Health Care Reform Confusion: 6 Common Questions

Health care reform continues to hold its front-runner status of hot topics weighing on business owners’ minds. As we move forward in 2013, there seem to be more questions than answers for employers grappling with this confusing legislation. As new guidelines attempting to clarify the law are made available, more questions arise.

Below are answers to six common health care reform questions.

Q1: What information is required to be included on an employee’s W2?

A: The Affordable Care Act (ACA) requires that employers report on the W2 the value of health plan coverage for each employee. This includes both the employer and employee share of the cost of health coverage, but excludes dental and vision coverage under separate policies. Reportable amounts also exclude contribution towards Health savings Accounts (HSA) and employee contributions to health flexible accounts (Health FSA)

Q2: If a company has less than 50 employees, is there a penalty for not providing insurance?

A: There are no penalties for employers with less than 50 full time equivalent employees.

Q3: Regarding the Cadillac Tax: If a firm has a high-risk pool of insureds, does that mean they have “Cadillac plans” even if they’re offering “bronze” coverage?

A: Yes, based on current guidelines, the Cadillac tax is based on the value of the health plan and does not adjust that value for older age or higher risk groups.

Q4: How will Health Care Reform affect staffing companies?

A: Staffing companies will be treated as the employer and will be subject to PPACA requirements. Temporary employees for the staffing company will be treated as an employees of the staffing company. If the staffing company has more than 50 full time equivalent employees they will be subject to the lager employer mandate and penalties.

Q5: If a company’s health benefits period is Dec 1 – Nov 30, is it correct to assume that compliance would not be required until 12/1/14?

A: Yes. Based on guidelines issued on January 2, 2013, most employers that offer benefit plans and have a plan anniversary other than Jan 1st will be required to be compliant with PPACA provision on their plan anniversary after Jan 1, 2014. If an employer is only offering benefits to a small number of employees, they may be required to be complaint on January 1. 2013. Federal Register Vol 78 and No 1 provide additional detail.

Q6: If you only offer an HSA and the employer is not making any contribution, will the employer have to pay a penalty since they are not contributing to the insurance?

A: An employer sponsored high deductible health plan with a health savings account will have to meet the “affordable” test. That would require a 60{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} actuarial value and an employee premium not more than 9.5{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} of income to avoid the $3,000 penalty. This applies if an employee purchases coverage on the exchange and is eligible for a premium subsidy.

These are just a few common questions about the Affordable Care Act. If you require additional information regarding any 2013 health care reform questions, do not hesitate to contact us.