Attention all employers: An important Affordable Care Act (ACA) deadline is on the horizon. By no later than October 1, 2013, all employers must notify employees about the existence of the health care marketplace and provide marketplace contact information.
This deadline affects all employers, regardless of size, whether they ultimately will be subject to the ACA employer mandate, or whether they offer a health plan. A very limited deadline exception applies to employers that are not subject to the Fair Labor Standards Act. (The Department of Labor has a short online survey tool that enables employers to determine whether they are subject to the FLSA.)
The employer mandate (“pay or play”) provisions of the ACA have been delayed until 2015. But when it comes to the so-called individual mandate, there has been no corresponding delay. This means that most individuals in the U.S (with very limited exceptions) will be required, effective January 1, 2014, to maintain minimum essential health coverage for themselves and their dependents. If they do not maintain minimum coverage, they face a penalty to the IRS at tax time.
To ensure coverage for all people, the ACA calls for the creation of state- or federal-run exchanges — also called the marketplace — that will provide access to health care coverage. Depending on annual household income and other factors (we'll cover other factors in an upcoming blog!), some people also may be eligible for credits or subsidies that will reduce their out-of-pocket cost of buying coverage in the marketplace. The marketplace is scheduled to be available for open enrollment October 1, 2013, with coverage effective January 1, 2014.
For 2014, the annual penalty for people who do not maintain coverage is the greater of:
With the passage of the ACA, the FLSA now requires all FLSA-covered employers to issue a notice, no later than October 1, 2013, to each of their employees. The purpose is to notify employees of the existence of the marketplace and to provide marketplace contact info. The notice must share:
The good news is that the DOL has issued model notices that are designed to fulfill the employer’s notice obligation. Here are two model notices [which are downloadable as PDF and Word files]:
All employees must receive the notice, regardless of whether they are covered by the health plan or regardless of full-time or part-time or union status. Employers do not need to send separate notices to dependents of family members.
The notice needs to be delivered:
Per Technical Release 2013-02, the notice should be delivered free to employees by:
Because coverage on the marketplace will be an alternative to employees that are offered COBRA coverage, the DOL also has issued a revised COBRA notice that includes information about the availability of marketplace coverage. Employers subject to COBRA also should revise their COBRA notices.
Unrelated to the ACA, there is an upcoming HIPAA compliance deadline for certain health plan sponsors. This deadline is September 23, 2013. The HIPAA Omnibus Rule, issued in January, may require certain employers to update privacy notices, business associate agreements, and HIPAA policies, procedures and forms.
This is most significant for employers that sponsor self-insured plans (including HRAs and FSAs). The Omnibus Rule has a variety of implications for “covered entities.” Legal counsel will help you determine exactly how the new HIPAA Omnibus Rule applies to your organization and what you need to do to ensure compliance. An HNI Relationship Manager also may help clear up compliance questions.
Pay or Play Health Care Reform Penalties Delayed Until 2015