Pay or Play: Penalties for Failing to Offer Dependent Coverage

Beginning in 2015, the Affordable Care Act (ACA) generally requires applicable large employers to offer affordable, minimum value health coverage to their full-time employees (and dependents) or pay a penalty. These employer mandate penalties are also known as “shared responsibility” or “pay or play” penalties.

On May 13, 2014, the Internal Revenue Service (IRS) released FAQs addressing consequences under the employer shared responsibility rules for applicable large employers that offer health insurance coverage to all full-time employees, but do not offer dependent coverage.

In general, an employer will potentially be liable for an employer shared responsibility penalty only if a full-time employee:

  • Enrolls in coverage through an Exchange
  • Receives a subsidy to help pay for the Exchange coverage

Whether or not one or more of its full-time employees’ dependents enrolls through an Exchange and receives a subsidy does not affect an employer’s liability.

Read the full Health Care Reform Bulletin to learn more about:

  • Liability for Employer Shared Responsibility Penalties
  • Transition Relief for Offering Dependent Coverage in 2014

Consequences of Reimbursing Individual Insurance Premiums

Affordable Care Act (ACA) reforms that took effect this year may make purchasing health insurance in the individual market more accessible. Due to these reforms and the rising costs of health coverage, some employers have considered helping employees pay for individual health insurance policies instead of offering an employer-sponsored plan.

On May 13, 2014, the Internal Revenue Service (IRS) issued FAQs addressing the consequences for employers that do not establish a health insurance plan for their employees, but instead reimburse employees for premiums they pay for individual health insurance (either inside or outside of an Exchange). These arrangements are known as employer payment plans. Read the full Health Care Reform Bulletin to learn more about:

  • Background on Employer Payment Plans
  • Consequences for Employers

Reporting Requirements for Employers and Health Plans

The Affordable Care Act (ACA) created a number of federal reporting requirements for employers and health plans. The additional reporting is intended to promote transparency with respect to health plan coverage and costs. It will also provide the government with information to administer other ACA mandates, such as the large employer shared responsibility penalty and the individual mandate.

This Health Care Reform Legislative Brief brought to you by Clark and Associates of Nevada provides a summary of the following reporting provisions:

  • Form W-2 reporting
  • Applicable large employer health coverage reporting (Code 6056)
  • Reporting of healthy coverage by health insurance issuers and sponsors of self-insured plans (Code 6055)
  • Transparency in coverage reporting and cost-sharing disclosures
  • Quality of care reporting

Read the full Legislative Brief for more information.

Annual Deductible Limit Repealed for Small Health Plans

On April 1, 2014, President Obama signed the Protecting Access to Medicare Act of 2014 (Act) into law. The Act’s main provisions preserve the pay rate for physicians treating Medicare patients and delay the compliance deadline for converting to the updated International Classification of Diseases codes for at least one year. The Act also eliminates the Affordable Care Act’s (ACA) annual deductible limit that applied to health plans in the small group market. This change is retroactively effective to when the ACA was enacted in March 2010.

Quick Facts

  • For 2014 plan years, small group health plans were subject to annual deductible limits.
  • A new law repeals the ACA’s annual deductible limit, effective retroactively.

Read the full Health Care Reform Bulletin brought to you by Clark and Associates of Nevada to learn more about the repeal of annual deductible limit for small health plans.