Celtic Healthcare Consultants works with businesses of all sizes from start-ups to established businesses on their health insurance needs.
We work with our clients to keep them informed and in compliance with the provisions of the Affordable Care Act (ACA). Listed below are some of the key provisions of the ACA as it pertains to small and large business groups.
Key Provisions Under the Affordable Care Act for Employers with Fewer Than 25 Employees
The information outlined below is a summary of the key provisions of the Affordable Care Act to date. Additional provisions may have been added therefore, please consult with your tax advisor for the most up-to-date information. Some of the provisions that may impact employers with fewer than 25 employees include:
Small Business Health Care Tax Credit
The Small Business Health Care Tax Credit helps small employers afford the cost of providing health care coverage for their employees and is specifically targeted for those employers with low- and moderate-income workers.
Small Business Health Options Program (SHOP)
Small employers with generally up to 50 full-time equivalent (FTE) employees have access to the new Health Insurance Marketplace through the Small Business Health Options Program (SHOP). To purchase coverage in SHOP, eligible employers must have at least one common law employee, offer SHOP coverage to all of their full-time employees, and meet minimum participation rates. If you are a self-employed business owner with no employees, you would not be eligible to purchase coverage through SHOP, but you can buy coverage in the individual Marketplace.
Employer Notice to Employees of the New Health Insurance Marketplace
Under the Affordable Care Act, employers covered by the Fair Labor Standards Act (generally, those companies that have at least one employee and at least $500,000 in annual dollar volume of business), must provide notification to their employees about the new Health Insurance Marketplace; inform employees that they may be eligible for a premium tax credit if they purchase coverage through the Marketplace; and advise employees that if they employee purchase a plan through the Marketplace, they may lose the employer contribution (if any) to any health benefits plan offered by the employer. Employers were required to provide this notice to all current employees by October 1, 2013, and to each new employee at the time of hire beginning October 1, 2013, regardless of plan enrollment status (if applicable) or of part-time or full-time status. The Department of Labor has provided employers with two sample notices they may use to comply with this rule, one for employers who do not offer a health plan and another for employers who offer a health plan for some or all employees. For more information refer to DOL’s Technical Guidance
Summary of Benefits and Coverage (SBCs) Disclosure Rules
Employers are required to provide employees with a standard “Summary of Benefits and Coverage” form explaining what the plan covers and what it costs. The purpose of the SBC form is to help employees better understand and evaluate their health insurance options. Penalties may be imposed for non- compliance.
Medical Loss Ratio Rebates
Under the ACA, insurance companies must spend at least 60% of premium dollars on medical care rather than administrative costs.
Limits on Flexible Spending (FSA Accounts)
For plan years beginning on or after January 2013, the maximum amount an employee may elect to contribute to health care flexible spending arrangements (FSAs) for any year will be capped at $2500, subject to cost-of-living adjustments. Note that the limit only applies to elective employee contributions and does not extend to employer contributions. To learn more about FSA Contributions, please refer to www.IRS.gov
90-Day Maximum Waiting Period
Beginning January 1, 2014, individuals who are eligible for employer-provided health insurance coverage will not have to wait more than 90 days to begin coverage. Please refer to www.IRS.gov on how employers should apply the 90-day rule. This temporary guidance will remain in effect at least through the end of 2014.
Workplace Wellness Programs
The Affordable Care Act creates new incentives to promote employer wellness programs and encourage employers to take more opportunities to support healthier workplaces. Health-contingent wellness programs generally require individuals to meet a specific standard related to their health to obtain a reward, such as programs that provide a reward to employees who don’t use, or decrease their use of, tobacco, and programs that reward employees who achieve a specified level or lower cholesterol. For more information and to view the final rules, visit www.dol.gov/ebsa.
Information Reporting on Health Coverage by Self-Insured Employers
Beginning in 2015, the Affordable Care Act provides for new information reporting by employers that sponsor self-insured plans. (Section 6055 rules). Separate reporting requirements apply to those employers that have 50 or more full time or full-time equivalent employees. (Section 6056 rules). Under Section 6055 rules, self-funded employers, issuers, and other parties that provide health coverage must submit new reports to the IRS detailing information for each covered individual. The first of these reports must be filed in 2016.
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