Embed Size (px)
Citation preview
www.laborlawyers.com
Healthcare Reform
What Employers Need to KnowPresented By
Sheldon J. Blumling
Fisher & Phillips LLP
(949) 798-2127
Atlanta Boston Charlotte Chicago Cleveland Columbia Dallas Denver Fort Lauderdale Houston Irvine Kansas City Las Vegas Los Angeles Louisville Memphis New England New Jersey New Orleans Orlando Philadelphia Portland San DiegoSan
FranciscoTampa Washington D.C.
www.laborlawyers.com
Fisher & Phillips LLP
ATTORNEYS AT LAW
Solutions at Work®
Healthcare Reform
Today’s Agenda:1. Delay of Enforcement of Employer
“Play or Pay” Mandate to 20152. Provisions and Obligations that Remain3. Recent Exchange Notice4. Employer “Play or Pay” Mandate
Overview5. What Employers Should be Doing Now
Healthcare Reform
Delay of Enforcement of Employer “Play or Pay”
Mandate to 2015: July 2nd Treasury Blog Post
July 5th HHS Guidance re Exchange Verification
Requirements
July 9th IRS Notice 2013-45
Bottom Line
Healthcare Reform
Delay of Enforcement of Employer “Play or Pay”
Mandate to 2015: What Now?
Initial IRC 6055/6056 Reporting Guidance Issued
Future Guidance on Employer “Play or Pay” Mandate
What Happens to Transition Rules?
How Much Room to Simplify?
Possible Legislative Changes?
Effect on Employees…
Healthcare Reform
Provisions and Obligations that Remain: Individual Mandate
Exchange (“Marketplace”) Coverage
90-Day Waiting Periods
Elimination of Pre-Existing Condition Limitations
Essential Health Benefits
Prohibition on Annual Limits
Cost-Sharing and Deductible Limits
New Fees
New Wellness Program Rules
Healthcare Reform
Provisions and Obligations that Remain: Providing SBCs
MLR Rebates
W-2 Reporting of Cost of Coverage
Coverage Mandates
Employer Exchange Notice
Healthcare Reform
Exchange Notice— Basic concept of notice
Back and forth on effective dates
“Temporary” guidance:
New notice req. applies to employers “subject to
FLSA” (see
www.dol.gov/elaws/esa/flsa/scope/screen24.asp)
Must provide notice to all employees
Existing employees—by October 1, 2013
Within 14 days of start date for employees hired
on or after October 1, 2013
No specific penalties, but…
Healthcare Reform
Exchange Notice—
Model Notices: http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf (for use if a
plan is offered)
http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf (for use if
a plan is not offered)
Revisions to DOL Model COBRA Notices: http://www.dol.gov/ebsa/modelelectionnotice.doc (model
notice)
http://www.dol.gov/ebsa/modelelectionnoticeredline.doc
(redline of prior model notice)
More to come…
Healthcare Reform
Employer “Play or Pay” Mandate— Now effective January 1, 2015 Applies to “large employers”
50 or more “full-time” employees (including full-time equivalents)
“Full-time” means 30 or more hours per week In order to “play” and avoid the possibility of
“paying,” an employer must offer adequate and “affordable” group health plan coverage to substantially all full-time employees and their dependents Plan covers at least 60% of the cost of benefits
(minimum value) Employee premium cost must not exceed 9.5% of
“household income”
Healthcare Reform
Employer “Play or Pay” Mandate— If an employer fails to “play” by not offering
coverage to substantially all full-time employees and their dependents AND at least one full-time employee receives Federal premium assistance for purchasing coverage through an insurance exchange, then the employer will “pay” an annual penalty tax of $2,000 per full-time employee, excluding the first 30 full-time employees. An employee may qualify for Federal premium
assistance if his or her income is less than 400% of the Federal poverty level (approximately $94,000 for a family of four)
Healthcare Reform
Employer “Play or Pay” Mandate— If an employer fails to fully “play” by offering
inadequate and/or unaffordable coverage AND at least one full-time employee receives Federal premium assistance for purchasing coverage through an insurance exchange, then the employer will “pay” an annual penalty tax equal to the lesser of (i) $3,000 per full-time employee receiving assistance OR (ii) $2,000 per full-time employee, excluding the first 30 full-time employees. An employee may qualify for Federal premium
assistance if his or her income is less than 400% of the Federal poverty level (approximately $94,000 for a family of four)
Healthcare Reform
Proposed Employer “Play or Pay” Mandate
Guidance—
“Substantially all” = 95%
“Dependents” do not include spouses
9.5% affordability “safe harbors”
Application of controlled group rules
Measurement and stability periods for
determination of full-time status
Transition Rules
Healthcare Reform
Employer “Play or Pay” Mandate—
Common Questions and Considerations:
What about small employers?
