United Benefit Advisors Insight and Analysis Blog

Keeping Pace with the Protecting Affordable Coverage for Employees Act

Posted by: Vicki Randall    Feb 16, 2017 9:30:00 AM

Last fall, President Barack Obama signed the Protecting Affordable Coverage for Employees Act (PACE), which preserved the historical definition of small employer to mean an employer that employs 1 to 50 employees. Prior to this newly signed legislation, the Patient Protection and Affordable Care Act (ACA) was set to expand the definition of a small employer to include companies with 51 to 100 employees (mid-size segment) beginning January 1, 2016.

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Topics: health care costs, ACA, essential health benefits, minimum essential coverage, Affordable Care Act, PACE Act, Compliancedashboard, Vicki Randall, Protecting Affordable Coverage for Employees Act, small employer

Making Sense of Form 1095 Minimum Essential Coverage Reporting

Posted by: Vicki Randall    Jan 12, 2017 9:30:00 AM

In a few weeks, a second season of shared responsibility reporting will begin. For some of you, last year’s inaugural year of reporting may have felt eerily similar to Lewis Carroll’s famous book. You know the one. It included a little girl falling down a dark hole, a rabbit frantically checking his watch and a lot of other crazy characters. Now that you have the benefit of one year of reporting under your belt, let’s look at the reporting forms and try to make them less confusing by breaking them down.

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Topics: ACA, IRS Form 1095, minimum essential coverage, employer shared responsibility, Affordable Care Act, individual shared responsibility, Compliancedashboard, IRS reporting, Form 1095-B, Form 1095-C

Employer FYI: Individual Mandate Requirements and Proposed Regulations

Posted by: Danielle Capilla    Nov 9, 2016 10:30:00 AM

Though employers are not required to educate employees about their individual responsibilities under the Patient Protection and Affordable Care Act (ACA), it is helpful to know about the individual mandate.

The individual responsibility requirement (also known as the individual mandate) became effective for most people as of January 1, 2014. Under the individual mandate, most people residing in the U.S. are required to have minimum essential coverage or they must pay a penalty. Many individuals will be eligible for financial assistance through premium tax credits (also known as premium subsidies) to help them purchase coverage if they buy coverage through the health insurance Marketplace (also known as the Exchange).

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Topics: ACA, PPACA, Individual mandate, minimum essential coverage, Danielle Capilla, Affordable Care Act

Controlled Groups and Affiliated Service Groups: How They Apply to the ACA

Posted by: Danielle Capilla    Oct 18, 2016 10:30:00 AM

The Patient Protection and Affordable Care Act (ACA) imposes a penalty on “large” employers that either do not offer “minimum essential” (basic medical) coverage, or who offer coverage that is not affordable (the employee’s cost for single coverage is greater than 9.5 percent of income) or it does not provide minimum value (the plan is not designed to pay at least 60 percent of claims costs). A large employer is one that employed at least 50 full-time or full-time equivalent employees during the prior calendar year. To discourage employers from breaking into small entities to avoid the penalty, the ACA provides that, for purposes of the employee threshold, the controlled group and affiliated service group aggregation rules will apply to health plans. Essentially, this means that the employees of a business with common owners or that perform services for each other may need to be combined when determining if the employer is “large.”

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Topics: ACA, PPACA, minimum essential coverage, Danielle Capilla, Large Employers, controlled group, affiliated service group

Reporting Minimum Essential Coverage

Posted by: Danielle Capilla    Oct 6, 2016 10:30:00 AM

Minimum essential coverage (MEC) is the type of coverage that an individual must have under the Patient Protection and Affordable Care Act (ACA). Employers that are subject to the ACA’s shared responsibility provisions (often called “play or pay”) must offer MEC coverage that is affordable and provides minimum value.

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Topics: ACA, minimum essential coverage, employer shared responsibility, Danielle Capilla, Affordable Care Act, MEC

ACA Penalties and Taxes and Fees — Oh My!

Posted by: Bill Olson    Jan 28, 2016 12:00:00 PM

Employers breathed a sign of relief when the looming Cadillac tax was delayed. But are you subject to other fees and penalties under the ACA? The ACA has introduced a multitude of new fees that employers must pay, in addition to penalties for non-compliance with employer shared responsibility rules. These dollar amounts change annually, as does the percentage amount used to calculate affordability in relation to the ACA. UBA’s new ACA Advisor, “Patient Protection and Affordable Care Act Fees, Penalties” gives a quick reference summary of the key 2015 and 2016 fees and penalties associated with the ACA.

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Topics: ACA, Transitional Reinsurance Fee, Cadillac Tax, minimum essential coverage, Affordable Care Act, PCORI Fee, ACA penalties

IRS Provides Major Delay in 6055 and 6056 Reporting

Posted by: Danielle Capilla    Jan 14, 2016 12:00:00 PM

Under the Patient Protection and Affordable Care Act (ACA), individuals are required to have health insurance, while applicable large employers (ALEs) are required to offer health benefits to their full-time employees. In order for the Internal Revenue Service (IRS) to verify that (1) individuals have the required minimum essential coverage, (2) individuals who request premium tax credits are entitled to them, and (3) ALEs are meeting their shared responsibility (play or pay) obligations, employers with 50 or more full-time or full-time equivalent employees and insurers will be required to report on the health coverage they offer.

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Topics: ACA, minimum essential coverage, employer shared responsibility, Danielle Capilla, Affordable Care Act, applicable large employers, ACA reporting, IRS Form 6055 and 6056

Template Letter to Employees about IRS Forms 1095-B and 1095-C

Posted by: Danielle Capilla    Dec 8, 2015 12:00:00 PM

UBA has created a template letter that employers may use to draft written communication to employees regarding what to expect in relation to IRS Forms 1095-B and 1095-C, and what employees should do with a form or forms they receive. The template is meant to be adjustable for each employer, and further information could be added if it is pertinent to the employer or its workforce.

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Topics: employee communication, IRS Form 1095, minimum essential coverage, Danielle Capilla, minimum value coverage

IRS Notice on Minimum Essential Coverage Reporting

Posted by: Danielle Capilla    Oct 8, 2015 12:00:00 PM

Minimum essential coverage or "MEC" is the type of coverage that an individual must have under the Patient Protection and Affordable Care Act (ACA). Employers that are subject to the ACA's shared responsibility provisions (often called play or pay) must offer MEC coverage that is affordable and provides minimum value.

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Topics: ACA, PPACA Affordable Care Act, minimum essential coverage, employer shared responsibility, play or pay requirements

IRS Proposes Minimum Value Rule Change to Mesh IRS and HHS Rules

Posted by: Danielle Capilla    Sep 24, 2015 12:00:00 PM

Beginning in 2015, under the Patient Protection and Affordable Care Act (ACA), large employers must offer affordable, minimum value coverage to their full-time employees or potentially pay a penalty. Some companies have or had been marketing a plan that they state satisfies the minimum value requirement (an actuarial value of 60 percent), based upon a calculator provided by the Department of Health and Human Services (HHS), even though the plan does not cover inpatient hospital charges. New information provided by the IRS and HHS in 2014 and recently in 2015 should be considered as employers review their benefit offerings.

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Topics: ACA, PPACA Affordable Care Act, minimum essential coverage, minimum value coverage, play or pay requirements