Affordable Care Act large group
By Hubie Laugharn
Below is a bullet point list of the most important aspects of the Affordable Care Act for large employer groups over 50 employees.
This is what we know as of 2-18-13
- Starting Jan. 1, 2014 or a company’s open enrollment for 2014.
- The Employer Shared Responsibility provisions apply to an employer with 51 or more employees. Employer will be required to offer healthcare insurance to all full-time employees or pay a tax/fine (Pay or Play).
- Play: an employer must offer a minimum of the Bronze plan and contribute toward the premium of the employee so the employee does not pay more than 9.5% of their wage. If the employer complies with both the “minimum value” and the “minimum employer’s contribution” 9.5%, the employer cannot be taxed/fined, if an employee goes to the exchange for financial help!
- Play: Plans must cover minimum benefit package: The “Medal” plans: Bronze, Silver, Gold, and Platinum. Bronze / 60% plan (least expensive) individuals will be responsible for 40% of the medical cost. Silver / 70% plan, the insured will be responsible for 30% of the medical cost. Gold / 80% plan and the Platinum / 90% plan.
- Pay: if an employer does not offer healthcare insurance and no employee receives assistance from the exchange, there is No Tax/Fine.
- Pay: if an employer does not offer healthcare insurance but one employee gets assistance from the exchange, the employer will pay $2,000 per employee excluding the first 30 employees.
- Pay: if the employer offers healthcare insurance, but their plans are not equivalent to the minimum Bronze plan or the premium paid by the employee exceeds 9.5% of their pay, and one employee gets assistance from the exchange, the tax/fine will be $3,000 per employee getting financial help from the exchange. However, the max tax/fine is the lower of the $2,000 or the $3,000 tax/fine.
- The employer is not taxed/fined for part time employees (29 hrs or less).
- The max deductible on all plans will be $2,000.
- HSA health plans will still be able to continue with their high deductibles over $2,000, however, we feel that they may be deemed “Cadillac” plans and as such, will be taxed 40% starting in 2018. In 2012, the tax for non-prescription drugs was raised from 10% to 20%.
- Increase medical expense deduction from 7.5% to 10% to employees.
- W-2 filing is required after Jan. 31, 2013 for companies that issue more than 250 W-2s annually. The amount of the total premium is divided by the total W-2s issued and entered in the appropriate boxes.
- Must provide notice regarding “Covered California” the name of the exchange in California.
- Max waiting period may not exceed 90 days. 30-60 day waiting period will have a $400 tax/fine.
- Incentives for wellness participation increases to 30% from 20% deductions.
- Special payroll tax of .9% for employees with incomes over $200K.
For more Affordable Care Act large group information call Solana Insurance Services today (949) 675-1920.
Solana Insurance Employee Benefits
3700 Newport Blvd. #309
Newport Beach, CA 92663
Topic: Affordable Care Act large group