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Employer Shared Responsibility

Large employers (50 or more full-time employees) face penalties if they do not offer affordable minimum essential coverage to their employees and dependents and any of their employees receive a subsidy to obtain coverage through a public health care exchange.

Articles

House to consider changes to ACA employer provisions, Lockton, 9/11/2018

IRS Letter 5699 – The Good, The Bad and The Ugly, Accord Systems, LLC, 9/4/2018

The IRS wants to know: Has your company filed Form 1095-C?, Lockton, 8/13/2018

Update to the Marketplace Notice , Winston & Strawn, LLP, 8/8/2018

New 2019 Guidance Documents For Insurers, Health Affairs, 7/26/2018

Recent Observations on ACA Employer Mandate Enforcement, HUB International, 7/25/2018

IRS Doubles Down on Employer Mandate Enforcement, Conduent, 7/17/2018

Three Things about the Affordable Care Act Employers Need to Focus on Now , Hanson Bridgett LLP, 7/9/2018

IRS Releases ACA Affordability Rates for 2019, The Wagner Law Group, 7/5/2018

The Five Flavors of Employer Mandate Acknowledgment Letters, HUB International Limited, 6/26/2018

IRS Releases More Details on Letter 227 – Response to Appeal on Employer Shared Responsibility Payment, Marsh & McLennan Agency, LLC, 6/14/2018

IRS increases ACA employer mandate affordability threshold for 2019, Lockton, 5/30/2018

ABD Compliance Alert - How the 2019 ACA Affordability Increase to 9.86% Affects Employers, ABD Insurance & Financial Services, 5/24/2018

Ask the Expert: Managing Benefits for Employees with Fluctuating Hours, BLR HR Daily Advisor, 5/17/2018

For Applicable Large Employers Cutting Back Hours Doesn’t (Necessarily) Mean Cutting Off Coverage, HUB International, 4/18/2018

Responding to IRS employer mandate assessment letters, Willis Towers Watson, 4/16/2018

Incorrect TIN Error Message Problem Lingers, Causing Confusion – Employers Can Continue to Ignore , Accord Systems, 4/12/2018

ACA and Play or Pay—IRS Letters 226-J Arrive, International Foundation, 4/5/2018

Update on ACA Employer Mandate Enforcement, Conduent, 3/21/2018

IRS Releases Sample Notice CP 220J - Notification of 2015 Employer Shared Responsibility Liability, Thomson Reuters, 3/1/2018

New 2018 Federal Poverty Guidelines Affects ACA Safe Harbor, HUB International, 2/16/2018

A Game Plan for Employers Facing Possible ACA Penalties, Carlton Fields Jorden Burt, P.A. , 1/17/2018

IRS Once Again Extends Distribution (Not Filing) Deadline for ACA Reporting and Continues Good Faith Standard , Proskauer, 1/2/2018

IRS Again Delays Employer ACA Reporting, Conduent, 12/27/2017

So, Your Employee Received an ACA Premium Tax Credit . . ., International Foundation, 12/20/2017

A Comprehensive Look at the Employer Mandate Penalty Assessment – Options, Real Examples, and Lingering Problems, Health Care Attorneys P.C., 12/18/2017

Employer Shared Responsibility Penalty Assessment Toolkit, Gallagher, 12/15/2017

Watch Your Mail: IRS Begins Collection of Employer Mandate Penalties , Foley & Lardner, 11/30/2017

Final Pieces of Employer Mandate Assessment Released – IRS Issues Sample Forms 14764 and 14765, Accord Systems, 11/27/2017

ACA Employer Mandate Assessments Coming, Proskauer, 11/16/2017 Contains chart with section 4980H penalty amounts.

