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Number of IRS Agents being hired to enforce Affordable Care Act (ACA) compliance

Employers with 50 employees or more must start offering affordable benefits solutions starting January 1st, 2015

The amount of the fine for each employee that receives a subsidy through a federal or state exchange

Employers with 50 employees or more must file IRS Forms 1094-C & 1095-C forms with the Internal Revenue Service

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January 2015

Employer Shared Responsibility “Play or Pay”
Frequently Asked Questions (FAQ’s)

What are the "Shared Responsibility" requirements?

Effective January 1, 2015, employers that employ 50 or more full-time employees including full-time equivalent employees (“FTEs”) must offer group health plan coverage to their full-time employees (and their dependent children up to age 26) or potentially be liable for a penalty. A penalty will apply if the employer:

  1. fails to offer “minimum essential coverage” under an “eligible employer sponsored plan” to at least 95% of full-time employees, or
  2. offers coverage that does not meet certain “minimum value” and “affordability” requirements, and at least one full-time employee receives a premium tax credit to help purchase coverage for himself or herself through an Exchange.

Different penalties are imposed based on whether the employer is in category (A) or (B) above. Also, a smaller employer (fewer than 100 full-time employees) may satisfy (A) above as long as coverage is offered to all but 5 or fewer full-time employees. Note that full-time employees who are part of the 5% that are not offered coverage may trigger the penalty associated with category (B) above.  Certain transition relief applies for 2015

What if an employer does not offer dependent coverage?

For these purposes, “dependent” means an employee’s child under age 26, and includes natural and adopted children. Starting in 2015, an employer subject to Shared Responsibility generally must offer coverage to its full-time employees and their children up to age 26 to satisfy the Shared Responsibility requirements. In general, an employer will not be subject to a penalty for failing to offer children under age 26 coverage for plan years that begin in 2015 if the plan takes steps during its 2014 plan year to add dependent coverage (if certain conditions are met). However, an employer is not required to contribute toward the cost of dependent coverage, as coverage is “affordable” for purposes of the Shared Responsibility requirements based on the cost of employee-only coverage (not to exceed 9.5% of employee pay-check)

Note that employers are not required to offer spousal coverage, and the receipt of a premium tax credit by an employee’s spouse or dependent will not result in a penalty on the employer.

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What is "minimum essential coverage" or MEC?

The ACA mandates that most individuals maintain minimum essential coverage for themselves and their dependents or potentially be subject to an income tax penalty (this requirement is known as the “Individual Mandate”). Minimum essential coverage includes coverage under an employer-sponsored group health plan, coverage in the individual market, coverage under grandfathered health plans, Medicare, Medicaid, and certain other types of coverage.

What is an "eligible employer-sponsored plan"?

Any health insurance coverage offered by an employer to an employee that is available in the small or large group market, or a governmental plan. The term also includes self-insured group health plans. Note that while an individual must maintain minimum essential coverage to comply with the Individual Mandate, a large employer (see Applicable Large Employers below) must offer coverage under an “eligible employer-sponsored plan” that meets affordability and minimum value requirements to avoid a potential Shared Responsibility penalty.

When are the Shared Responsibility requirements effective?

Penalties have been delayed entirely for 2014.  Penalties will not be imposed in 2015 (and months in 2016 in the 2015 plan year) on employers with 50-99 full-time employees and full-time equivalent employees as long as those employers do not restructure their workforce or change their health coverage in 2014-2015.  For employers with 100 or more full-time employees and full-time equivalent employees, transition relief applies for 2015 (and months in 2016 in the 2015 plan year) under which the employer will not be assessed the $2,000 penalty if it offers coverage to at least 70% of its full-time employees. Information reporting requirements apply beginning 1/1/2015.

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