health care reform · 11/11/13 4 large employer – safe harbor • affordability safe harbor and...

11/11/13

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Ross Manson, Principal Tonya M. Rule, Tax Manager

Health Care Reform

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Health Care Reform Update

•  ACA employer penalties delayed until 2015 •  1/1/2014

•  Establishment of Public Exchanges •  Payment of Individual Subsidies •  Individual Mandate

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EMPLOYER BASICS Health Care Reform

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Employers key number is

50

> = 50 = Large Employer and subject to pay or play penalties

< 50 Small Employer and NOT subject to pay or play penalties

Full time equivalent employees

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Health Care Reform – Large Employer?

•  Large employer = 50 or more Full-Time Equivalent Employees

Steps: 1.  Calculate your Full-Time Employees (average 30 hours/

week or 130 hours per month) 2.  Calculate your (part-time and seasonal) FTEs (add up

total hours and divide by 120) 3.  Add the two numbers in steps 1 and 2 4.  Add up the 12 monthly numbers in 3 and divide by 12 5.  If less than 50, not applicable large employer 6.  If greater than or equal to 50, greater than 120 days?

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Part-Time and Seasonal Employees

•  Part-Time and Seasonal Employees •  Part-time employees: those working fewer than 30

hours a week for the year •  Included in calculating whether an employer has over 50 full-

time equivalents •  Not included in penalties

•  Seasonal employees: as designated by the Department of Labor

•  Included in calculating penalties in the months applicable •  Excluded if: seasonal employees caused employer to have

> = 50 full-time equivalents for equal or less than 120 days

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Hours of Service Rules

•  Hours of service include not only hours worked but also hours for which an employee is paid or entitled to payment even when no work is performed. Including: •  Vacation, holiday, illness, incapacity, layoff, jury duty,

military duty or leave of absence •  Service outside of the U.S. is generally not counted

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Large Employer – NO insurance

•  Employers NOT offering health insurance •  A penalty of $2,000 per year/per full-time employee •  Exempts the first 30 full-time employees from

computation •  Example: 100 full-time employees and one goes to an

Exchange and utilizes credit •  Penalty = (100-30) x $166.67 = $11,667/month

•  $140,000 annually •  Triggered on all full-time employees if one full-time employee

goes to the exchange and receives a subsidy

•  Penalty is NOT tax deductible

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Large Employer – Offer Insurance

•  Potential penalty if employer OFFERS health insurance •  A penalty of $3,000 per year/per FT employee who goes to

the exchange and receives an exchange subsidy

•  Subsidy eligibility based on unaffordable or inadequate insurance

•  Unaffordable = Employee insurance premiums exceeding 9.5% of HHI

•  Inadequate = Insurance policy less than 60% of actuarial value

•  Capped by the amount of penalty for not offering insurance coverage (in aggregate, not per employee)

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Large Employer – Safe Harbor

•  Affordability safe harbor and proposed regulations issued 12/28/12 •  Employer must offer minimal essential coverage •  Employee portion of self-only premium for the lowest

cost coverage that provides minimum value must not exceed 9.5% of the employee’s wages

•  Wages equal Box 1 on Form W-2 •  “Rate of Pay” – rate of pay at beginning of year multiplied by

130 hours. This becomes base amount for 9.5% affordability calculation.

•  Federal poverty line (FPL) – self only coverage < 9.5% of FPL for a single individual.

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Large Group Coverage

•  Employer must offer coverage to at least 95% of all full-time employees and their dependents •  Help protect against errors that could occur in

identifying full-time employees; •  Coverage must be offered to dependents – only

required to pay premium towards single plan (can’t exceed 9.5% test);

•  Dependents; •  Children up to age of 26 •  Spouse not defined as a dependent

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Health Care Reform Terms

•  Waiting period •  Measurement period

•  Initial measurement period •  Standard measurement period

•  Stability period •  Administrative period

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Waiting Period

•  Waiting Period – period of time that must pass before an employee or dependent, who is otherwise eligible to enroll under terms of a group health plan, can receive coverage. This period cannot exceed 90 calendar days

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Measurement and Stability Period

•  Measurement Period – period of not fewer than three or more than 12 months, chosen by the employer, as the measurement period that can be looked back to in order to determine the full- or part-time status of an employee

