Does Your Company Know About The Affordable Care Act’s Employer Shared Responsibility Payment?

Under the Affordable Care Act, applicable large employers – those with 50 or more full-time employees, including full-time equivalent employees – are required to take some new actions. Applicable large employers (ALEs) particularly need to pay attention. ALEs are subject to the employer shared responsibility provisions. A goal of Pontrelli, Timour & Associates is to provide our clients and potential clients with the best information available about the employer shared responsibility provisions and all the requirements of the Affordable Care Act. After all, information is the power to chart the right course.

The Affordable Care Act’s Employer Shared Responsibility Payment

employer shared responsibility payment

Employer Shared Responsibility Payment

Whether an employer is an applicable larger employer in a particular calendar year depends on the size of the employer’s workforce in the preceding calendar year. This is a key distinction to remember. To be defined as an ALE for a particular calendar year, an employer must have had an average of at least 50 full-time employees (including full-time-equivalent employees) during the preceding calendar year. All types of employers can be ALEs, including tax-exempt organizations and government entities.

To prepare for 2016, if your organization is an applicable large employer, you need to keep track information each month in 2015, including the following:

  • Whether you offered full-time employees and their dependents minimum essential coverage that meets the minimum value requirements and is affordable
  • Whether your employees enrolled in the minimum essential coverage you offered

PT Benefits can help our clients keep track of this information by providing supporting guidance and information.

Your company needs to track this information because you could be subject to an employer shared responsibility payment if your organization falls into either of these circumstances:

  • You offered coverage to fewer than 70 percent of your full-time employees in 2015 while at least one full-time employee enrolled in coverage through the Health Insurance Marketplace and receives a premium tax credit. The 70 percent threshold is for 2015, after 2015 this increases to 95 percent.
  • You offered coverage to at least 70 percent of your full-time employees and their dependents in 2015, but at least one full-time employee receives a premium tax credit because coverage offered was not affordable, did not provide minimum value or the full-time employee was not offered coverage. After 2015, this threshold increases to 95 percent.

 Pontrelli, Timour & Associates Can Help

Pontrelli, Timour & Associates understands if these requirements and logistics seem complicated. We can help you understand your company’s designation and take the steps to remain in compliance with the Affordable Care Act. Naturally, our goal is to help your company avoid an employer shared responsibility payment. To learn more and access the help you need, please call the group insurance experts at PT Benefits at 626-795-4138.Employer Shared Responsibility Payment

PT Benefits Explains Employer Shared Responsibility Reporting Requirements Under PPACA: Code Sections 6055 & 6056

PT Benefits wants our clients and potential clients to understand that there are two types of employer shared responsibility payments, also known as pay or play penalties, under the Affordable Care Act (ACA). The first penalty under Internal Revenue Code (Code) Section 4980H(a) is the penalty for failure to offer health coverage.  Effective for plan years that began on or after January 1, 2015, a $2,000 annual penalty applies to a large employer that fails to offer at least 70 percent of its full-time employees (FTEs) health coverage. Employer Shared Responsibility Reporting Requirements mean serious business.

Penalties & Employer Shared Responsibility Reporting Requirements

Employer Shared Responsibility Reporting Requirements, PPACA

Employer Shared Responsibility Reporting Requirements

The second penalty under §4980H(b) is for the failure to offer coverage that is of minimum value and affordable. The Section 4980H(b) penalty is a $3,000 annual penalty assessed on a monthly basis, and applies to each FTE who is not offered minimum value affordable coverage by the large employer, goes to the Marketplace Exchange and receives an exchange subsidy for insurance he or she purchases through the Marketplace Exchange.  It is important to note that even if an employer offers coverage to 70 percent of its FTEs for 2015 and 95 percent of its FTEs for 2016 and beyond, the employer could still be subject to penalties under Section 4980H(b) if the coverage is unaffordable or does not provide minimum value.

What is even more troubling when it comes to Employer Shared Responsibility Reporting Requirements is that even if an employer meets the 70/95 percent threshold, it still faces the potential for the $3,000 Section 4980H(b) penalty for every FTE who is not offered coverage (i.e., the 30/5 percent safe harbor employees) if that employee receives an exchange subsidy for insurance he/she purchases through the Marketplace Exchange.

