Administration issues new game-changing health care reform regulations

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On February 11th, the Treasury Department issued its much-anticipated final regulations on the Affordable Care Act’s (ACA) so-called employer mandate, under which certain employers have to either (a) offer affordable, minimum-value health coverage to full-time employees and their dependents, or (b) pay certain penalties. These final regulations are game-changers.

The biggest headline so far is that certain medium-sized employers with 50-99 full-time employees (counting full-time equivalents) have effectively been given another year until 2016 to comply. If you are an employer and you think you qualify for this delay, be careful how you count your employees because it is not just as simple as adding up the number of your full-time employees.ACA-TreasuryDept Indeed, it appears you will need to be very precise and factor in your part-time employees when running this calculation. Employers are generally not permitted to reduce the size of their workforce to fit into the 50-99 employee size. Also, to qualify for this delay, it appears an employer must maintain some level of previously-offered health coverage through December 31, 2015, and must also certify to the government that the employer qualifies for the delay.

Another big change is that employers with 100 or more employees only have to offer coverage to 70% of their full-time employees in 2015 in order to avoid the largest (but not all) of the employer mandate penalties. This is a nice change for those employers who, for example, currently offer coverage to employees with 35 or more hours per week but do not yet offer such coverage to employees working 30-34 hours per week. But it is very important to point out that this relief for employers with 100 or more employees does not avoid all of the employer-mandate penalties. While an employer with 100 or more employees only has to offer coverage to 70% of its full-time employees in 2015 to avoid the largest employer-mandate penalty, that same employer might still get hit with the smaller employer mandate penalty for failing to offer affordable, minimum value coverage in 2015 to all its full-time employees.

These new regulations contain roughly 227 pages of complex rules that employers will be scrambling to digest over the weeks to come. But here are a few more items worth noting that we see so far:

  • A “full-time employee” is still an employee who works on average 30 hours (or more) per week.
  • The final regulations continue to allow employers to use an optional look-back measurement period to make it easier to determine whether employees with varying hours and seasonal employees are “full-time employees.” In fact, a special one-time six-month measurement period is allowed in 2014 for 2015 – provided the measurement period starts no later than July 1, 2014.
  • Dependent coverage: The requirement to offer coverage to dependents of full-time employees generally will not apply in 2015 to employers that are taking steps to arrange for such coverage to begin in 2016.
  • Adjunct faculty: The regulations contain a new approach for crediting an adjunct faculty member with 2¼ hours of service per week for each hour of teaching or classroom time.
  • Special transition relief is provided to non-calendar year plans.
  • In the near future, Treasury and the IRS will issue final regulations on the employer information reporting requirements, which will likely first require reporting in January of 2016.

Topics:  Affordable Care Act, Employee Definition, Healthcare Reform, Pay or Play, Shared Responsibility Rule, Transition Relief, U.S. Treasury

Published In: Health Updates, Labor & Employment Updates, Tax Updates

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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