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Get Ready for Upcoming Affordable Care Act Compliance Deadlines

Posted on Fri, Oct 31, 2014

Just around the corner is an immediate deadline imposed by the Affordable Care Act (ACA), November 5, 2014. Fortunately that is not a difficult one to fulfill. The requirement is to get a "health plan identifier number," or HPID. Small plans -- those through which less than $5 million flows in a year, have a November 5, 2015 deadline. The requirement pertains to the government's desire to simplify HIPAA compliance monitoring. For that, you will need to consult with an accounting professional for details.

Ten days later, November 15, 2014, is the deadline for self-insured employers to submit an enrollment count to the Department of Health and Human Services in order to establish your 2014 Transitional Reinsurance Fee. The fee for this year is $63 per covered employee. Payment of the fee is due January 15, 2015. Note: If your health plan is fully insured, your carrier will take care of this. Data can be submitted via

Self-insured employers have until July 31 next year to pay a similar, but much less expensive fee, which is the Patient-Centered Outcomes Research Institute Trust Fund fee. The new per-capita fee is $2.08, and is based on average plan enrollment over the course of the plan year. That rate applies to plan years ending after September 30, 2014 and before October 1, 2015.describe the image

Pay-or-Play Bite Begins

As is widely known, next year is when most "non-grandfathered" employers with at least 100 full-time equivalent (FTE) employees will be subject to penalties if they have not complied with the employer mandate. In theory, they were subject to the mandate this year, but will not pay a penalty for ignoring it. If your company is in the 50-99 FTE bracket, you have a reprieve until 2016.

A quick ACA refresher on this topic: For 2015, you're required to offer coverage to 70 percent of your employees and their dependents, or pay the penalty. That jumps to 95 percent in 2016 and thereafter.

Alternatively, you'll be subject to a penalty if your plan does provide "minimum essential coverage," but that coverage is unaffordable. This is based on the employee's share of the cost in relationship to household income, or based on paying less than 60 percent of the plan's value. Note: If your plan year doesn't coincide with the calendar year, you might not be subject to the mandate until the first day of your 2015 plan year.

New Out-of-Pocket Maximums

Another limit on the financial burden employees can be asked to bear has been adjusted upward -- by about 1.6 percent -- for 2015. Specifically, the maximum out-of-pocket limits, combining employee deductibles, co-pays and coinsurance, cannot exceed $6,600 for employee-only and $13,200 for family coverage. Ceilings on deductibles for high-deductible health plans offered in conjunction with a health savings account rose to $6,450 and $12,900, respectively. If you have a separate pharmacy benefit plan, employee maximum costs under that plan must be added to the basic health plan in calculating maximum employee cost-sharing.

Data Roundup

Most self-insured health plan sponsors will need to start collecting certain health plan data in 2015 to report to the IRS in 2016. These requirements are governed by two Internal Revenue Code sections: 6055, pertaining to minimum essential coverage, and 6056, which addresses "large plan reporting" (large being at least 50 FTEs; self-insured employers of any size are required to supply minimum essential coverage). IRS regulations have been issued describing these requirements in detail. Draft copies of the reporting forms also are being circulated.

The IRS forms require Taxpayer Identification Numbers (TINs, which are typically Social Security numbers) not only for employees but also for covered spouses and dependents. The sooner you start chasing down those numbers, the better. The IRS will give employers a one-year pass if they can't gather all the TINs for the minimum essential coverage form, so long as they have made a "good faith effort" to get them.

One More Thing

Remember the 2013 Windsor v. United States decision requiring ERISA plans to accord the same spousal benefits to same-sex spouses as opposite-sex couples? Although the ruling wasn't specific on the point, it is considered advisable to have a plan amendment reflecting that ruling -- if anything else in your plan documents would suggest otherwise -- by the end of 2014.

Tags: Healthcare, EHTC Article, Affordable Care Act (ACA), Healthcare Law, Health Insurance, IRS, ACA, Newsletter, Articles, Affordable Care Act