Impact of related employers
What about seasonal employees?
Any special rules for temps?
Any obligations for part-time employees?
Effect of waiting periods
Considerations for a “play or pay” comparison
Healthcare Reform
Employer “Play or Pay” Mandate Guidance
—
Lookback and Stability Period Concepts-Ongoing
EEs Lookback period of 3 to 12 months Stability period of at least 6 months, but no
shorter than lookback period Use of an “administrative” period for
enrollment process must overlap the stability period in order to prevent potential gaps in coverage
Different periods for different groups permitted in some circumstances
Healthcare Reform
Employer “Play or Pay” Mandate Guidance
—
Lookback and Stability Period Concepts-New
Employees Apply to new (i) “seasonal employees” and
(ii) “variable hour employees” for whom it cannot be determined that the employee is reasonably expected to work on average at least 30 hours per week.
Maximum 90-day waiting period for otherwise eligible new full-time employees
Healthcare Reform
Employer “Play or Pay” Mandate Guidance
—
Lookback and Stability Period Concepts-New
Employees Lookback period of 3 to 12 months Stability period of at least 6 months, but no
shorter than lookback period (and stability period for ongoing employees)
May apply an additional “administrative” period for enrollment process, as long as coverage begins no later than the end of the first calendar month beginning on or after an employee’s first anniversary
Healthcare Reform
Beyond the Employer “Play or Pay”
Mandate—
Automatic Enrollment Implementation
Applies to “large employers” of more than 200 full-
time employees
Informal guidance indicates that requirement will
not be implemented until sometime after 2014
Delayed Implementation of Nondiscrimination
Requirements for Insured Plans
Healthcare Reform
What Employers Should be Doing Now:
1. Modeling the impact of the Employer “Play or Pay” Mandate
Does it Apply? How Much Will it Cost? Impact on Employees
2. Addressing ongoing compliance obligations
3. Watching for new near-term guidance: Revised/Final Employer Mandate Guidance Revised/Final IRC 6055/6056 Reporting
Guidance
Healthcare Reform
What Employers Should be Doing Now:
4. Following developments in the law as other new guidance is issued:
Exchange Notices Nondiscrimination Requirements Automatic Enrollment Plenty more to come…
www.laborlawyers.com
Questions ?
Atlanta Boston Charlotte Chicago Cleveland Columbia Dallas Denver Fort Lauderdale Houston Irvine Kansas City Las Vegas Los Angeles Louisville Memphis New England New Jersey New Orleans Orlando Philadelphia Portland San Diego
San FranciscoTampa Washington D.C.
www.laborlawyers.com
Fisher & Phillips LLP
ATTORNEYS AT LAW
Solutions at Work®
www.laborlawyers.com
Healthcare Reform
What Employers Need to KnowPresented By
Sheldon J. Blumling
Fisher & Phillips LLP
(949) 798-2127
Atlanta Boston Charlotte Chicago Cleveland Columbia Dallas Denver Fort Lauderdale Houston Irvine Kansas City Las Vegas Los Angeles Louisville Memphis New England New Jersey New Orleans Orlando Philadelphia Portland San DiegoSan
FranciscoTampa Washington D.C.
www.laborlawyers.com
Fisher & Phillips LLP
ATTORNEYS AT LAW
Solutions at Work®
