Employer Shared responsibility Mandate Delayed

In an unexpected announcement pre-July 4th the big news was Obamacare Employer Mandate Delayed with penalties under the Affordable Care Act (ACA) until 2015.  The mandate also known as the “Employer Shared Responsibility” requires employers with 50 or more FTEs to offer affordable health insurance coverage to their workers or face financial penalties for not doing so.  Those penalties would originally have been applied beginning in 2014.

There has been a follow up guidance issued last week July 9th by the IRS.  According to the IRS, the delay will give employers more time to prepare for the change in how health insurance is provided and will also give the Obama Administration time to simplify the insurance-related reporting requirements that employers face. This transition relief appears to come with “no strings attached.”  Although the IRS guidance encourages employers to voluntarily comply with the employer mandate and maintain or expand health care coverage in 2014, the IRS will not impose penalties for a failure to do so.

Although the IRS guidance encourages employers to voluntarily comply with the employer mandate and maintain or expand health care coverage in 2014, the IRS will not impose penalties for a failure to do so.Notably, the guidance issued on July 9th also does not require employers to make “good faith” efforts to comply. As a result of this transition year, employers will have the option of deciding to what extent (if any) they will continue efforts to comply with the employer mandate during 2014.

Employers who intended to rely on one of the transition rules previously announced for 2014 should keep in mind that the latest IRS guidance does not provide special transition rules for 2015. Other group health plan requuirements still apply as discussed in our prior blog Essential Health Benefits Not Delayed.

This means that for plan years beginning on and after January 1, 2014, all group health plans must:

  •  Eliminate all pre-existing condition exclusions (regardless of age);
  • revised Summary of Benefits and Coverage templates;
  •  Essential Health Benefits Not Delayed; and
  •  Eliminate waiting periods of longer than 90 days.
  • Maximum Cost Sharing Deductible to $2,000/individual ($4,000/family); limit in-network out-of-pocket maximums to $6,350/individual ($12,700/family)

  • Individual Mandate Still Applies. individuals will still be required to obtain health care coverage or pay a penalty for each month they do not have coverage, beginning January 1, 2014
  • Exchanges (Marketplaces) Open for Enrollment October 1, 2013.

    The IRS notice makes it clear that individuals who enroll in coverage on the marketplaces will continue to be eligible for a premium tax credit if their household income is within a specified range and they are not eligible for other minimum essential coverage.

  • Employers Must Send Notice of Exchanges (Marketplaces) Before October 1, 2013.  These notices must be sent to current employees by October 1, 2013.  Then, beginning October 1, 2013, employers must send this notice to new hires within 14 days of their start date.
  • New taxes still apply – Patient Centered Outcomes Research Institute (PCORI) excise taxes and transitional reinsurance program fees;HRA/HSA/FSA clients also pay a monthly $1/employee tax.

We will continue to monitor ACA developments and will provide you relevant updated information when available.  In the meantime, please visit to view past blogs and Legislative Alerts at https://www.medicalsolutionscorp.com/feed. 

PEO: Co-Employment
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