By the end of 2017 the IRS plans to send notification to applicable large employers (ALE) of potential liability for failure to comply with the “pay or play” mandate of the Affordable Care Act (ACA). These notifications (Letter 226J) will be sent to ALE employers that the IRS determines had one or more employee, in at least one month in 2015, that received a subsidy toward health care premiums purchased through the marketplace because the employer failed to provide health coverage that is compliant with the ACA requirements (affordable and providing minimum essential coverage). The IRS will make this determination based on information provided by employers on Forms 1094-C and 1095-C (required ACA reporting forms) as well as information provided to the IRS on individuals’ tax returns. Continue reading
Based on the regulations of the Affordable Care Act (ACA), Health Care Insurance Marketplaces (also referred to as Exchanges) will begin to send out notifications to certain employers when one or more of their employees enrolls in coverage through the Marketplace and is eligible for a subsidy, or Advanced Premium Tax Credit, for one or more months. In 2016 the notices will only be sent when employees provide a complete address for the employer. This means that in 2016 employers may not get notices from the Exchange for all employees who are receiving subsidies. A sample notice can be found here.
The following are some common questions many employers have about these notices. Continue reading
A lot has happened over the past few years. The Affordable Care Act, or ACA, has transformed the way millions of people obtain health insurance coverage for themselves and their families. But it’s a complicated law, with a lot of moving parts. Many consumers, workers and human resources professionals/employers are confused about whe
re their role in covering workers ends and the ACA begins. This is particularly true in instances where a worker has left the job and is no longer eligible for coverage under the employee group plan. Here are answers to some of the most frequently asked questions:
If your organization employs seasonal workers or part-timers for the holidays, take note: The IRS has issued a Health Care Tax Tip on how these individuals affect whether your business is subject to the shared responsibility provisions of the Affordable Care Act (ACA).
A major component of the Affordable Care Act is guaranteed preventive care services at no cost to any person with healthcare insurance. At first glance it would appear that free preventive care would include annual wellness exams from the subscriber’s primary care physician along with other yearly checkups at no cost to the subscriber. However further review of this mandate makes it clear that it has a much broader intention.
Historically, employers that wanted their employees to be protected with health coverage, but didn’t want the hassle of having a company health plan, could simply give them an amount of money sufficient to reimburse them for the cost of buying that coverage or some portion of it. As long as the individuals provided evidence that they used those funds for that purpose, the dollars were excludable from taxable income for the employees.
Alternatively, employers could just pay the premiums directly to the insurance carrier.
Back in November 2014, however, the Department of Labor (DOL) declared that companies reimbursing employees for medical care instead of offering a health care plan is equivalent to a health plan and is subject to the Affordable Care Act (ACA). And since those reimbursement arrangements failed to meet ACA requirements in two ways — that is, the condition that group health plans have no annual limits on benefits, and also that no co-pay for certain preventive health services must be paid — they were ruled to be noncompliant with the law.
Does your company’s health insurance plan include health reimbursement arrangements (HRAs) or flexible spending accounts (FSAs)? If so, you should know these plan components are both subject to the Affordable Care Act (ACA) and its “market reform” provisions. The Department of Labor and other principal agencies have issued another round of guidance to answer some of the frequently asked questions about health care reform, including questions about the use of HRAs and FSAs.
According to the new guidance, HRAs and FSAs are covered by the Affordable Care Act’s prohibition on annual benefit limits and are required to provide the same set of preventive health benefits as any other compliant health plan. The sticking point comes when you try to bolt HRA or FSA accounts onto an “individual market” policy. This cannot be done.