•  Stability Period – next period where an employee is locked in according to the results of the measurement period

•  Measurement and Stability periods apply to: •  Ongoing employees •  New variable hour employees •  New seasonal employee

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Measurement Period

•  Standard Measurement Period (SMP) applies to ongoing employees •  Employees employed at least one full SMP

•  Initial Measurement Period (IMP) applies to new variable hour and seasonal employees •  Is usually going to be different than the SMP •  Begins between the employee’s start date and first day of

next calendar month

•  IMP and SMP will likely overlap for new employees

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Stability Period

•  The Stability Period is the period in which an employee’s status is determined for offering insurance or paying penalties •  Status will be either a full time or part time employee

(as determined from the measurement period) •  Full time employee: stability period has to be at least

six months or the length of the measurement period •  Part time employee:

•  Ongoing employee – not longer than SMP •  New variable hour seasonal employee – not longer than IMP

plus one month and status must be tested again during first SMP

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Administrative Period

•  Administrative Period – this is the time allowed between the measurement period and stability period used to determine the status of the employee which cannot exceed 90 days and cannot delay the effective date of coverage to an eligible full-time employee

•  Initial measurement period and administrative period cannot exceed past the last day of 1st calendar month beginning on or after 1-year anniversary of new variable hour employee (approximately 13 months)

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Permissible Employee Categories – for Measurement Periods

•  Collectively bargained employees and non-collectively bargained employees

•  Each group of collectively bargained employees under separate agreements

•  Salaried and hourly employees •  Employees in different states

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Example 1

•  Ongoing full time employee: •  SMP – 11/1/13 to 10/31/14 (12 months)

•  Admin period – 11/1/14 to 12/31/14 (2 months)

•  Stability period – 1/1/15 to 12/31/15 (12 months) •  Employee Alex has worked for XYZ for 10 years and

averaged more than 30 hours per week •  Alex would be considered a full time employee during

the Stability period of 1/1/15 to 12/31/15 •  XYZ must offer insurance to Alex or pay a penalty

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Example 1 Chart

SMP = Standard Measurement Period AP = Administrative Period SP = Stability Period

11/1/13 SMP 10/31/14

1/1/15 SP 12/31/15

AP

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Example 1 Chart

SMP = Standard Measurement Period AP = Administrative Period SP = Stability Period

11/1/13 SMP 10/31/14

1/1/15 SP 12/31/15

11/1/14 SMP 10/31/15

1/1/16 SP

AP

AP12/31/16

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Example 2

•  New variable hour employee: •  Carter is a new employee who started June 1, 2014

for XYZ •  XYZ choses a 12 month IMP starting on Carter’s hire

date (6/1/14 to 5/31/15) •  XYZ’s SMP is 11/1/14 to 10/31/15

•  Admin period: •  New employee – 6/1/15 to 6/30/15 •  Ongoing employees – 11/1/15 to 12/31/15

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Example 2 continued

•  Carter averages more than 30 hours a week during IMP (6/1/14 to 5/31/15) •  Carter is a full time employee of XYZ from 7/1/15 to

6/30/16

•  XYZ must also track Carter’s hours during the SMP and if Carter’s hours during the SMP are greater than 30 per week, than XYZ must consider Carter full time during the stability period associated with the SMP

•  i.e. 7/1/16 to 12/31/16

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Example 2 Chart

6/1/14 IMP 5/31/15 AP7/1/15 SP-IMP 6/30/16

11/1/14 SMP 10/31/15

1/1/16 SP-SMPAP

12/31/16

IMP = Initial Measurement Period AP = Administrative Period SP = Stability Period SMP = Standard Measurement Period

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Employment Status Change

•  Change in employment status for new variable hour or seasonal employee during IMP •  If employee would have started in that employment

status and been expected to work 30 hours per week, then employee must be treated as full-time and coverage would need to be extended on the first day of the fourth month following the change

•  This rule does not apply to ongoing employees as their status is locked (during stability period) even if they have a change in employment status

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Employees Rehired

•  A rehired employee will resume their full-time or part-time status for the remainder of the stability period

•  Status would change if: •  Employee did not have 1 hour of service within the

prior 26-week period preceding the return to work •  Rule of parity – employee was gone for longer than

their length of service measured in weeks which would also be longer than 4 weeks

