On Friday, August 31, the Internal Revenue Service (IRS) issued guidance regarding the application of the employer-sponsored health coverage mandate. Employers need to begin planning for these rules as soon as possible. While the employer coverage mandate itself does not apply until 2014, it may be necessary to begin tracking the hours of employees as soon as this October in order to facilitate compliance.
The Play or Pay Rules
The employer-sponsored health coverage mandate is designed to require non exempt employers to either provide employees with adequate and affordable health coverage or to require those employers to pay certain penalties for their failure to do so. Specifically, penalties are triggered if:
- (1) An employer fails to offer all of its “full-time employees” the opportunity to enroll in an employer-sponsored health plan; or (2) the employer-sponsored health plan offered to “full-time employees” is “unaffordable” or fails to provide “minimum value”; AND
- Any employee impacted by such a failure purchases individual health insurance coverage through a State-based or Federally-facilitated Exchange and qualifies for a subsidy.
Failure to Provide Coverage
Employers who fail to provide coverage to all of their “full-time employees” are subject to a penalty of $2,000 per year (assessed on a monthly basis) multiplied by their total “full- time employee” count. For employers that provide health coverage, the challenge with respect to this rule is identifying all of their “full-time employees”—and making sure all such employees are offered coverage. In the event that even one “full-time employee” is not offered coverage and subsequently attains subsidized coverage through an exchange, the penalty is applied to all “full-time employees.” Thus, with respect to any employees who do receive employer-sponsored coverage, the employer could end up “playing” and “paying.” Read More Here
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