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Healthcare Reform What Employers Need to Know Presented By Sheldon J. Blumling Fisher & Phillips LLP (949) 798-2127 PowerPoint Presentation
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Healthcare Reform What Employers Need to Know Presented By Sheldon J. Blumling Fisher & Phillips LLP (949) 798-2127 - PowerPoint PPT Presentation


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Fisher & Phillips LLP ATTORNEYS AT LAW Solutions at Work ®. Healthcare Reform What Employers Need to Know Presented By Sheldon J. Blumling Fisher & Phillips LLP (949) 798-2127 sblumling@laborlawyers.com. www.laborlawyers.com.

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Fisher & Phillips LLP

ATTORNEYS AT LAW

Solutions at Work®

Healthcare Reform

What Employers Need to Know

Presented By

Sheldon J. Blumling

Fisher & Phillips LLP

(949) 798-2127

sblumling@laborlawyers.com

www.laborlawyers.com

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.

healthcare reform
Healthcare Reform

Today’s Agenda:

  • Delay of Enforcement of Employer “Play or Pay” Mandate to 2015
  • Provisions and Obligations that Remain
  • Recent Exchange Notice
  • Employer “Play or Pay” Mandate Overview
  • What Employers Should be Doing Now
healthcare reform1
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 reform2
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 reform3
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 reform4
Healthcare Reform

Provisions and Obligations that Remain:

  • Providing SBCs
  • MLR Rebates
  • W-2 Reporting of Cost of Coverage
  • Coverage Mandates
  • Employer Exchange Notice
healthcare reform5
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 reform6
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 reform7
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 reform8
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 reform9
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 reform10
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 reform11
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 reform12
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 reform13
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 reform14
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 reform15
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 reform16
Healthcare Reform

What Employers Should be Doing Now:

  • Modeling the impact of the Employer “Play or Pay” Mandate
    • Does it Apply?
    • How Much Will it Cost?
    • Impact on Employees
  • Addressing ongoing compliance obligations
  • Watching for new near-term guidance:
    • Revised/Final Employer Mandate Guidance
    • Revised/Final IRC 6055/6056 Reporting Guidance
healthcare reform17
Healthcare Reform

What Employers Should be Doing Now:

  • Following developments in the law as other new guidance is issued:
    • Exchange Notices
    • Nondiscrimination Requirements
    • Automatic Enrollment
    • Plenty more to come…
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Fisher & Phillips LLP

ATTORNEYS AT LAW

Solutions at Work®

Questions ?

www.laborlawyers.com

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.

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Fisher & Phillips LLP

ATTORNEYS AT LAW

Solutions at Work®

Healthcare Reform

What Employers Need to Know

Presented By

Sheldon J. Blumling

Fisher & Phillips LLP

(949) 798-2127

sblumling@laborlawyers.com

www.laborlawyers.com

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.