Important Information regarding the "Employee Notice of Coverage Options" per the Affordable Care Act (ACA)

The Department of Labor (DOL) has issued temporary guidance about the Employee Notice of Coverage Options, formerly the "Notice of the Exchange":

• The Notice is applicable to all employers that are subject to the Fair Labor Standards Act (FLSA). This includes most employers, regardless of size.
• Employers must submit the Notice to all current employees by October 1, 2013, and to new hires within 14 days of their employment start date, at least for 2014.
• The Notice must be provided free of charge, in writing, and delivered either by mail or electronically, in accordance with ERISA standards for electronic delivery. 
• The Notice must be provided to all full-time and part-time employees, regardless of whether the employer sponsors coverage or if the employee is enrolled in an employer-sponsored medical plan. 
• The Notice does not need to be sent to dependents.
• The Notice must inform employees that if their plan is not "affordable" or does not meet "minimum value" standards (as set by the ACA), they may be eligible for a subsidy on the Exchange (also referred to as the Marketplace). Employers must indicate on the Notice whether their plan meets these criteria by checking a box that states, “If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.”

For purposes of the Notice, "Minimum Value" can be assessed by using the Dept. of Health and Human Services' (HHS) minimum value calculator. An example of a plan that meets the Minimum Value standard would have a deductible of $5,000, coinsurance of 70%, an Out of Pocket (OOP) maximum of $6,350, and pharmacy coverage. 

"Employer Mandate" also known as 'Play or Pay' of the ACA delayed until 2015

The Dept of Treasury announced late on Tuesday the decision to delay the Employer 'Play or Pay' rules of the Affordable Care Act (ACA) to 2015.

While this is good news for the many employer groups who were not prepared for, familiar with, or ready to implement this provision (that requires groups with 50+ FTEs to provide 'affordable' and 'minimal' coverage or pay a per employee penalty of $2k to $3k per offense), it is important to clarify the only provisions of the ACA to be delayed are as follows:

• 6055: Individual Mandate reporting
• 6056: Play or Pay reporting
• 4980H: Play or Pay Employer rules

The following ACA provisions (among others) continue to apply:

• Individual Mandate:  presumably, the IRS will monitor compliance through self-certification on each individual's tax return

• Marketplace ("Exchange") Notices:  at this time employers are still required to send the marketplace notice to all employees no later than 10/1/13

• Health Insurance Reforms: the reforms such as the maximum 90-day waiting period  that are set to go in effect the 1st of the month during which the plan renews after 1/1/14 all still apply

• PCORI Fee: this is still due at the end of the month if you have a calendar plan year or a plan year that ended October or November 2012.

• Transitional Reinsurance Fee    

• W-2 reporting    

• The limit on Health FSA salary reductions

If you have any questions on the ACA please visit the 'Resources' page of our site or www.healthcare.gov