What is the Health Care Reform Impact on my Business?


Beginning in 2015, large employers who meet the definition of an “Applicable Large Employer ” must offer affordable health care coverage to their full-time employees or be subject to financial penalties.  RMHP can help our Large Employer groups understand the new Employer Shared Responsibilities and what they mean for your specific health plan.

Proposed regulations were slated to be effective in 2014, however the IRS announced on July 2, 2013 the rules for mandatory employer requirements and tax penalties have been postponed for one year.  Final Regulations were issued on February 10, 2014 that include notable changes and more Transition Relief for certain large employers.

The Questions and Answers provided here represent the latest guidance from the final rules issued February 10, 2014.

  • What constitutes a full-time employee?
    Effective for plan years on or after January 1, 2014:  Full-time employees work 30 hours or more a week, or 130 hours or more in a calendar month.
  • How do I calculate full-time equivalents (FTE)?
    • If you have employees who work less than 30 hours, you will need to track their hours of service each month.
      • Add their collective hours together for the month and then divide by 120. This will give you the full-time equivalent number.
      • Here is an example: Employer X has 25 employees who each average 80 hours of service per month (20 hours/week)
        • The 25 part-time employees are aggregated (25 x 80 hours) and divided by 120: (25 x 80 = 2,000 / 120 = 16.6)
        • Employers are allowed to round “down” to the next lowest whole number  
        • Employer X has 16 FTEs (Full-Time Equivalents)
  • How do I determine if I am an Applicable Large Employer?
    Reporting of group size postponed until 2015:  If you add together the number of full-time employees and full-time equivalent employees, and the number is 51 or greater, you are an Applicable Large Employer.

    The guidance provided in the final regulations published by the IRS provides this formula: “Calculate the number of full-time employees + the number of full-time equivalents (FTEs) for each month in the preceding calendar year and divide by 12.”

    Updates for 2015 – Transition Relief rule for employers with at least 50 but fewer than 100 full-time employees. Recently issued FAQs from the IRS provide more detail on this transition relief.

    Employers with at least 50 but fewer than 100 full-time employees (including full-time equivalents) in 2015 will not be subject to Employer Shared Responsibility if they meet these conditions:

    1. Employer monitors and reports their average employee count in 2014 following the measurement rules for determining group size.
    2. During the time period of February 9, 2014 and December 31, 2014, employer does not reduce the size of their work force or the overall hours of service of its employees in order to qualify for the transition relief (unless these reductions are part of a bona-fide business reason).
    3. During the time period of February 9th and December 31, 2014, employer does not eliminate or materially reduce health coverage offered to employees and dependents, including contribution levels and eligibility criteria.

  • Who is entitled to health insurance coverage?
    • All full-time employees (30hrs or more/week)
    • Dependent children* of the employee up to age 26 (includes adopted children, foster children and stepchildren). Coverage for spouses is not required.

    *Dependent children coverage will be required in 2015. Employers may rely on employee’s representation regarding children and their ages.

    Updates for 2015 – Transition relief has been extended to not require dependent coverage until 2016.  Recently issued FAQs from the IRS provide more detail on this transition relief.

    • This transition relief applies only to employers whose plans did not cover (all or some) dependents in both 2013 and 2014 and the employer is taking steps to cover dependents in 2014 and 2015.  If the large employer changed their eligibility criteria in 2014 to exclude dependents, this transition relief is not available for 2016.
  • How do I determine who is considered a full-time employee for purposes of offering health insurance coverage?
    Final regulations provide two Measurement Methods employers can use for different categories of employees. Recently issued FAQs from the IRS provide more detail on these Measurement Methods.

    Measurement methods provide a structured timeline using information about employees you employ during the prior year to determine their full-time status for the following year. The following Measurement methods will become part of the Human Resource functions going forward.

    Standard (Look-Back) Measurement Method – A time period of at least three but no more than 12 consecutive months. This measurement period is one option to use to measure employee’s hours of service. The determination made during this period will drive which employees must be offered health benefit during the future Stability Period.

    Monthly Measurement Method (New) – Another measurement option for hourly or salaried employees.

    Applicable Large Employers are required to use either monthly or look-back measurement periods to determine full-time status of their employees.
  • How do I determine if a newly hired employee whose hours may be variable should be entitled to health insurance coverage?
    If you cannot reasonably expect the newly hired employee to work on average 30 hours or more per week, you are not obligated to offer coverage.

    You will need to start monitoring their hours through the Initial Measurement Period Method. to determine full-time status  for the subsequent Stability Period (see above).

  • Are there any new reporting responsibilities?
    Reporting Requirements have been postponed until 2015.  The following information is based on these final regulations.

    Employers required to report certain health coverage information to the IRS and to furnish certain related employee statements to full-time employees.

    Employee Statements (Similar to a W-2)

    • Provides specific information about the employer’s offer of health coverage
    • Specific Form to complete (Form 1095-C*) Employers meeting specific criteria may use Alternative Method A.
    • Can be mailed or sent electronically (with prior consent from employee)
    • Must be furnished on or before January 31st   following the calendar year for which the report is due.

    First Statement Due: February 1, 2016 (since 1/31/2016 falls on a Sunday)

    *Self-Funded employers complete “entire” Form. Fully-insured employers complete certain portions only.  Carrier provides remaining details through their reporting obligations.

    Transmittal Form Filing to IRS

    • Provides aggregate employer-level data for all full-time employees
    • Specific Transmittal Form to complete (Form 1094-C) Employers meeting specific criteria may use Alternative Method B.
    • Must be sent electronically (if employer has 250 or more full-time employees, optional for employers with less than 250 full-time employees)
    • Must be submitted to IRS on or before:

    February 28 (paper submission) or March 31 (electronic submission) following the calendar year for which the report is due.

    First Statement Due: March 1 or 31, 2016 (since 2/28/2016 falls on a Sunday)

    Transmittal Form Filing to IRS (Form 1094-C)

    Data Elements:

    • Name, address and employer identification number (EIN)
    • Name and telephone number of ALE contact person
    • Certification that MEC was offered  to full-time employees/dependents
    • Number of full-time employees  each calendar month
    • For each employee, the months MEC was available
    • For each employee, the employee’s share of the lowest cost monthly premium for self-only coverage by calendar month
    • Name, address and taxpayer identification number for each full-time employee and the months, if any, during which the employee was covered under an eligible employer-sponsored plan.

    Alternative Methods

    • Method A - Abbreviated Employee Statement (1095-C).  Option to provide an abbreviated report to the IRS and short statement to employees if coverage is offered to a least 95 percent of employees.     Note: only available for the 2015 calendar year.
    • Method B - Abbreviated IRS Transmittal Form (1094-C). Option to Report without separate identification of full-time employees if 98% of employees are offered coverage.
    • Method C - Option for Employers with 50-99 employees. Provide prescribed statement in lieu of completing IRS Transmittal Form (1094-C).