ACA and Play or Pay—IRS Letters 226J Are On the Way, International Foundation, 11/15/2017

How to Respond to IRS Letter 226J about Affordable Care Act Penalties, The ACA Times, 11/13/2017

Employer Mandate Penalty Assessments Are Coming Soon, HUB International, 11/6/2017

HRAs, AHPs, and STLDIs: What the Executive Order Means for Benefit Plans, IFEBP, 10/20/2017 Blog explains President Trump's Executive Order dated October 12, 2017, and how it could affect employers and employees

ACA Numbers & Limitations, Kaufman & Canoles, 10/1/2017 Chart including employer 4980 penalty amounts from 2015 - 2018

Crossing the Threshold – Small Business to “ALE”, Jackson Lewis, 9/8/2017

Out of Sight, Out of Mind . . . But Don’t Forget the Possibility of ACA Retaliation Claims, Ogletree Deakins, 9/7/2017

IRS Will Enforce Employer Mandate Regardless Of Any Executive Orders, Fisher Phillips, 9/5/2017

Careful – The Affordability Test is More Restrictive on Employers in 2018, Accord Systems, 8/31/2017

The Ins and Outs of Opt-out Incentives, Spencer Fane, 8/29/2017

Little Known Fact – Sections 4980H(a) and 4980H(b) Penalty Amounts Already Finalized for 2018, Accord Systems, 8/22/2017

Treasury Inspector General Releases Assessment on IRS Implementation of Employer Shared Responsibility Provisions, Ernst & Young LLP, 6/15/2017

IRS Announces ACA Indexing Adjustments for Affordability and Premium Tax Credit Determinations for 2018, Thomson Reuters, 5/11/2017

Revisiting the Affordable Care Act, McDonald Hopkins, 3/30/2017

Employer Responsibility Under the Affordable Care Act, Kaiser Family Foundation, 9/30/2016

Employee Classifications Irrelevant in Determining Shared Responsibility Penalties, Wagner Law Group, 9/8/2016

Are You Down With O.O.P.s?: Opt-Out Payments Under the Affordable Care Act, Jackson Lewis, 8/19/2016

Responding to Marketplace Notices, McDermott Will & Emery, 8/3/2016 Employers have begun to receive notices from the Health Insurance Marketplace Exchanges (Marketplace) notifying them that one or more of their employees is eligible for governmental subsidies under the Marketplace.

Medicare-Enrolled Employees' Impact on ACA's Employer Mandate Penalty, Wagner Law Group, 7/28/2016

The Beautiful, Rhythmic Beat of Seasonal Employees under the Affordable Care Act, Accord Systems, 7/26/2016

IRS Proposes Additional Regulations Clarifying Handling of 'Opt-Out' or 'Cash-in-Lieu' Programs Under PPACA, Benefit Revolution, 7/23/2016

IRS Releases Proposed Regulations Regarding the Affordable Care Act's Calculation of Coverage Affordability for Employers Offering Opt-Out Payments, Liebert Cassidy Whitmore , 7/11/2016

ACA Cost Increases Hitting Employee Wallets, International Foundation , 6/27/2016 Faced with rising costs due to the Affordable Care Act (ACA), employers have made a number of changes to their health plans that directly impact their employees' wallets, according to the 2016 ACA Impact Survey.

How to Tell an Employee You Are Appealing Their ACA Subsidy, International Foundation, 5/31/2016

It’s Time for ALEs to “Do the Math” on Controlled Group Status, E is for ERISA, 4/22/2016

What's Working: Helping Members with Health Care Decisions, International Foundation, 7/1/2015 The administration of a multiemployer health and welfare fund describes how the fund took adavantage of ACA to gain subsidized coverage for union members who did not qualify for the fund's plans.

