Murphys, CA…The 2010 Patient Protection and Affordable Care Act (ACA) includes provisions that directly affect
employers and business owners. The following is a brief overview of some of the ACA provisions that employers should be aware of. SHOP Marketplace The ACA created the Small Business Health Options Program (SHOPs) to help small businesses provide health coverage to their employees. The SHOP Marketplace is available to employers with 50 or
fewer full-time equivalent employees and provides a forum for employers to compare health insurance coverage based on price and benefits offered, and purchase suitable insurance for employees.
Small employer tax credit
If you employ fewer than 25 full-time equivalent
employees (FTEs) with average annual wages of less
than $50,000, and you contribute at least 50% toward
the cost of your employees’ health insurance that is
purchased through a Marketplace, you may qualify for
a small employer tax credit. The credit is up to 50%
(35% for qualified charitable employers) of the lesser
of your actual cost for health insurance coverage, or
the amount of contributions you would have made
during the taxable year if each employee had enrolled
in coverage based on a benchmark premium.
The full credit is available if you have 10 or fewer
FTEs with average annual wages below $25,000. The
credit is reduced if you have more than 10 FTEs (but
less than 25 FTEs) and/or pay average annual wages
greater than $25,000 (but less than $50,000). In any
case, the credit is only available for two consecutive
years.
Play or pay
Employers are generally not required to offer
coverage, but those that don’t may be subject to a
penalty tax. In 2015, the penalty tax applies only to
employers with 100 or more full-time equivalent
employees (FTE) who do not offer qualifying health
coverage to at least 70% of their FTEs. In 2016, in
order to avoid the penalty tax, qualifying coverage
must be offered to 95% of FTEs, and extends to
employers with 50 or more FTEs. The penalty is
assessed to eligible employers that do not offer
coverage if at least one FTE receives a federal
premium subsidy for coverage purchased through a
health insurance Marketplace. In 2015, the employer
penalty is $2,000 per FTE excluding the first 80 FTEs.
Beginning in 2016, the same penalty applies but after
excluding the first 30 FTEs.
In addition, if an eligible employer offers health
insurance that is not considered affordable or does
not provide minimum value, the penalty is the lesser
of $3,000 per FTE receiving a federal subsidy, or
$2,000 per FTE, minus the first 30 FTEs. Health
insurance provides minimum value if it pays for at
least 60% of covered health care expenses. Health
insurance is affordable when the cost of coverage is
no more than 9.5% of an employee’s family income.
Employers with more than 200 full-time employees
that offer health insurance must automatically enroll
new full-time employees, subject to a waiting period
of no longer than 90 days.
Other employer incentives
In an effort to promote wellness and decrease health
insurance costs, employers may offer employees
rewards, such as premium discounts and added
benefits, for participating in wellness programs and
meeting certain health-related standards. The value
of the rewards can equal as much as 30% of the cost
of coverage and may even reach 50% in some cases.
Group health plan coverage
requirements
Group health plan requirements under the health-care
legislation directly apply to insurers. However, most of
these provisions are incorporated by reference into
ERISA and the Internal Revenue Code, extending
their application to employers offering group health
insurance. Beginning in 2010, some important group
health plan requirements include:
• Group plans that offer coverage for dependent
children must extend the age for dependent
coverage to age 26. For plans in existence prior to
March 23, 2010 (the date of legislative enactment),
the extension of dependent coverage applies only
if an adult child is not eligible to enroll in any other
eligible employer-sponsored health plan.
• Coverage for a plan participant cannot be
rescinded except for fraud or intentional
misrepresentation, and plans may not impose
pre-existing condition exclusions on any plan
participant or beneficiary.
• Plans may not impose lifetime limits on the dollar
value of essential health benefits for plan
participants and beneficiaries. Essential health
benefits are intended to include those benefits
customarily provided under a typical employer
health plan, as defined by the Secretary of Health
and Human Services. Also,plans cannot impose
annual coverage limits for essential health
benefits.
• Most preventive care services and immunizations
recommended by the U.S. Preventive Services
Task Force will not be subject to deductibles,
co-pays, and co-insurance. (Plans in existence on
or before March 23, 2010, are exempt from this
provision.)
• Most employers must meet certain reporting and
disclosure requirements, which include providing a
summary of plan benefits and annual reports to
participants; reporting annual enrollment and
claims practices to the Secretary of Health and
Human Services; and providing premium and
coverage information to the IRS.
Tax provisions
Employers must include the aggregate cost of group
health plan benefits (with some exclusions) provided
to employees on Form W-2. And, employers are
responsible for collecting and reporting an increase of
0.9% in FICA taxes on wages above $200,000. The
increase applies only to the employee-paid portion of
FICA taxes.
Group health plan sponsors may be assessed a tax of
two dollars or more per average number of insured
lives beginning. The tax is intended to finance a
comparative effectiveness research program
measuring the value of various medical interventions.
The tax is scheduled to sunset after September 30,
2019.
Health-care legislation makes changes to health
savings accounts (HSAs), Archer medical savings
accounts (MSAs), flexible spending accounts (FSAs),
and health reimbursement accounts (HRAs) that
affect both plan participants and employers.
Over-the-counter drugs no longer qualify for
distributions/reimbursements under HSAs, Archer
MSAs, health FSAs, and HRAs. In addition, the tax on
nonqualified distributions from HSAs or Archer MSAs
is 20%. Also, contributions to health FSAs are limited
to $2,500 per year.
In 2018, a 40% excise tax is imposed on certain
group health plans (excluding long-term care, vision,
and dental plans) if the annual cost exceeds $10,200
for single coverage and $27,500 for family coverage,
indexed for inflation.
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Quest Capital Strategies, Inc.
Brian J. Tewksbury |
Brian J. Tewksbury
Biography
Born and raised in New England, Brian grew up in a large middle class family with a love
for the outdoors and sports. Educated in both public and private schools Brian attended
Keene State College from 1975-1979 where he studied Sociology and Mathematics.
After college Brian attempted a career in baseball, playing in the Independent Leagues
until 1982. With no prospect in professional baseball Brian moved to San Diego and began
to build a life on the west coast. Brian joined The Sherwin-Williams Company in 1984 where
he enjoyed a twenty year career, developing relationships and catering to businesses big and small.
Moving from Los Angeles to Northern California Brian met and married his wife Kareen in
1988. Brian is a serial entrepreneur and enjoys giving back to society through organizations
catering to disadvantaged youth. Brian sought a career in the financial services industry in 2009.
Gaining a Property and Casualty insurance license Brian was recruited to join Morgan Stanley Smith Barney,
where he added Life and Health and gained his Series 7 and 66 securities licenses.
Today as an Independent Financial Advisor with Quest Capital Strategies, Inc., Brian enjoys helping
people with their investment needs. Anticipating the effects of the Patient Protection
and Affordable Care Act Brian gained certification through Covered California Healthcare
Exchange and manages this segment of business through HealthMarkets, Inc.
Brian feels his life experiences prepare him well for an opportunity as your personal and
business Financial Advisor. Brian lives in Murphys with his wife Kareen, (their dog Stella)
and enjoys spending time with family (especially the two grandchildren) and friends.
Securities offered through Quest Capital Strategies, Inc., Member FINRA/SIPC
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Health-Care Reform Changes Affecting Employers ~From Brian J Tewksbury added by admin on
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