AFFORDABLE CARE ACT: HOW DOES IT AFFECT MY COMPANY?

Transcription

1 AFFORDABLE CARE ACT: HOW DOES IT AFFECT MY COMPANY? This flowchart provides an overview of the Large and Small employer health coverage rules beginning in 2014 and 2015 under the Patient Protection and Affordable Care Act (ACA). Use the option buttons to navigate between screens. To begin, click the Get Started button. While employers may follow the flowchart and determine possible outcomes, it is not intended to be comprehensive for that purpose. Rather, it is offered as a way to look ahead and better understand the many pathways to compliance that will exist beginning in Flowchart accurate as of August Copyright BerryDunn. Get Started berrydunn.com GAIN CONTROL

2 ARE YOU A LARGE OR SMALL EMPLOYER? In the prior year, did you average 50 or more full-time equivalent employees (FTEs)? Yes No Don t Know

3 95% RULE Do you offer health insurance to at least 95% of your full-time employees (30+ hrs/wk)? Yes No Back

4 AFFORDABILITY TEST W-2 Method: Do your employee premium payments exceed 9.5% of wages reported on Form W-2, Box 1? Yes No Back

5 AFFORDABILITY TEST Rate of Pay method: Do your employee monthly premium payments exceed 9.5% of 130 hours times hourly rate of pay? Yes No Back

6 AFFORDABILITY TEST Federal Poverty Line Method: Do your employee premium payments exceed 9.5% of the federal poverty line for an individual? Yes No Back

7 MINIMUM VALUE REQUIREMENT Does your health plan cover at least 60% of costs using any of the following? Minimum value calculator Design-based safe harbors: Proposed regulations have been issued outlining three safe harbor plan designs. Each safe harbor design includes all ten Essential Health Benefits (EHB). Actuarial certifications: An actuary assesses the value of non-standard features and adjusts calculation. Yes No Back

8 PENALTY $2,000 penalty per full-time employee in excess of 30 if any full-time employee goes to the Exchange and qualifies for a credit. Contact us: William G. Enck benck@berrydunn.com Roger Prince rprince@berrydunn.com Back to Start Back One

9 PENALTY $3,000 penalty per full-time employee who goes to the Exchange and qualifies for a credit. Contact us: William G. Enck benck@berrydunn.com Roger Prince rprince@berrydunn.com Back to Start Back One

10 PENALTY $3,000 penalty per full-time employee who goes to the Exchange and qualifies for a credit. Contact us: William G. Enck benck@berrydunn.com Roger Prince rprince@berrydunn.com Back to Start Back One

11 HEALTH INSURANCE Does your company offer health insurance? Yes No Back

12 EXCHANGE Consider using the Exchange for new employer insurance or send employees to the Exchange. Contact us: William G. Enck Roger Prince Back to Start Back One

13 GRANDFATHERED Has your insurance been in effect and unchanged since ACA enactment on 3/23/10? Note: To maintain a grandfathered plan, there must be no changes to the plan after 3/23/10. Yes No Back

14 GRANDFATHERED Grandfathered plans do not need to offer EHB. Talk to an advisor before making plan changes. Contact us: William G. Enck Roger Prince Back to Start Back One

15 ESSENTIAL HEALTH BENEFITS (EHB) Does your plan offer ALL of the following benefits? Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventative and wellness services and chronic disease management Pediatric services, including oral and vision care Yes No Back

16 DEDUCTIBLES Are deductibles limited to $2,000 for single coverage ($4,000 for family coverage)? Yes No Back

17 OUT OF POCKET Are out-of-pocket expenses limited to $6,250 (est.) for single coverage ($12,500 for family coverage)? Note: Special 2014 transition relief may allow some plans with multiple service providers to use multiple out-of-pocket limits. Consult with your advisor about this. Yes No Back

18 DESIGN CHANGES REQUIRED Talk to your plan advisor to make the changes necessary to comply. Contact us: William G. Enck Roger Prince Back to Start Back One

19 DESIGN CHANGES REQUIRED Talk to your plan advisor to make the changes necessary to comply. Contact us: William G. Enck Roger Prince Back to Start Back One

20 DESIGN CHANGES REQUIRED Talk to your plan advisor to make the changes necessary to comply. Contact us: William G. Enck Roger Prince Back to Start Back One

21 NO PENALTY Your plan may meet the Affordability Test and the Minimum Value requirement. Confirm with your advisors. Contact us: William G. Enck Roger Prince Back to Start Back One

22 DONE Your plan may meet the ACA requirements. Confirm with your advisors. Contact us: William G. Enck Roger Prince Back to Start Back One

23 ARE YOU A LARGE OR SMALL EMPLOYER? A. Calculate the number of full-time employees (130+hrs/mo.) for each month in the preceding year. B. Calculate the number of full-time equivalent employees (FTEs) for each month in the preceding year. (1) Calculate the total number of hours worked in a month (may not exceed 120 hours for any one employee) by variable hour (i.e., part-time) employees. Note: Do not count seasonal workers. (2) Divide the total in (B)(1) by 120. This equals the number of FTEs for the month. C. Add the numbers calculated in steps (A) and (B) for each of the 12 months in the preceding year. D. Add the 12 monthly numbers in step (C) and divide the sum by 12. This will serve as your total number of FTEs. More than 50 FTEs Fewer than 50 FTEs Back

24 ARE YOU A LARGE OR SMALL EMPLOYER? A. Calculate the number of full-time employees (130+hrs/mo.) for each month in the preceding year. B. Calculate the number of full-time equivalent employees (FTEs) for each month in the preceding year. (1) Calculate the total number of hours worked in a month (may not exceed 120 hours for any one employee) by variable hour (i.e., part-time) employees. Note: Include seasonal workers. (2) Divide the total in (B)(1) by 120. This equals the number of FTEs for the month. C. Add the numbers calculated in steps (A) and (B) for each of the 12 months in the preceding year. D. Add the 12 monthly numbers in step (C) and divide the sum by 12. This will serve as your total number of FTEs. Done

25 SEASONAL WORKERS Do you employ seasonal workers? Yes No Back

26 SEASONAL WORKERS If you include seasonal workers, would you have more than 50 FTEs? Yes No Recalculate

27 TALK TO YOUR ADVISOR It may be possible to disregard seasonal workers. Contact us: William G. Enck Roger Prince Back to Start