ACA

Affordable Care Act

Pay Now or Pay Later.

Another update from the HR jungle….

9098832-a-set-of-tools-for-repairs-vector-illustrationBarb owns a small home repair business with six employees. She pays them wages higher than the industry average so that they won’t defect to larger competitors who can offer more benefits. She’d like to add a group health plan as another incentive to remain loyal to her company.

But, once again, the health insurance quotes Barb received gives her sticker shock. There’s no way she can pay the employer’s portion of the premium for a group health plan. She’s already paying a fortune for her worker compensation premiums.

She knows her employees can’t afford the employee’s portion of the premium on a group health plan. Don Juan Smith’s paycheck is subject to the maximum allowed payroll deductions due to the court-ordered child support he owes to two girlfriends. High Risk Randy’s wages are being garnished for old debts and he’s never paid voluntarily for any employee benefit.

What options are available to Barb?

  1. She can remind her employees that annual open enrollment for the Exchange (a/k/a Marketplace) began on November 15th. They can apply for individual health policies or apply for an individual exemption to the requirement of having health insurance.
  2. She can tell her employees to talk to a health insurance agent about coverage options for the employee or for the employee’s family.

Is your business struggling to understand the Affordable Care Act and how it affects your company and employees? Corporate Compliance Risk Advisor can provide an overview of how the ACA affects employers and employees and answer specific questions you may have.

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Be Kind, Not Nice.

Another update from the HR jungle….

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“Be kind, not nice” is a favorite saying of one of my friends. Consider what that means for employers and their employees.

Leslie’s company has less than 50 employees, so the Family Medical Leave Act (FMLA) does not apply to her company. This fact became important yesterday when Beth revealed that she has breast cancer and needs extended leave while she undergoes treatment. Beth also says that she wants to return to work full-time after completing her initial treatment.

Leslie counts Beth as a personal friend as well as an employee and wants to help. Beth was one of the first employees she hired and has always been a stellar performer. But Leslie knows that if Beth is granted extended leave, other employees will demand the same treatment later. She also worries that her staff is too small to cover for an employee who is absent for an extended period of time.

Leslie considers her situation and how she can be kind, but not nice to Beth. What options are available to Leslie?

  1. She can be kind to Beth by offering support as a friend and accommodating Beth’s treatment schedule as much as reasonably possible without disrupting the company’s work flow.
  2. She can protect her company by documenting the business reasons for making an exception to the leave policy for Beth. For example, Beth’s work performance and length of service could justify making an exception to the leave policy.

Distinguishing kind from nice may not be easy particularly when creating HR policies. Corporate Compliance Risk Advisor can help you separate kind from nice in your employee practices with HR policies that are appropriate for your company.

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Private Exchanges and the Small Employer.

Another update from the HR jungle….

Dorothy runs a small retail business with 8 employees. It’s a low margin business so there’s not much room for employee perks. Dorothy always wanted to offer a group health plan to her employees but could never afford it. She had high hopes of lower premiums under the Affordable Care Act (ACA or Obamacare) but after looking at a couple of quotes she doubts if she can ever afford a group health plan for her employees.

Recently at a business networking event, Dorothy learned that a local hospital chain is teaming up with the largest health insurance company in the area to offer a private Exchange. A private Exchange does not offer premium and cost sharing subsidies like the public Exchange (a/k/a Marketplace). But a private Exchange offers some financial certainty to employers.

A private Exchange allows an employer to contribute a fixed dollar amount toward the cost of health coverage. Employees can then “buy up” to a higher premium level of health plan if they want lower deductibles or co-pays.

What options are available to Dorothy?

1. She can contribute a fixed dollar amount that covers the employee-only premium at a bronze plan level. Employees would be responsible for paying the premium for their family members added as dependents.
2. She can pay employees a bit more in wages and allow them to sort out their health coverage options.
3. She can continue doing nothing monetarily but encourage her employees to apply for individual coverage via the Healthcare Exchange (a/k/a Marketplace) in hopes they may qualify for some of the subsidies it offers to lower income individuals.

Is your company struggling to understand how the ACA will affect the employee group health plan? Corporate Compliance Risk Advisor can help you grasp the basics of the ACA and how it affects an employer of your company’s size.

