS has released the final forms and instructions: Form 1094-B, Form 1094-C,Form 1095-C, Instructions for 1094-B, Instructions for 1094-C and 1095-C.
Minimum essential coverage reporting
The individual shared responsibility provision of the ACA states that every person has to have basic health insurance coverage or face a penalty. This is known as minimum essential coverage (MEC). To make sure people have MEC, the Internal Revenue Service (IRS) needs reports to be sent by those who provide MEC. This is called Minimum Essential Coverage Reporting, or IRS Code Section 6055 Reporting. This is required of insurers with fully insured business and employers with self-funded (ASO) plans.
The IRS has released the final forms and instructions: Form 1095-B, Form 1095-C, Instructions for 1095-B, Instructions for 1095-C.
As a reminder, nothing needs to be done with the forms this year. These are for reference only since employer mandate and MEC reporting are not required until January of 2016 for the 2015 coverage year.
Questions?
Go to this fact sheet for more about employer mandate reporting. For more details about MEC reporting, read this fact sheet.

New HHS Regs 'Clarify' That Health Plans Covering Families Must Have 'Embedded' Individual Cost-Sharing Limits

"[HHS] now requires group health plans to embed an individual cost sharing limit within the family limit.... The HHS clarification is not effective until plan years beginning on or after January 1, 2016. It is important to note that, at the moment, it is unclear whether the HHS clarification is intended to apply to self-insured plans.... Additionally, all previous cost sharing guidance applicable to self-insured plans have been issued jointly by the HHS, Department of Treasury and [DOL]. As of the date of this [article], the Departments of Treasury and Labor have not issued a similar clarification."

Americans Are Feeling a Little Better About Their Retirement Crisis

Fewer Americans are worried they won't have enough money to be self-sufficient in old age, but healthcare costs concerns still loom large. READ MORE »

How to avoid legal trouble when firing an employee

Firing an employee can lead to legal complications if you aren't careful, writes Kim Shandrow. Among other things, ask yourself whether you are within the boundaries of the law and company policy. "No matter what, stick to your plan, your script, and be professional -- which isn't easy when someone cries or slams the table or threatens you with violence," said Chas Rampenthal, general counsel for LegalZoom. Entrepreneur online

HR Demo Video  Are HR Platform available to clients with online resources and answers from professionals to your questions.

ACA Countdown to Compliance for Employers (PDF)

135 pages. "52 weekly blog posts that comprise the series ... [which] appeared in the Mintz Levin Employment Matters Blog during 2014. Each of the posts addressed compliance issues affecting employers with a particular, though not exclusive, focus on that law's employer shared responsibility (a/k/a 'pay-or-play) rules. The end of the series coincided with the January 1, 2015 'go live' effective date of the new rules. The issues discussed week-to-week were generally gleaned from newly-issued guidance or developing problems, questions or concerns." (Mintz Levin)  click here for the report

Question about Health Care Reform relating to the employer contribution?

Question about Health Care Reform We are subject to the Employer Mandate this year and are trying to determine how much we will need to contribute to our employees' plans to make them “affordable” under the ACA. We would like to use the safe harbor method of using 9.5% of W-2 wages. Is it possible to use this method and charge employees different amounts for the same insurance based on their salaries?

