Key Provisions of the Affordable Care Act (ACA)

The Affordable Care Act (ACA) is a piece of legislation with over 2,400 pages! Even with a J.D. and a new pair of reading glasses, the language poses great difficulty to the law’s comprehension. Here, we’ll break it down by isolating key provisions that may very well affect your business!

KeyProvisions1Employer Shared Responsibility

On July 2, 2013, the U.S. Treasury Department announced a delay in the Employer Shared Responsibility provision until 2015.

Under Health Care Reform, employers have responsibilities to provide their employees with health insurance coverage. These responsibilities are addressed in the Employer Shared Responsibility (ESR) provisions of the ACA.

Effective January 1, 2015, applicable large employers with 50 or more full-time equivalent (FTE) employees (and have at least one full-time employee obtaining a subsidy for coverage) could be assessed a penalty if:

  • They don’t offer employees and their dependents health coverage that meets established minimum essential coverage requirements; or,
  • Employer coverage is determined to be unaffordable or does not provide minimum value.

Employers with 50-99 full-time equivalents have been provided transition relief until January 1, 2016 and are not required to pay penalties for 2015 for lack of providing health insurance coverage.

KeyProvisions2Form 1094/1095 Reporting

Employers with over 50 full-time employees (applicable large employers) must begin reporting insurance coverages offered to full-time employees beginning January 1, 2015 (first set of returns are due in January 2016 for tax year 2015).  Employee statements must also be provided to employees.

KeyProvisions3Medical Loss Rebates

The Medical Loss Ratio (MLR) provision of the Affordable Care Act required insurance carriers to issue rebates to affected employers and employees for the 2011 plan year by August 1, 2012.

BenefitsAdmin4Small Business Tax Credits

Small businesses that offer health insurance to their employees can find much-needed relief through small business tax credits. If you already offer health coverage to your employees, you may qualify for a credit to offset the cost of premiums. If you don’t currently offer health insurance, the tax credit may help you afford it.

KeyProvisions5W-2 Reporting

Employers filing 250 or more W-2 Forms will now have to report the value of employees’ health benefits.

KeyProvisions6Summary of Benefits and Coverage (SBC)

The Summary of Benefits and Coverage (SBC) and Uniform Glossary provision requires health insurance carriers, group health plans, and their administrators to provide applicants, enrollees, beneficiaries, and participants with an SBC and a Uniform Glossary. The purpose is to provide health insurance coverage information in a concise, consistent format to allow consumers to easily compare and choose plans.

The provision becomes applicable on the first day of the first open enrollment period on or after September 23, 2012.

Questions about the ACA in 2018? Give us a call.