Top 10 Things to Know about the Affordable Care Act

09.09.2013
Issues & Policies

With summer winding down, now is a good time for a brief review of what Connecticut employers need to know about impending federal healthcare legislation, known as the Affordable Care Act (ACA). Rollout of new ACA rules is coming in just a few months–January 2014.   

1.     Employee Notice: You must provide your employees with notice of the state health exchange by October 1, when the state exchange is beginning its open enrollment period.

2.     Employee Benefits Summary: A Summary of Benefits and Coverage form must be provided to employees to explain their benefit options

3.     Large or Small Employer? The ACA has its own definitions of large and small employers.  You must determine if your company breaks the 50-employee threshold and counts as a large employer (subject to specific rules and requirements).

4.     Counting Employees: Counting employees means more than counting heads. It’s a complicated calculation that includes part-time and seasonal employees and should be done now (important for future planning since the penalties are delayed).

5.     Play or Pay Delayed: With the employer penalty now delayed, employers with 50 or more employees will not face potential penalties until 2015. If you have fewer than 50 employees, you will not face penalties for providing insufficient, or not providing at all, health insurance.  More information here.

6.     W-2 Reporting Delays: Reporting certain information on your employees’ W-2 forms has been deemed optional by the IRS. See: http://www.irs.gov/uac/Form-W-2-Informational-Reporting-of-the-Cost-of-Employer-Sponsored-Group-Health-Plan-Coverage.

7.     Wellness Programs and Preventive Care: New regulations cover financial incentives and types of allowable wellness programs and the federal legislation includes a focus on preventive care.

8.     New Taxes and Fees: The ACA is introducing new taxes and fees, such as the Patient Centered Outcomes Research Institute (PCORI) fee (which applies to insurers and self-insured businesses), as well as new taxes, such as the Medicare tax (with thresholds of  $250,000 for those who are married and file jointly, $125,000 for those who are married and file separately, and $200,000 for others). It’s critical to be aware of taxes or fees that could impact your business.

9.     Subsidies: Individuals, and employers with fewer than 50 employees, may be eligible for financial subsidies through the new state health insurance exchange

10.  Nondiscrimination Rules: Non-grandfathered fully funded plans must comply with nondiscrimination rules (self-funded plans must already comply under previous laws). However, until the IRS issues additional guidance, employers are not subject to penalties.

For more information, contact CBIA’s Jennifer Herz at 860.244.1921 or jennifer.herz@cbia.com. Also visit CBIA’s Healthcare Resource Center.

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