How will the government know who has coverage through their job? Simple, sort of. Employers are required to complete the 1094C ACA Compliance draft form. It is called the transmittal of employer provided health insurance offer and coverage information returns. It will be used to identify employees on payroll that are receiving health coverage. It is also accompanied by a 1095C form to be filed by ALE members which is the Applicable Large group Employer(50+ employees on payroll). The Internal Revenue Service has issued draft versions of the reporting forms. Most employers will begin using the forms next year to show that their group health insurance plans comply with the health care reform law.
The long-awaited draft forms are the first practical application of employers' health care coverage and enrollment reporting obligations under the Patient Protection and Affordable Care Act since the regulations were finalized in March.
The forms are the primary mechanism through which the government intends to enforce the health care reform law's minimum essential coverage and shared responsibility requirements for employers.
Beginning in 2015, employers with at least 100 full-time employees will be required to certify that benefits-eligible employees and their dependents have been offered minimum essential coverage. Their employees' contributions to their premiums must comply with cost-sharing limits established under the reform law. Smaller employers with 50-99 full-time employees are required to begin reporting in 2016.
Additionally, self-insured employers will be required to submit documentation to ensure compliance with minimum essential coverage requirements under the reform law's individual coverage mandate. Download the 1094C ACA Compliance Form Draft below.
This form is a draft and not to be used for filing. The purpose is to give employers a better understanding of the program requirements and prepare them for compliance in 2015. As always Mainline Insurance is on your side and ready to assist in form preparation and enrollment.
The Affordable Care Act (ACA) requires employers to provide their employees with a written notice about exchanges to help explain some of the benefits and potential consequences associated with purchasing through an exchange. Employers must issue these notices as of October 1, 2013. We were just notified on Aug 28th, 2013. We thought an extension was in order.
The Exchange Notice must:
In order to provide your employees with the notification, please follow the link below to download the Employer Exchange Notification in PDF format. In order for employees to access the exchange they are required to fill out this form.
Click Here To Download
Mainline is certified and authorized to offer programs on the Health Benefit Exchanges as well as the private market plans. We are here to support our clients and friends. We encourage you to reach out with any and all questions as we transition into this new healthcare system.
Vincent Reda & Mainline Staff
Yes it will.
For businesses with under 50 Full time eligible employees on the payroll: you can purchase plans on the Small Business Health Options Program Exchange or purchase coverage through the regular non exchange marketplace. You are not obliged to provide coverage to the employees under the Health Care Reform Act. If you offer coverage and your employees do not participate and go on your plan we will then obtain coverage for them on the Individual Exchange to avoid penalties.
For businesses with over 50 full time eligible employees on the payroll: you cannot purchase plans on the Small Business Exchange. In NYS there is conversation they will raise that threshold to 100 employees in 2017.
Recently as of July 2013 they repealed the penalty for large groups (50+ full time on the payroll). No penalty will be imposed if they do not provide affordable healthcare to employees. The penalty will be reactivated in 2015. The penalty is $2000 per employee. The first 30 employees are forgiven, after that its $2000. The penalties’ will increase over time.
For individuals: if you do not obtain health insurance from your employer you will have to obtain it on the exchange. If you do not obtain coverage you will be faced with a penalty. The penalty is $95 or 1% of your w2 wages. The penalties’ will increase over time.
Stay tuned as the Affordable Care Act unfolds and we break it down for you.
Finally, the rates and plan designs for the health insurance plans to be offered on the New York State Health Benefit Exchange has been released. Policies vary based on guidelines set forth by the Federal government under the Affordable Care Act. This comprises of two exchanges; one for the Individual (non-business) and the other for Small Businesses with 2-50 employees.
Click Here To Download New Rates (PDF)
We are still awaiting guidance from New York State concerning different rules and regulations. A comprehensive set off rules is scheduled for October of this year. On July 2, 2013, the Obama Administration announced on the Treasury Department’s website that it would delay the employer mandate for one year, until 2015. In the statement, the Administration said that they were delaying implementation in order to meet two goals:
“First, it will allow us to consider ways to simplify the new reporting requirements consistent with the law. Second, it will provide time to adapt health coverage and reporting systems while employers are moving toward making health coverage affordable and accessible for their employees."
Note, the employee mandate, which is a penalty for large employers (50+ on the payroll) has been pushed off till 2015. On July 2nd 2013 the Obama administration announced
However, the penalty for the employees still remains. Those employees will have to obtain coverage or be penalized. At Mainline Insurance we will be well prepared to help. Many of these employees will receive an Advance Premium Tax Credit to help them afford their coverage. If any of you would like to have some discussion on this matter please feel free to call or email.
The education and certification process for us to provide guidance is to start shortly. It appears it is taking the State some time to get the curriculum together. I anticipate the pace to pick up now since October is right around the corner.
We will be keeping all of you well informed periodically.
Mainline President Vincent Reda is a Healthcare specialist with 40 years of experience in providing healthcare coverage to individuals and organizations.