Student Employees and the Affordable Care Act – Part 1 of 4: Can We Exclude Student Workers From Our Health Plan?, Mintz Levin, 6/2/2015

New Regulations Permit Employers to Offer Limited Wraparound Health Coverage as Excepted Benefit, McGuire Woods, 4/29/2015

Implementing Health Reform: Preliminary 2015 Enrollment Numbers; Guidances, Health Affairs, 2/19/2015

Eligibility Rules Need To Be In Writing, Fisher Phillilps, 2/2/2015

COBRA, Marketplace Coverage, Stability Periods, and Cafeteria Plan Elections, Mintz Levin, 6/23/2014

Employer “Pay or Play” Mandate Final Regulations Issued—Major Impact on Educational Institutions, Ogletree Deakins, 2/14/2014

FAQs

Can an employer offer a stipend for employees to use to purchase their own individual health insurance policies?, International Foundation, 9/4/2018

How has the 9.5 percent affordability threshold amount been adjusted over time? , International Foundation, 8/24/2018

If an employee is turning age 65 and transitioning from full-time to part-time, when does the employer remove the employee from health insurance? , International Foundation, 8/21/2018

How is ACA affordability affected when an employee has a pay decrease during the year or changes position to a lower-paying position?, International Foundation, 7/30/2018

Can an employer satisfy the employer shared responsibility provisions by providing mandatory health coverage to all full-time employees?, International Foundation, 5/30/2018

How much are the employer shared responsibility penalties (4980H A & B)? , International Foundation, 5/9/2018

Does the ACA require an employee to accept or decline an offer of health coverage every year?, International Foundation, 4/25/2018

Are employers required to include Puerto Rico employees in any ACA reporting or coverage requirements?, International Foundation, 4/6/2018

If a small employer is part of an ALE group, but does not offer coverage to its employees, could it owe any employer shared responsibility penalties?, International Foundation, 2/14/2018

If an employer will become an Applicable Large Employer (ALE) in 2018, when will the employer be required to offer health coverage to full-time employees?, International Foundation, 2/1/2018

How much are the employer shared responsibility penalties (4980H A & B)?, International Foundation, 1/16/2018

Does the Tax Cuts and Jobs Act change any employer ACA responsibilities?, International Foundation, 1/4/2018

Under what circumstances can an individual receive a premium tax credit (PTC) on the public exchange, and why should employers care?, International Foundation, 12/14/2017

When does the IRS expect to begin notifying employers of potential employer shared responsibility payments?, International Foundation, 9/7/2017

Are opt-out payments to employees included in the affordability calculation?, International Foundation, 9/1/2017

How has the 9.5 percent affordability threshold amount been adjusted over time?, International Foundation, 7/12/2017

Does an employer have to count the hours of unpaid interns for purposes of determining employer shared responsibility?, International Foundation, 5/11/2017

When determining application large employer (ALE) status and counting full-time equivalents (FTEs), how is a resulting fraction handled? Should it be rounded up or down?, International Foundation, 3/10/2017

We just hired our 50th employee on November 2, 2016. Are we required to complete Forms 1094-C or 1095-C for 2016 coverage?, International Foundation, 11/30/2016

Must a self-insured, grandfathered health plan offer pediatric dental and vision benefits?, International Foundation, 10/17/2016

When calculating the employer penalty tax “A”, is the penalty multiplied by all full-time employees or is it multiplied by the number of employees we should have offered coverage to but didn’t?, International Foundation, 7/6/2016

If an employer has only part-time employees but has over 50 full-time equivalents (FTEs) is the employer subject to the employer mandate?, International Foundation, 6/27/2016

Can HMOs exclude dependents under age 26 because they live outside the service area?, International Foundation, 6/23/2016

If an ongoing full-time employee goes on disability leave during the stability period under the look-back measurement method, how long is the employer required to continue offering health coverage?, International Foundation, 6/17/2016

Are we required to track actual hours worked for employees who are hired into full-time, salaried, exempt positions?, International Foundation, 5/26/2016

How do you count temporary workers (assigned by a temporary staffing agency) for purposes of the employer shared responsibility requirements?, International Foundation, 4/6/2016

How does an applicable large employer (ALE) determine whether a temporary worker, not hired through an agency, has to be offered health coverage?, International Foundation, 4/1/2016