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Service breaks

Educational organizations need to apply hours during school breaks based on one of the two following methodologies: •  Average hours per week excluding the break period which

would be the average hours for the entire measurement period

OR •  Credit employee break period with average hours at a rate

equal to the rate without regard to the break period

•  There is a cap of 501 hours required to be added for school break periods (exceptions for special unpaid leave)

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Grandfathering Provisions

•  Grandfathered health plan is one that was in existence on March 23, 2010

•  Loss of status events •  Reduce or eliminate benefits •  Raising co-insurance, or significantly raising co-

payments and deductibles •  Significantly lowering employer premium contributions

•  To maintain grandfather status – document the plan and policy terms effective as of 3/23/10

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Non-discrimination Testing

•  The penalty for plans will have an excise tax of $100 per day for the plan per person discriminated against

•  Maximum penalty of $500,000 for non willful failures

•  Penalties are under IRC 4980D •  Is for plan years beginning after ________???

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Health Care Reform – Employers

•  40% excise tax on “Cadillac” health plans ($10,200 for individual, $27,500 for family) – Effective 2018 •  Retirees limit is $11,850 for individual and $30,950

for family •  Tax is on excess benefit calculated on a monthly basis •  Applicable on coverage paid by both employer and/

or employee •  Includes pretax contribution to FSAs, HRAs, HSAs •  Employers are to calculate this penalty for insurers,

penalty is 100% plus interest

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Reporting

•  Exchange •  IRC Section 36B •  1095-A

•  Health insurance issuer/Self-insured •  IRC Section 6055 •  1095-B

•  Employers •  IRC Section 6056 •  1095-C


Simplified reporting

•  The Treasury and the IRS are considering whether, in certain circumstances, other methods of furnishing information to an employee may be sufficient (for example, through the use of a code on the Form W-2).


Reverse Discrimination

•  Affordability is 9.5% of HHI •  You test for affordability and you have four

employees that each fail by $50 per month •  Total exposure to penalty is $12,000 •  What if you just pay $50 more per month for

insurance for those four employees •  Total cost to fix the problem $2400 ($50*12*4)

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Health Care Reform

HEALTH CARE REFORM ANALYTICS

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Health Care Reform Analytic

•  Help Understand: •  Determination of Large/Small Employer •  Employee Status – full time and part time •  Potential costs and fees with ACA •  Affordability calculation •  Employee subsidies •  Cadillac tax potential •  Benefit plan opportunities in a developing

marketplace!

•  Helps you make an informed decision!


Employee Breakdown

88 employees worked 1,560 or more hours 101 employees worked less than 1,560 hours - 4 part time employees enrolled in single coverage

Full time employees are included in the analysis 36

Below displays a breakdown of XYZ’s employees by full time & part time as well as by EBI enrolled plan:

Plan Type Full Time Part Time Total" " " " " " " "

Single 28 4 32 SPD 7 - 7 Family 7 - 7 Single Waived 31 80 111 Family Waived 15 17 32 " " " " " "

Total 88 101 189 " " " " " "

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2013 and 2014 Premiums

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Below displays the baseline 2013 and 2014 baseline inflated EBI monthly and annual premiums:

PlanEmployee Per Month

Employer Per Month

Employee Annual

Employer Annual

Total Premium" " " " " " " " " " " "

2013Single 133$ 370$ 1,596$ 4,445$ 6,041$ SPD 374 525 4,488 6,297 10,785 Family 689 626 8,268 7,509 15,777

2014Single 145 404 1,740 4,845 6,585 SPD 408 572 4,892 6,864 11,756 Family 751 682 9,012 8,185 17,197

* - SPD: Single plus dependent coverage


Employers will be assessed whether their insurance is affordable or adequate. The two charts below show insurance affordability based on the W-2 wages and an estimate for household income:

Subsidy Factors

Qualified Health Plan (Actuarial Value) = ? < 60% of actuarial value

are determined to be Inadequate health plans

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Affo

rdab

ility

A

dequ

acy

67 , 76%

21 , 24%

Single Premium as a % of W-‐2 Wages (safe harbor)

