What Was NOT Delayed in the ACA
Two recent blog posts informed of a one-year delay in implementing two parts of the Affordable Care Act’s so called employer mandate – the reporting requirements and the associated “pay-or-play” penalties. Last week, the Treasury Department issued official guidance (in the form of Notice 2013-45) that clarifies the delay. Here are a few key points and implications extracted from the guidance:
Three specific ACA requirements (enforceable through IRS code) are affected by this delay:
1. Employers with self-funded plans, insurers, and other providers of health coverage will be required to submit a detailed report to the IRS concerning the health coverage it provided and the individuals to whom the coverage was provided. They will be required to distribute the same information to the individuals who were listed on the IRS reports. Due to the one-year delay, no such reports will be required in 2014.
2. Large employers (at least 50 full-time equivalent employees) will be required to submit a detailed report to the IRS concerning the health coverage it offered to its full-time employees. Large employers will be required to distribute the same information to their full-time employees who were listed on the IRS report.
Due to the one-year delay, no such reports will be required in 2014.
3. Large employers would be subject to penalties if they failed to offer affordable, minimum-value health coverage to all of their full-time employees. These so-called “pay-or-play” penalties were to begin accruing in 2014.
Due to the one-year delay, no such penalties will be assessed for 2014.
Importantly, here are some of the more important ACA provisions that remain unchanged, and will continue to be implemented barring any announcements, guidance, etc. (Note: this list is NOT intended to be all inclusive, but rather a brief overview of the more pressing requirements.)
·Individual mandate and individual penalties (Note: as I write this blog post, the House of Representatives is moving to advance a bill to delay this provision.)
·Opening of the marketplaces/exchanges (scheduled to be open by 10/1/13)
·Availability of subsidies (also known as “premium tax credits”) for eligible applicants purchasing coverage through an exchange/marketplace
·Requirement to report and pay PCORI fees by July 31, 2013
·Distribution of an exchange notice to employees by October 1, 2013
·Distribution of a Summary of Benefits and Coverage upon the occurrence of certain events
·Requirement that waiting periods for coverage be limited to 90 days or less
·Dollar limitations on deductibles and out-of-pocket maximums (fully insured/under 50 employees)
· Prohibition on pre-existing condition exclusions
I hope to be able to write about something other than the delay of the ACA’s employer mandate next week!