Answer from Jenny A., one of our HR Pros Currently, there is uncertainty around this particular issue as there is no case law or guidance that tells us whether this contribution method will comply with ERISA’s anti-discrimination guidelines. As you know, under the Affordable Care Act, one of the safe harbor methods for determining affordability is to use the 9.5% of the employee’s W-2 wages method.  Another is to use the 9.5% of the employee’s monthly income method.  These methods naturally lend themselves to employers wanting to set their contribution structure based on each employee’s earnings.  And under the Affordable Care Act, doing so would seem to comply with the Act. The problem lies in existing legislation, namely ERISA.  Under the ERISA anti-discrimination guidelines, similarly situated employees must be treated consistently when it comes to contribution.  Disparities in contribution structures must be supported by legitimate employment-based classes of employees.  For example, ERISA allows one contribution schedule for hourly employees and another for salaried employees, as long as similarly situated employees are treated consistently.  Another example is for employees in different geographical locations, so you could contribute 50% to employee only coverage for Georgia employees, and 75% of employee only coverage for California employees and still comply with ERISA. So, using the method you described of each employee paying only 9.5% of their wages for the employee-only portion of their coverage certainly works for ACA compliance, but could potentially violate ERISA’s anti-discrimination guidelines.  Of course, the employer could argue that each employee is paying the same percentage of wages, and that may be a good argument.  Until a case on that point actually arises through, it is difficult for us to predict whether a court of law would consider this an ERISA violation.  Therefore, our recommendation right now is not to use this contribution schedule.  Rather, we recommend setting a blanket contribution amount for all similarly situated employees, publishing that amount in the official plan documents and remaining consistent with that contribution throughout this plan year.  After that time, hopefully we will have some case law to review to see how the courts have decided on this issue. As a side note, if you are looking for the most simple (though perhaps not most cost-effective) method of setting your contribution schedule to meet the affordability provisions of the ACA, my favorite method is the federal poverty level safe harbor.  Rather than being a percentage of income, this method uses a flat amount that the employer can contribute in order to meet the ACA affordability provisions.  For 2015, this amount is $1100.  So as long as no full-time employee has to spend more than $1100/year for the employee-only portion of their health insurance coverage, you have met the affordability test.  Again, this may not be the most cost-effective method, especially if the majority of your employees make more than the federal poverty level, but this is a fairly simple method to use, as it in no way hinges on the employee’s monthly or W-2 wages, which of course may fluctuate.  It also allows for a bit of ease when completing the ACA reporting at the end of the year.

Jenny has over 15 years of Human Resources Management experience. She has worked with clients in a variety of industries to reduce exposure to employment-related liability and assist with employee relationship issues. Jenny holds a Bachelors of Business Administration (BBA) from the University of Georgia and a Masters of Business Administration (MBA) degree with a concentration in Human Resources Management from Georgia State University. She is certified as an SPHR (Senior Professional in Human Resources) through the Human Resource Certification Institute.

Contact information

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Legal Disclaimer: The HR Support Center is not engaged in the practice of law. This response should not be relied upon or construed as legal advice, and does not create an attorney-client relationship. If you have legal questions concerning your situation or the information you have obtained, you should consult with a licensed attorney. The Company can in no way be held liable for any actions taken as a result of this correspondence. To change your subscription preferences, please click Unsubscribe. © 2015 HR Support Center

VA vs Employer Coverage? And Covered Ca.

Posted: 09 Jan 2015 09:23 AM PST

Question: I have had no medical insurance for 2014 except for how I am covered at the VA. The job I have for 2015 now offers insurance. Will I be penalized for using the VA and not acquiring CC insurance for 2014? Answer: VA health coverage is recognized by the ACA aa meeting the "minimum acceptable coverage" requirement, so you are not subject to penalty if you opt out of your employer-based coverage. If you take the employer's coverage and keep the VA coverage, your benefits will be coordinated with the employer coverage used first and the VA covering the gaps.

Have you updated your new employee waiting periods?

Health Care Waiting Periods

The beginning of 2015 is ripe with new health care reform requirements. While the majority of these, such as the implementation of the first phase of the Employer Mandate and the reporting requirements for health coverage, impose additional burdens on employers, the California-specific change actually relaxes an earlier requirement. The previously-in-effect cap of 60 calendar days on waiting limits for otherwise eligible employees to be allowed to join an employer-sponsored health plan will be gone on January 1, 2015. With this requirement removed, employers are permitted to follow the federal waiting period cap of no more than 90 calendar days.



We can help you with your new options, contact us at info@amsinsure.com or call 800-334-7875

ACA's employer mandate goes into effect for some businesses

Businesses with 100 or more full-time employees must offer health insurance to at least 70% of those employees this year or face a tax penalty under the Affordable Care Act. New reporting requirements also take effect this year, and some consultants are offering training sessions. American City Business Journals/Portland, Ore./Health Care Inc. Northwest blog (12/29)