Affordable

Unaffordable

73 , 83%

15 , 17%

Single Premium as a % of Household Income

Affordable

Unaffordable


The following graph and chart below shows the breakdown of subsidy eligible based on no employer based insurance:

Household Income as a % of Federal Poverty Level

Subsidy Factors – with Spousal Income

Income Level Employee Exchange Premium Employee Grouping # of FT Employees

Up to 133% FPL 2% of income (exchange enrollee) Medicaid 18

133 – 150% FPL 3 – 4% of income Large Subsidy 2

150 – 200% FPL 4 – 6.3% of income Large Subsidy 21

200 – 250% FPL 6.3 – 8.05% of income Small Subsidy 15



400%+ FPL 100% of premium No Subsidy 12

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18 , 20%

23 , 26%35 , 40%

12 , 14%

Medicaid

Large SubsidyEligible

Small SubsidyEligible

No SubsidyEligible

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Executive Summary: Employer

Below displays the employer impact for XYZ based on the points in time & key assumptions:

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* - BL: Baseline

$239,000 $260,000

$513,000

$386,500

$116,000

Baseline BL Inflated BL Adjusted (100%Waived Included)

BL Adjusted (50%Waived Included)

No Insurance andNo Comp Adjustment

Employer Cost

2013 Baseline Plus Inflation Plus Waived No Insurance


Executive Summary: Employee

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Below displays the employee impact for XYZ based on the points in time & key assumptions:

$140,000 $153,000

$280,000 $216,500

$289,000

Baseline BL Inflated BL Adjusted (100%Waived Included)

BL Adjusted (50%Waived Included)

No Insurance andNo Comp Adjustment

Employee Cost

2013 Baseline Plus Inflation Plus Waived No Insurance

* - BL: Baseline


Defined Contribution Advantages/Private Exchange

•  Cost control •  Contribution used by non-subsidy eligible

employees •  Subsidy eligible employees go to public exchanges •  More plan choice for employees

•  Total compensation transparency •  Health coverage will be reported on W-2 beginning in

2013

•  More transparency will better educate employees about the full cost of health coverage

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Health Care Reform – Employers

Requirement to notify employees of exchange – by October 1, 2013…in 2014 must be given to new hires within 14 days of hire date. It must: •  Inform employees of exchange •  Inform employees of potential tax credit if

insurance is purchased on exchange •  Inform employees of potential loss of employer

contribution if they get insurance from exchange •  Inform employees that this contribution may be

excluded income on their Federal tax return

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Additional Fees

•  PCORI (Patient Centered Outcomes Research Institute) •  Fees applicable to policy and plan years after October 1, 2012

and before October 1, 2019 and is on the average number of covered lives under the plan:

•  $1 the first year, $2 in subsequent years

•  Transitional Reinsurance Fee •  (2014 thru 2016) – fee on insurers and self funded plans. In

place to create a fund for insurance companies to offset the cost of covering people in the individual market:

•  Fee is $63 per covered life in 2014 – raise $12B •  2015 fee decreases – raise $8B •  2016 fee decrease – raise $5B

•  Health Insurance Industry Fee

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Employer Next Steps:

•  Make an Informed Decision •  Determine if you are controlled group •  Calculate your full-time and part-time employees •  Conduct affordability testing •  Determine actuarial value of plan •  Determine strategy on health insurance benefit

•  Look at current plan design •  New options available

•  Evaluate impact to employees •  Track hours if a large employer •  Consult experts – to determine penalties, but also to

stay on top of new regulations

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Thank you!

Ross Manson, Principal

[email protected] Tonya M. Rule, Tax Manager

[email protected]

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These seminar materials are intended to provide the seminar participants with guidance on the portions of the Affordable Care Act. The materials do not constitute, and should not be treated as professional advice regarding the use of any particular portion of the Affordable Care Act or the savings/penalties associated with any technique. Every effort has been made to assure the accuracy of these materials. Eide Bailly LLP and the author do not assume responsibility for any individual's reliance upon the written or oral information provided during the seminar. Seminar participants should independently verify all statements made before applying them to a particular fact situation, and should independently determine the rules surrounding the Affordable Care Act and any particular penalty/insurance offering technique before recommending the technique to a client or implementing it on the client's behalf.

health care reform · 11/11/13 4 large employer – safe harbor • affordability safe harbor and...

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