The Affordable Care Act (ACA) penalizes large employers that do not offer minimum essential coverage to full-time employees and their dependents. Large employers that offer this coverage may still be responsible for a penalty if the coverage is unaffordable or does not provide minimum value. Recently the IRS published final regulations on the employer mandate and clarified the definition of hours of service for employers. This clarification will help employers when determining who is a full time employee and should be offered coverage.
The following are definitions of hours of service:
- Each hour for which an employee is paid or entitled to payment while working
- Each hour for which an employee is paid or entitled to payment while on paid time off (vacation, holiday, illness, jury duty, leave of absence)
The final regulations state that all paid leave must be taken into account. It also states that all hours of service worked for all entities should be treated as a single employer. There are different methods of calculating hours worked when dealing with different employee types or categories for example hourly or non-hourly employees. These two are reviewed below but several other employee categories are covered in the healthcare reform bulletin.
A waiting period is the period of time that must pass before coverage becomes effective for an employee or dependent who is otherwise eligible to enroll in the plan. Under the ACA, all calendar days are counted beginning on the enrollment date, including weekends and holidays. However, if an individual enrolls as a late enrollee or special enrollee, any period before the individual’s late or special enrollment is not a waiting period.
The waiting period limit does not require an employer to offer coverage to any particular employee or class of employees, including part-time employees. The waiting period limit only prevents an otherwise eligible employee (or dependent) from having to wait more than 90 days before coverage under a group health plan becomes effective.
The Affordable Care Act (ACA) requires non-grandfathered fully insured health plans to satisfy nondiscrimination rules regarding eligibility to participate in the plan and eligibility for benefits. This requirement was originally set to take effect for plan years beginning on or after Sept. 23, 2010. However, in late 2010, the IRS announced that the nondiscrimination requirement for non-grandfathered fully insured plans is delayed indefinitely, pending the issuance of regulations (or other administrative guidance) on how to comply with the requirement.
The IRS has still not issued regulations (or other administrative guidance) on the ACA’s nondiscrimination requirement for non-grandfathered fully insured plans. Because the nondiscrimination requirement has been delayed indefinitely pending the issuance of regulations, IRS officials have confirmed that the requirement will not be enforced this year.
Prior to the Affordable Care Act (ACA) becoming law, it was common practice for insurance companies to vary the price of premiums based on things like health status, demographics, industry and the amount of time someone has been on a plan. While those practices are currently still in effect, they will be banned for some plans starting Jan. 1, 2014
In addition to premiums rising, there will be additional tax provisions. Click the links below to see full legislative briefs on both premium cost and tax provisions.
Responding to pressure from consumers and Congress, on Nov. 14, 2013, President Obama announced a new transition policy for 2014. Under the new policy, individuals and small businesses whose coverage has been canceled (or would be canceled) because it does not meet the ACA’s standards may be able to re-enroll or stay on their coverage for an additional year.
However, this one-year reprieve may not be available to all consumers. Because the insurance market is primarily regulated at the state level, state governors or insurance commissioners will have to allow for the transition relief. Also, health insurance issuers are not required to follow the transition relief and renew plans, and have expressed concern that the change could disrupt the new risk pool under the federal and state Health Insurance Marketplaces.