What are the 30 hours per week or 130 hours per month requirements that are used for determining full-time employee status under the Affordable Care Act?, International Foundation, 3/31/2016

Under the Affordable Care Act (ACA), may an employer still offer different health plan benefits to different groups of employees?, International Foundation, 3/23/2016

If an employer offers one plan of minimum value that is affordable, can they also offer one that does not meet those requirements?, International Foundation, 3/19/2016

Does an employer need to count employees on maternity leave when determining how many full-time employees it has?, International Foundation, 3/16/2016

Under the Affordable Care Act (ACA), can an employee waive coverage without the employer being penalized?, International Foundation, 2/16/2016

How does an employer determine when a part-time worker who becomes a full-time worker must be offered health coverage?, International Foundation, 2/12/2016

How does an employer determine when an ongoing full-time employee who becomes part-time can be taken off health insurance?, International Foundation, 2/5/2016

Must an employer file Form 1095-B if it only offers self-funded dental and/or vision benefits?, International Foundation, 12/31/2015

When calculating the penalty tax 4980H(a), is the penalty multiplied times all plan eligible employees or is it multiplied by the number of employees we should have offered coverage to but didn’t?, International Foundation, 12/10/2015

What is the “monthly method” for determining full-time employee status, and how is it used for new and ongoing employees?, International Foundation, 11/9/2015

Can we offer a stipend for employees to use to purchase their own individual health insurance policies?, International Foundation, 11/3/2015

If medical, prescription, dental, and vision benefits are each processed and paid by separate providers, does the maximum out-of-pocket limit apply to all the benefits combined, or are the limits applied separately to each benefit?, International Foundation, 9/8/2015

Does the ACA require an annual open enrollment period for large, self-funded employer plans?, International Foundation, 7/22/2015

Do applicable large employers that do not maintain a group health plan have any reporting duties under the ACA?, International Foundation, 6/22/2015

Can an employer offer a health plan to part-timers that is not necessarily affordable, as long as they offer a compliant plan to substantially all full-time employees?, International Foundation, 6/17/2015

What is the difference between part time employees and variable hour employees?, International Foundation, 5/15/2015

Does an SPD have to include what method the employer is using to track employee hours for the ACA?, International Foundation, 5/8/2015

If an employer provides paid leave (such as vacation, funeral and jury duty) to its employees, should these hours be counted when determining full-time employee status?, International Foundation, 5/1/2015

Who is responsible for the ACA applicable large employer reporting required under section 6056 when an applicable large employer member is part of a controlled group?, International Foundation, 4/24/2015

Do employers with fewer than 50 full-time equivalent employees have to offer health coverage to employees working 30 or more hours per week?, International Foundation, 4/16/2015

What five requirements must limited wraparound plans fulfill in order to be considered “excepted benefits” exempt from most ACA provisions?, International Foundation, 3/30/2015

When determining whether health coverage is affordable, does an employer make the determination on a person-by-person basis?, International Foundation, 3/20/2015

How do you count an employee’s hours to determine if they are a full-time employee, if they are paid per diem and work on a case by case basis?, International Foundation, 2/6/2015

Are church plans exempt from the ACA’s Employer Shared Responsibility (pay-or-play) provisions?, International Foundation, 12/19/2014

Is it true that when using the look-back method to count employee hours, the sum of the measurement and administrative periods must be less than 13 months?, International Foundation, 12/17/2014

How do the Affordable Care Act’s 90-day waiting period, permissible orientation period, and employer shared responsibility requirements interact?, International Foundation, 11/21/2014

If we are unable to measure hours worked on a monthly basis, can we use a weekly or bi-weekly counting period instead?, International Foundation, 11/12/2014

Do applicable large employers have to offer health coverage to full-time H-2B visa workers under the ACA’s employer shared responsibility requirements?, International Foundation, 9/11/2014

