The Employer Mandate: Companies face new health care regulations

Ross Carmichael

As 2015 and the beginning of the Employer Mandate era draw nearer, employers should make sure that they are prepared for the new regulations that concern offering affordable, minimum-value coverage to full time employees (those working on average more than 30 hours a week or 130 hours a month) and the associated reporting requirements. Earlier this year, the IRS issued final regulations on the shared responsibility for employers regarding health coverage known as the “Employer Mandate” and the reporting of health coverage by employers required by the Affordable Care Act (ACA). Released in multiple parts, the final regulations expand on two sections of the IRC: (1) Section 4908(h) that requires large employers to offer affordable, minimum value coverage to all full time employees, and (2) Section 6056 that governs the reporting of information regarding large-employer health coverage provided to full-time employees.

Employer Mandate The ACA’s Employer Mandate only applies to applicable large employers (ALEs) that average at least 50 full-time employees (including full-time equivalents, or FTEs) on business days in the previous calendar year. Normally, employers use an entire calendar year to make this determination. However, under transitional relief provided in the final regulations, employers can use any six consecutive calendar months in 2014 when calculating their number of employees for 2015. Additionally, employers that certify they had more than 50, but less than 100, full-time employees plus FTEs were granted an extra year of relief and will not have to comply until 2016, provided that they do not cut employee hours or terminate anyone during 2014 in an attempt to get under 100. Despite the delay, these employers that will be subject to the law should already be asking themselves these questions and planning accordingly: • When do we have to start complying? Will it be in 2015 or 2016? Do we have to start on January 1 or on our plan’s renewal date? There are special rules related to these questions, including calculating hours of part-time and seasonal employees and testing fiscal (non-calendar) year plans to determine when they become subject to the law. • Have we set up our Standard Measurement/Administrative/Stability periods for our ongoing employees? What about Initial/Administrative/Stability periods for variable hour employees? How are we going to track all of these employees and certify that we have offered coverage to “substantially all” (95 percent) eligible employees and dependents to avoid the $2,000 penalty? An employer needs to closely examine its workforce to make sure it is offering coverage to all full-time employees and review its methods for tracking/reporting employee hours (in-house, through its payroll company, through a third-party vendor, etc.) to reduce the administrative burden and cost of complying. • Have we reviewed the insurance we offer and the pay rate of our employees to make sure that the coverage offers Minimum Value and is affordable to avoid the $3,000 penalty? Will our plan be subject to the 40 percent “Cadillac” excise tax in 2018? Employers must balance their enterprise’s financial and competitive costs when making decisions on coverage, like setting contribution levels, moving to self-funding or offering multiple tiers of coverage. Section 6056 Reporting ALEs subject to the Shared Responsibility rules must file an annual return with the IRS describing the terms and conditions of the health coverage provided to their full-time employees and containing certain information about covered employees. Employers must also provide those full-time employees with statements informing them that the employer reported their information to the IRS, which, in conjunction with the Section 6056 return, will help determine whether they are eligible for premium tax credits. Employees are ineligible for premium tax credits if they are offered or enroll in affordable Minimum Essential Coverage under an employer-sponsored, minimum-value plan. This is just a brief summary of some of the thousands of pages that have been issued and that employers have had to wade through since Congress passed the ACA in 2010. Although these requirements will not become effective until 2015, with the first cycle of IRS reports due in early 2016, employers can – and should – assess their situations now to allow ample time to collect and assemble the necessary data, formulate an attack plan and set up proper implementation.

Ross Carmichael is vice president of compliance and operations at Higginbotham.