Code Section 6055 requires health insurance issuers and employers that sponsor self-insured health plans to report information concerning the type and period of coverage to the IRS and to the covered individuals.  Section 6055 reporting is intended to serve as verification that the individual has MEC for purposes of enforcing the ACA’s individual responsibility requirements.  Code Section 6056 requires large employers to provide information to the Internal Revenue Service (IRS) about whether MEC is offered to their FTEs and their dependents. The IRS will determine whether an employer owes a shared responsibility payment under Code Section 4980H and whether an employee is eligible for a premium tax credit on a Marketplace Exchange will use this information.

Employer Shared Responsibility Reporting Requirements – 6055 & 6056

Employers with 50 or more FTEs use Forms 1094-C and 1095-C to report the information required under Code Sections 6055 and 6056.  Form 1094-C is used to report to the IRS summary information for the employer and to transmit the Forms 1095-C to the IRS.  Form 1095-C is used to report information about each applicable employee. If an employer provides coverage through an insured plan, part of Form 1095-C will be left blank.  The insurance company will separately report on MEC for those individuals enrolled in fully insured plan options.

Recognizing the burden of these Employer Shared Responsibility Reporting Requirements imposed on employers, the IRS has provided a simplified reporting method for large employers that make qualifying offers of coverage to FTEs, their spouse and their dependents for all 12 calendar months of the reporting year. A simplified alternative that allows the employer to report without identifying or specifying the number of FTEs is also available for employers that offered, for all 12 months of the calendar year, affordable health coverage under IRS safe harbors.

Help With Employer Shared Responsibility Reporting Requirements

PT Benefits believe that employers should review the draft reporting forms and instructions to familiarize themselves with the types of information that must be provided under these Employer Shared Responsibility Reporting Requirements.  If such forms and instructions are too complicated, PT Benefits will help our clients navigate this maze of PPACA bureaucracy. To learn more about how PT Benefits can help your company with Employer Shared Responsibility Reporting Requirements and whether your company qualifies for an IRS safe harbor, please call 626-795-4138 today.

2015 ACA Mandate Changed The Playing Field For 100-Plus Company Employers With 2016 To Come

aca mandate

Affordable Care Act & Your Company

In 2015, the ACA mandate and huge potential penalties for businesses that fail to provide medical coverage for their workers changes the playing field for 100-plus company employers. From requiring employers to provide medical coverage to spurring the creation of new models for how health insurance is structured and sold, the effect of the Affordable Care Act on business owners will is becoming increasingly clear. In 2015, if you are a larger employer and you fail to provide health insurance, your company will have to pay a penalty for each employee that does not receive coverage.

 The 2015 ACA Mandate

As insurance brokers and benefits program managers, Pontrelli, Timour & Associates understands that larger companies have become more conscious of the minimum value required by the ACA to avoid having to pay penalties. The ACA has prompted such employers to reexamine how they offer insurance. Some midsized businesses are switching from traditional, fully funded commercial insurance plans to self-funded plans, in which they pay employee claims directly. Whenever such decisions are made, the importance is to have a benefits plan management professional to help.

Is Your Company Being Penalized For The ACA Mandate?

Self-funded plans allow businesses to see the overall claims from their workers and tailor employee wellness plans to serve those workers. The efficiencies of self-funded plans are primarily attractive to businesses with hundreds of workers, but now are attracting firms in the 50- to 70-employee range. On Jan. 1, 2015, employers with 100 or more workers were forced to pay a penalty if they don’t provide insurance to at least 70 percent of full-time workers.

The 2016 ACA Mandate

In 2016, the mandate will be expanded, so that all businesses with the equivalent of at least 50 full-time employees will have to pay the penalty if they don’t provide insurance to at least 95 percent of their full-timers. Pontrelli, Timour & Associates is focused on helping such mid-sized companies find the best plans that make the most sense for their companies.

Is You Company Ready For The ACA Mandate?

Pontrelli, Timour & Associates understands how making such specific choices remains challenging for most business owners. By having a benefits program expert on your team, such choices can be made precisely from the vantage point of proven experience. If you want to know more about how PT Benefits can help your company with ACA challenges, please call 866-782-9899 or fill out our handy contact form for a free consultation.