Does the Affordable Care Act obligate large employers to continue offering health coverage to retirees if they currently do?, International Foundation, 8/13/2014

If an employer is considered an applicable large employer based on its part-time employees in addition to its full-time employees, must the employer offer health coverage to its part-time employees?, International Foundation, 7/2/2014

For purposes of the employer mandate, are employer health plans required to cover an employee’s spouse and/or dependents?, International Foundation, 5/31/2014

Can an employer or a collective bargaining agreement require an employee to work 1,456 hours within 12 consecutive months before becoming eligible for health care coverage?, International Foundation, 4/30/2014

How do controlled group rules apply for purposes of counting the number of full-time employees?, International Foundation, 4/4/2014

Must health plans get an actuarial certification attesting to minimum value under the ACA shared responsibility rules?, International Foundation, 3/31/2014

How do employers measure hours for employees who are out on unpaid family and medical leave for purposes of the employer shared responsibility (pay-or-play) provisions?, International Foundation, 3/20/2014

Are self-insured stand-alone dental and vision plans that are provided solely through employer contributions, with no employee contributions to premiums, subject to the ACA?, International Foundation, 1/31/2014

Government Resources

Affordable Care Act: Determining if you are an applicable large employer, IRS, 5/3/2018

Health Insurance Provider Fee: 2017 and 2019 Moratoriums – Questions and Answers, IRS Again Delays Employer ACA Reporting, 1/24/2018

IRS Notice 2018-06, IRS, 12/22/2017 IRS Notice 2018-06 delays the due date for furnishing calendar year 2017 1095-Cs to individuals. New deadline is March 2, 2018.

IRS Form 14764 (ESRP Response), IRS, 11/10/2017 Response form issued by IRS in 2017 for employers to use in responding to IRS Letter 226-J for 2015 employer shared responsibility mandate.

Understanding your Letter 226-J, IRS, 11/9/2017

IRS Questions and Answers 55 - 58: Making an Employer Shared Responsibility Payment, IRS, 11/8/2017 In November 2017, the IRS updated its website to include questions and answers on how to make an employer shared responsibility payment for 2015, if owed. FAQs 55-58 also include a sample letter the IRS will send employers to notify them of possible penalties.

Employer Shared Responsibility Provision Estimator, IRS, 10/15/2017 An online tool from the IRS-sponsored Taxpayer Advocate Service helps employers estimate how much they might owe in employer shared responsibility payments.

Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under ACA, HHS, 10/13/2017 Interim final rules October 2017

Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under ACA, IRS, 10/13/2017 Proposed rules October 2017

ACA Information Center for Applicable Large Employers (ALEs), IRS, 4/27/2017 What's trending, outreach materials, how to determine if you are an ALE

Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act, IRS, 4/20/2017

Affordable Care Act Tax Provisions for Employers, IRS, 4/17/2017

Types of Employer Payments and How They Are Calculated , IRS, 4/6/2017

Employer Shared Responsibility Provisions, IRS, 4/6/2017

Affordable Care Act (ACA) Information for Government Entities, IRS, 3/24/2017 Guidance for state and local governmental plans on complying with and reporting for the Affordable Care Act

Excepted Benefits; Lifetime and Annual Limits; and Short-Term, Limited-Duration Insurance, EBSA, HHS, IRS, 10/31/2016 Final rules

FAQs About ACA Implementation Part 33, EBSA, 10/1/2016 Premium reduction arrangements for student health plan coverage

Expatriate Health Plans and Qualified Expatriates; Excepted Benefits; Lifetime and Annual Limits; and Short-Term, Limited-Duration Insurance, EBSA, HHS, IRS, 6/10/2016 Proposed rule

Minimum Value of Eligible Employer-Sponsored Health Plans, IRS, 9/1/2015 Proposed rule withdrew, in part, a notice of proposed rulemaking published May 3, 2013, and replaces with rule proposing employer-sponsored plan provides minimum value only if the plan�s share of the total allowed costs of benefits provided to an employee is at least 60 percent and the plan provides substantial coverage of inpatient hospital and physician services

Amendments to Excepted Benefits, IRS, EBSA, HHS, 3/18/2015 Final rule to amend the definition of excepted benefits to include certain limited coverage that wraps around individual health insurance. Such coverage would have to be specifically designed to provide meaningful benefits such as coverage for expanded in-network medical clinics or providers, reimbursement for the full cost of primary care, or coverage of the cost of prescription drugs not on the formulary of the primary plan.

