Some time has passed since the fireworks of the July announcement of a one-year delay in employer penalties under the employer responsibility section of 4980H. In that month, many employers may have assumed that this meant all is status quo regarding employer health coverage for 2014—no penalties means non-compliance is okay, right?
Not so fast. While the delay is certainly welcome news for employers, it does not mean that they can ignore the ACA or the critical decisions it calls upon employers to make.
To put it in the clearest terms: the ACA is the law of the land, despite the penalty delay, and a very substantial number of compliance and management issues that are impacted by the ACA remain. 2014 is going to be a busy and confusing year for all. Employers need to be aware, prepared, and in compliance as major mandates go into effect beginning in October, less than a month away.
Critical ACA Regulations Currently in Effect
1. Benefit Mandates
b. Maximum 90-day waiting period.
c. No limits on pre-existing conditions or essential health benefits.
d. Dependent coverage changed to age 26.
e. Expansion of Wellness Incentives (30%, or up to 50% for smoking-related incentives).
f. Limits on deductibles and out of pockets not to exceed the HSA-regulated amount.
2. Summary of Benefits and Coverage
3. W-2 Reporting
b. Transitional Reinsurance Fee is $63/year or $5.25/month for each covered member that must be paid on or before January 15, first one in 2015.
5. Exchange Notification
6. Application for Advance Premium Credits
7. Employer Mandate Determination
While employers will avoid penalties for offering unaffordable plans or not offering coverage at all, it is wise to continue to track and forecast the future predicted penalty for non-compliance as well as any risk for discriminatory practice penalties.