48 THE QUEENS COURIER • HEALTH • MARCH 6, 2014 FOR BREAKING NEWS VISIT www.queenscourier.com health Employer Mandate Penalties Delayed Until 2015 COURTESY BENEFITS ADVISORY SERVICE The Obama Administration has postponed the Affordable Care Act (ACA) employer mandate penalties for one year, until 2015. The Department of the Treasury announced the delay on July 2, 2013, along with a similar delay for information reporting by employers, health insurance issuers and self-funded plan sponsors. The delay does not affect any other provision of the ACA, including individuals’ access to premium tax credits for coverage through an exchange. The Treasury plans to issue more formal information about the delay within a week. One-Year Implementation Delay The employer mandate provisions of the ACA are also known as the employer shared responsibility or pay or play rules. These rules impose penalties on large employers that do not offer affordable, minimum value coverage to their full-time employees and dependents. They were set to take effect on January 1, 2014. According to the Treasury, the delay of the employer mandate was required because of issues related to the reporting requirement. With the reporting rules delayed, it would be nearly impossible to determine which employers owed penalties under the shared responsibility provisions. Therefore, these payments will not apply for 2014. The now-delayed reporting requirements are found in Internal Revenue Code sections 6055 and 6056. These rules apply to insurers, self-insuring employers and other parties that provide health coverage, along with certain employers with respect to health coverage offered to their full-time employees. The administration’s decision is based on concerns voiced by businesses about the complexity of the requirements and the need for more time to implement them effectively. Effects of the Delay The additional year will give employers time to understand the employer mandate rules, to make decisions about providing health coverage and to adapt their reporting systems, without worrying about potentially signifi cant penalties. It is unclear how the new deadline will impact guidance that has already been issued, such as the transition relief for non-calendar year plans and the optional safe harbor for determining full-time status. Future Guidance The administration plans to use the additional implementation time to consider ways to simplify the new reporting requirements consistent with ACA. The Treasury also plans to discuss the rules with stakeholders, including employers that currently provide health coverage to employees, and then publish proposed rules implementing these provisions later this summer. It is the Treasury’s intention to minimize the reporting requirements. The pay or play regulations issued earlier this year left many unanswered questions for employers. The IRS had highlighted several areas where it would be issuing more guidance. Presumably, the additional time will give the IRS and Treasury the opportunity to provide more comprehensive guidance on implementing these requirements. Benefi ts Advisory Service, Inc is a New York-based employee benefi ts consulting fi rm and insurance brokerage, distinguished by our reputation for handson service and strategic approach to today’s benefi ts challenges. Founded in 1991, BAS has more than 20 years of success serving mid to large-size employers in the greater New York region. Our team is comprised of expert industry veterans of the insurance and human resource fi elds Follow them on Twitter for important benefi ts news and legislative updates! twitter.com/Benefi tsAdv. NYS Was Already Compliant Insurance Company Responsibility Insurance Company Responsibility Insurance Company Responsibility NYS Was Already Compliant Insurance Company Responsibility Insurance Company Responsibility Insurance Company Responsibility Federal Health Care Reform Bill Provisions NYS Was Already Compliant n/a Insurance Company Responsibility 2011 • Uninsured children covered to age 26 • Lifetime benefit maximums prohibited for essential benefits • “Reasonable” annual benefit maximums required for essential benefits • Pre-existing conditions exclusions prohibited for dependents < 19 • 100% preventive services coverage (grandfathered plans exempt) • Mandatory internal & external appeals processes • OTC medicines not covered in FSA/HRA/HSA without prescription • Insured plan medical loss ratio maximum/rebate provision • 20% HSA penalty on non-medical withdrawals • Early retiree reinsurance program implemented • For employers annually issuing > 250 W-2s, report the cost of medical premium (report in 2013) • Uniform Summary of Benefits and coverage (9/23/12) • 100% coverage for expanded women’s preventive health care (plan year beginning 8/1/12 or later) 2012 Insurance Company Responsibility Insurance Company Responsibility Insurance Company Responsibility Insurance Company Responsibility 2013 • FSA contributions limited to $2,500 • Medicare tax increase on earned and unearned income for high-income employees • Employer plans pay $1 PEPY for comparative effectiveness research ($2 PEPY beginning 2014) • 10/1/13 Employers are required to distribute a notice of the health insurance exchange • Exchanges set to open for individuals and small employers • Waiting periods longer than 90 days prohibited, benefits must begin on the 91st day • Annual benefit maximums prohibited for essential benefits 2014 • HIPAA-allowed wellness incentives increased to 30% • EE's working 30 hours per week need to be eligible for coverage • Health Insurer Tax Begins • Further Guidance regarding Non-Discrimination rules for fully insured plans Pending Additional Guidance • Out-of-pocket limits tied to HSA maximums (Max in 2014 $6,350/$12,700) Carrier Driven • Employer mandate ("pay or play") to provide creditable and affordable coverage for employers between 51-99 employees Discussion Point • Employer mandate (”pay or play”) to provide creditable and affordable coverage for employers over 100 employees Discussion Point • SHOP Exchanges scheduled to open for employers with more than 100 Employees Discussion Point 2016 • Employer sponsored plans cannot impose annual benefit limits • Health plans cannot impose pre-existing condition limits on adults Insurance Company Responsibility Insurance Company Responsibility Discussion Point 2015 2017 • Individual Mandate Begins 3/31/14 deadline Already Compliant n/a • Small group market expands to include employers with up to 100 eligible employees 2018 • 40% Cadillac Tax on “high-value” benefits plans ($10,200 single, $27,500 family) Pending Additional Guidance • New employee auto-enrollment Pending Additional Guidance COURTESY BENEFITS ADVISORY SERVICE AFFORDABLE CARE ACT
QC03072014
To see the actual publication please follow the link above