W2 vs 1099 Worker – ACA Regulations make it Important to Get It Right
July 16th we blogged IRC 60566/6056 “will prove to be the most cumbersome and costly part of Obamacare.” We wrote: “Employers with part-time, seasonal and variable hour workers (someone working for a company with different job functions/classifications, thus hours under two different pay codes) will particularly have difficulties and will need a managed solution. This makes […]
Humpty Dumpty Had a Great Fall
Employee Benefit Advisors blogged Oct 9, 2013 about court cases that have been falling under the radar. EBA said “These cases could dismantle health care reform as we know it.” – Yesterday the decision came down the “Court bars PPACA aid for federal exchange shoppers.” The decision has already been appealed, however, the way PPACA […]
Four Numbers that may cause you to say Four Letter Words
The U.S. Treasury Department and Internal Revenue Service has issued the final regulations on the employer mandate under the Affordable Care Act. The new 6055 & 6056 regulations are 227 pages long and Employee Benefit Advisors believes will prove to be the most cumbersome and costly part of Obamacare. We say costly because we believe […]
New Rule on Market Reforms – 22% MLR
The rule makes a temporary change to the administrative cost ceiling. Currently, as a result of the Medical Loss Ratio (MLR), insurers are allowed to have 20% of their costs be administrative, with the other 80% devoted to claims. That number has been increased to 22% for 2015 under the proposal to accommodate the increased […]
ACA Recap – Employer Checklist (Part 5 of 5): Exchanges
Types of Exchanges 1. State Exchanges – Individual Consumer – Federal or State Run Carrier participation will be voluntary State determines plan designs: Bronze (low cost), Silver, Gold, Platinum (high cost); Catastrophic Plan – young invincibles (18 -30) 2. SHOP Exchange – Small Employers Open in 2015 Limited to 50 FTE’s Employer picks plan for […]
ACA Recap – Employer Checklist (Part 4 of 5): Underwriting
Under ACA beginning with all new groups and for groups renewing in the 2014 calendar year the following criteria will be used to underwrite group. (In Florida, group size is determined by ATNE, Average Total Number of Employees. ATNE is calculated by averaging the total number all employees, full & part time, seasonal, temporary, etc… for […]
ACA Recap – Employer Checklist (Part 3 of 5): Compliant Plans
What is a Minimum Value Plan? Coverage that has an actuarial value (AV) of at least 60%. AV is the plan’s share of the total allowed cost of benefits provided to an enrolled individual Example, if a plan has an AV of 60% then the individual is theoretically responsible for 40% of the costs for all […]
ACA Recap – Employer Checklist (Part 2 of 5): Affordability
ACA Employer Responsibility Affordable Coverage Requirement Companies are only required to offer at least one medical plan that meets the “affordability” requirement (at the employee-only coverage level). Regulatory guidance allows companies to calculate affordability based on the employee’s income, using one of three IRS safe harbors. The Safe Harbors are: 9.5% of W-2 wages from […]
ACA Recap – Employer Checklist (Part 1 of 5): Accessibility
ACA Employer Responsibility: “Pay or Play” (Delay Announced) Large Employer Subject to “Pay” if they do not “Play” – Starting in 2015, applies to employers with 100 or more FTEs (Full Time Equivalents) Offer Minimum Essential Health Care to 70% of employees effective on the start of the plan year beginning on or after January […]
Healthcare Reform Update – ‘Pay or Play’ Delayed Until 2016
Large employers with fewer than 100 Full-Time Employees got some good news. The rules for employers with at least 50 full-time employees provide transition relief with respect to all of 2015 and, for non-calendar plan years that begin in 2015, for the portion of that 2015 plan year that falls in 2016. Key points to […]