FAQs About ACA Implementation Part XXIII, EBSA, 2/1/2015 Supplemental excepted benefits

Amendments to Excepted Benefits, EBSA, HHS, IRS, 12/23/2014 Proposed rule on limited wraparound coverage

Amendments to Excepted Benefits, CMS, DOL, EBSA, HHS, IRS, 10/1/2014 Final rule on excepted benefits under ERISA, the Internal Revenue Code and the Public Health Service Act. Excepted benefits, such as standalone dental, vision and employee assistance plans, are generally exempt from the health reform requirements that were added to those laws by HIPAA and ACA. Eligibility for excepted benefits does not exclude an individual from eligibility for a premium tax credit under if an individual chooses to enroll in coverage under a public exchange.

Approach to Changes in Measurement Periods or Methods Applicable to an Employee, IRS, 9/14/2014 Notice 2014-49 on proposed method for applying the look-back measurement period to identify full-time employees in two scenarios: employee transfers between two positions with different look-back measurement periods and employer changes the look-back measurement period for an entire employee class or group.

Shared Responsibility for Employers Regarding Health Coverage, IRS, 2/12/2014 Final rule commonly known as employer mandate. Under Internal Revenue Code Section 4980H, ALE must offer minimum essential coverage to full-time employees and their dependents that is affordable and provides minimum value or face penalties if any of their employees receive a subsidy to obtain coverage through a public health care exchange. Determine applicable large employer status, identify full-time employees, look-back and monthly measurement methods, types of employer payments, offer of coverage

FAQs About ACA Implementation Part XIII, EBSA, 3/8/2013 Expatriate group health insurance plans

Shared Responsibility for Employers Regarding Health Coverage, IRS, 1/2/2013 Proposed rule commonly known as employer mandate

FAQs About ACA Implementation Part II, EBSA, 10/8/2010 Grandfathered plans (plan changes other than the six specifically described, employer contribution on a tier-by-tier basis, how grandfather rules affect wellness programs), dental and vision excepted benefits, rescissions

Employer Shared Responsibility Provision (ESRP) Estimator, IRS Taxpayer Advocate Service Helps you determine your number of full-time employees, ALE status, estimate maximum amount of potential liability for the employer shared responsibility payment that could apply if ALE fails to offer coverage to full-time employees

Surveys

Affordable Care Act Large Employer Market Inquiry, EY, 10/15/2017 Companies weigh in on plans to navigate legislative and regulatory uncertainty

Employer Pulse Check: The Future of ACA, International Foundation, 7/11/2017 A July 2017 survey from the International Foundation of Employee Benefit Plans gauges employer support/opposition for 25 current and proposed health care provisions.

2016 Employer-Sponsored Health Care - ACA Impact Survey Results, International Foundation, 6/13/2016 A survey on employer concerns about plan design and funding, methods for communication with employees, cost-management initiatives and the 2020 Cadillac Tax.

Webcasts

ACA Strategy: Employer Shared Responsibility Payments, International Foundation, 11/16/2017 Although lawmakers have shifted focus from “Repeal and Replace” of ACA to tax reform, employers should not lose sight of ongoing government compliance and enforcement efforts. The recently released IRS FAQs on employer responsibilities under ACA indicate the Service is moving forward with compliance efforts that can affect employers and plans. This means employers still need to have an ACA strategy in place, and be prepared to deal with potential penalty notices and audits.