Join the HR Compliance Jungle today. Click here!

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Doing the Right Thing under the ACA.

Another update from the HR jungle….

Cindy owns a small business that has 6 employees. She would love to offer health insurance to her employees but has found it too expensive in the past. Instead, she raised wages slightly and encouraged her employees to buy individual coverage.

When Cindy first heard about the Affordable Care Act (ACA or Obamacare) she was excited about the possibilities. Early reports were that small employers like her company might finally be able to afford a group health plan. The Small Business Health Option Program (SHOP) would have standardized plans, making it easier to compare coverage. The SHOP was also supposed to allow small employers to offer more than one health plan option to employees.

Alas, the SHOP is part of the Healthcare Exchange or Marketplace. The roll out of the Individual Exchange was such a mess that all the most attractive features of the SHOP were delayed. Another year has gone by and open enrollment in (and outside) the Exchange will soon start. Cindy is pondering her choices.

What options are available to Cindy?

1. She could work with her insurance agent to apply for a group health plan via the SHOP, even though the coverage options are limited.
2. She could work with her insurance agent to apply for a group health plan outside the SHOP where there are more coverage options available from more insurers.
3. She could continue doing what she currently does, which is to increase her employees’ pay and encourage them to obtain individual coverage.

Is your company struggling to understand how the ACA will affect the employee group health plan? Corporate Compliance Risk Advisor can help you grasp the basics of the ACA and how it affects an employer of your company’s size.

Join the HR Compliance Jungle today. Click here!

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Pay Raises v. Health Insurance

Another update from the HR jungle….

Pete has a small company with 12 employees, many of whom are also related to him. Running a business with lots of family is not easy. (Who knew that Aunt Martha’s feud with Uncle Les would still be an issue after 50 years?) Pete figures the best way to keep everyone happy is to offer good pay and benefits.

One of the benefits he’s always wanted to offer is a group health plan. Pete gave up on a group plan for employees after his nephew had surgery and the rates on the group plan shot through the roof. Back when employees were risk-rated based on health factors, his nephew and a couple of other less healthy employees guaranteed that the premium increased dramatically each year.

Pete knows that under the Affordable Care Act (ACA or Obamacare) small group plans with less than 50 employees are no longer risk-rated. Instead, the premium is based on the age of each participant, geographic location, family size (number of individuals covered), and tobacco use. So Pete decides to ask his insurance agent for a quote on a group health plan for his employees.

Pete gets sticker shock again when he sees the amount of the premium. He knows that he simply can’t afford to offer a group health plan. Still, he wants to do something for his employees.

What options are available to Pete?

1. He can tell employees that no pay raises will be given this year so that he can offer a group health plan.
2. He can go ahead with his plan to give pay raises and let his employees buy individual health policies. He hopes some will qualify for the subsidies offered by the Healthcare Exchange (a/k/a Marketplace).
3. He can give each employee a set amount of money, in lieu of a pay raise, that would cover employee-only health insurance on a low cost bronze plan (bought via the Exchange or directly from the insurer).

Is your company struggling to understand how the ACA will affect the employee group health plan? Corporate Compliance Risk Advisor can help you grasp the basics of the ACA and how it affects an employer of your company’s size.

Join the HR Compliance Jungle today. Click here!

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Can My Company Live With the ACA?

Another update from the HR jungle….

Bob owns a company with 60 employees. He’s always offered health insurance to his headquarters employees but not to employees in the retail locations. The retail location employees tend to quit often, work varying schedules each week, and may have health coverage via a spouse’s employer’s plan. Bob decided long ago that it was a hassle to handle all the paperwork adding and terminating employees from the group health plan. So it was easier to not offer health insurance to the retail location employees.

Bob’s a sharp guy (that’s why he owns a company) and he’s tried to keep up with all the changes under the Affordable Care Act (ACA or Obamacare). He knows that his company is a “large” employer under the ACA because he has more than 50 employees. He knows that means his company could pay a penalty if the employee group health plan doesn’t meet the minimum standards set in the ACA, including offering coverage to most full-time employees.

