PPACA-ACA-aka Obamacare Rules

As we are all acutely aware, the ACA-Affordable Care Act has gone into startup mode but are you prepared and will you be in compliance?

We have all heard about the “in excess of 2700 pages” of the HealthCare bill, explaining and detailing the inner-workings of this new program and now we are now expected to begin communicating these benefits to our employees and we would like to assist you in both your understanding and obligations pertaining to at least a few of these 2014 requirements, as follows:

  • Effective with your Group Insurance Renewal, you MUST provide “all eligible employees”, regardless of hours, with the carriers SMD-Summary Plan Description.
  • Waiting Periods in excess of 90 days will NO LONGER be available unless you request a change to your current waiting period prior to 12/31/2013. However, upon the occasion of your subsequent renewal, you will be required to have a Waiting Period that will not exceed 90 Days.
  • Individuals are now beginning to be able to access the new Health Insurance Marketplace, where they will be able to shop for alternative plan coverage, effective for 1/1/2014, with the possibility of receiving financial assistance by way of tax credits, depending income upon eligibility based upon their tax filing status.
    • Effective May of 2013, the DOL required employers (refer to FSLA section 18B for qualification) to provide written notification to “ALL” employees by 10-1-13, even if you do not offer coverage, by properly distributing Federal Form OMB #1210-0149, which is intended to provide a General Overview of the Exchange Marketplace:
    • If you have an offer of health insurance from your employer that meets the minimum standards, you will NOT be eligible for a tax credit.
    • If the cost of an employer plan that covers you (and not any other members of your family) is more than 9.5% of your household income and/or doesn’t meet the “minimum value” standard, you may be eligible for a credit.
    • If you purchase a plan through the Marketplace, you may:
      • lose your employer contribution (if any)
      • payments made for coverage purchased through the Marketplace are made on an “After-Tax” basis, contrasted with,
      • payments made through Employer based Section 125 Plan premiums are typically “Pre-Tax”

Note for Employers: This reduction (or lack of reduction) of employee premiums directly impacts what we pay for Social Security, Worker’s Comp, Unemployment & SUI Insurance, as well as Retirement Plan contributions, amounting to a 10%-14% cost differential.

Currently, there is no penalty for non-compliance with Form OMB #1210-0149, however, we would strongly recommend that you at least maintain a detailed list of to whom and when you provided this notification and, preferably, request a written acknowledgement and maintain in your files to avoid future potential fines or litigation for non-compliance.

While the Employer Mandate has been postponed until 2015, effective March 31, 2014, the Individual Mandate will go into effect. If any of your employees find themselves going to the Exchange, this could impact not only your pocket book by way of penalties (large groups) but, if your group falls under the required 75% participation rate, you and your remaining group participants may no longer qualify for your Group Insurance Plan and be forced to purchase individual overage or rely upon the State Exchange/Marketplace (or SHOP for an Employer Plan).

We are pleased to inform you that we have taken the requisite training and licensing to be certified agents on the “Insurance Exchange” and “Small Business Health Options Program”, as well as continuing to be in the vanguard of being able to offer our “all available health plans” available in the State.

If you have any questions, please contact your representative or feel free to contact our office to provide you with further guidance.

However, we would strongly recommend that you at least maintain a detailed list of to whom and when you provided this notification and, preferably, request a written acknowledgement and maintain in your files to avoid future potential fines for non-compliance.

If you have any questions, please contact your representative or feel free to contact our office to provide you with further guidance.

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