Bob is concerned that some of the retail location employees may actually be full-time employees, meaning that they should be offered health insurance for calendar year 2015. Bob has also heard that there is transitional relief for employers with 50 – 99 employees. The transitional relief applies only to the 2015 calendar year but if his company meets the requirements, he gets another year penalty-free while he sorts out what he must do.

What options are available to Bob?

1. He could read the IRS regulation explaining the transitional relief requirements. (Bob’s tried reading IRS regulations before and he’d rather get his teeth drilled than go through that again.)
2. He could ask for assistance from the insurance agency or broker that sold the group health plan to his company, assuming they provide human resources assistance to clients.
3. He could take a quick look at the employer summaries on the IRS website and then wing it and hope it all works out.

Is your company struggling to understand how the ACA will affect the employee group health plan? Corporate Compliance Risk Advisor can help you grasp the basics of the ACA and how it affects an employer of your company’s size.

Join the HR Compliance Jungle today. Click here!

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How Many Employees Do We Have?

Another update from the HR jungle….

David is the HR director for his company. He’s attended seminars about the Affordable Care Act (ACA or Obamacare) but found most of the presentations confusing. He wasn’t sure what his company needed to do to comply with the law and, with all the delays in implementation, he moved this topic down his list of priorities.

Now David needs explain to the company owners what needs to be done to comply with the ACA. He knows the first step is to verify whether they are a “large” or a “small” employer. A large employer has at least 50 employees and is subject to an employer penalty if it doesn’t offer health insurance to its employees.

David’s company has 40 employees that work an average of 30 hours per week and so are full-time employees under the ACA. But his company also has 15 part-time employees.

How should David count the part-time employees under the ACA?

1. Add up the total hours worked during the month by the 15 part-time employees. Let’s assume that during the past month they collectively worked a total of 1260 hours.
2. Divide their aggregated hours by 120 (30 hours/week x 4 weeks = 120 hours per month). So David divides 1260 hours by 120. (1260 ÷ 120 = 10.5)
3. Round down to the nearest whole number. So David rounds down 10.5 to 10. During the past month the part-timers worked hours that are equivalent to 10 full-time employees. (That’s why part-time employees are called “full-time equivalents” or FTE’s).
4. Add the 10 FTE’s to the 40 full-time employees for a total of 50 employees. That means that in the past month, his company was a “large” employer under the ACA.

David should select 6 consecutive months in which to use the above formula to verify his company’s employer size. If during this 6 month counting period, the company has 50 employees, it is a “large” employer.

Is your company struggling to understand how the ACA will affect the employee group health plan? Corporate Compliance Risk Advisor can help you understand the basics of the ACA and how it affects an employer of your company’s size.

Join the HR Compliance Jungle today. Click here!

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Complying With the ACA Is Making Me Feel Sick!

Another update from the HR jungle….

Marilyn is the HR director for her company. She’s spent a couple of years trying to figure out what the Affordable Care Act (ACA or Obamacare) means for her company. They have 80 employees so she knows they are a “large” employer and could be subject to the employer penalty if the employee group health plan doesn’t meet the minimum standards set in the ACA.

Trying to sort through the details of the ACA, while keeping up with her regular duties is making Marilyn feel sick. She knows that she has to track each employee’s weekly hours to verify who is eligible for the group health plan. Under the ACA, a full-time employee works an average of 30 hours a week.

She knows that the ACA allows employers to use two different counting methods to count employee hours. The counting methods are the Monthly Measurement Period and the Look Back Measurement Method but she isn’t sure which method to use.

What options are available to Marilyn?

1. She could read the IRS regulation explaining how to count each employee’s weekly hours using the Monthly Measurement Period and the Look Back Measurement Period.
2. She could ask for assistance from the insurance agency or broker that sold the group health plan to her company, assuming they provide such assistance.
3. She could hope that the employer penalty will be delayed yet again so that she has another year to figure out what to do.

Is your company struggling to understand how the ACA will affect the employee group health plan? Corporate Compliance Risk Advisor can help you grasp the basics of the ACA and how it affects an employer of your company’s size.

Join the HR Compliance Jungle today. Click here!

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