Stay Compliant with ACA Requirements
The Affordable Care Act (ACA) requires businesses to take on a number of new tasks, from making sure you’re providing the required level of health insurance to providing new reports to your employees and the government. Use the checklist below to make sure you’re staying on track and here is a brief downloadable ACA Checklist for Large Employers for your reference.
Make sure you’ve addressed these requirements, which have been in effect since 2012 or earlier:
- Provide your employees with a Summary of Benefits and Coverage from your insurer, clearly explaining what their plan covers and what it costs.
- Make sure any health accounts you have set up for your employees, such as flexible spending accounts (FSAs), health reimbursement accounts (HRAs) or health savings accounts (HSAs), comply with new rules:
- They can no longer be used to buy over-the-counter drugs (except insulin) without a prescription.
- Employees are limited to contributing no more than $2,500 to FSAs.
- Employees will pay higher penalties (20%) for withdrawing HSA funds for nonmedical expenses.
Prepare to comply with these requirements in 2013 and beyond:
- If you have not been providing insurance, investigate your options now. If you have the the full-time equivalent (FTE) of 50 or more employees, you may have to pay a fee if you don’t provide adequate, affordable insurance.
- If you do provide insurance, make sure your health plan meets these new requirements:
- Is adequate and affordable: Insurance is considered “inadequate” if it pays less than 60% of health care expenses for a typical population and “unaffordable” if employees have to pay more than 9.5% of their family income to buy it.*
- Does not exclude people with pre-existing medical conditions.
- Does not put annual or lifetime limits on coverage.
- Does not cancel employees’ insurance coverage solely because of an honest mistake made on their insurance application.
- Does not make new employees wait more than 90 days for coverage.
- Provides coverage for employees’ adult children up to age 26.
- Provides essential benefits (not required for large-group plans, covering 100 or more people, or for grandfathered* plans). Benefits include:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
- Allows children to use a pediatrician as their primary care provider.*
- Allows women to use an ob-gyn as their primary care provider.*
- Allows patients to receive emergency care at a non-network hospital without preauthorization and without paying a higher copay or coinsurance.*
- Limits annual cost sharing to the caps on high-deductible plans linked to health savings accounts. Currently, those limits are $6,250 per year for individuals and $12,500 per year for families. In addition, small-group plans must cap deductibles at $2,000 for individual coverage and $4,000 for family coverage.*
- Provides required preventive care with no copay.*
- By Oct. 1, notify your employees about the availability of health insurance marketplace (exchange) plans and that they may be eligible for subsidies to help pay for coverage. Here is the template of information required for employers who offer coverage. Further guidance, and templates for employers who will not be offering coverage, are available from the Department of Labor.
- Inform your high-wage employees ($200,000 for individuals; $250,000 for joint filers) of new Medicare payroll and investment income taxes — effective in 2013 — and adjust your payroll system accordingly.
- Report to the federal government on whether you offer health coverage, the total number and names of those receiving coverage, and the cost of the plan. The first report is due in 2015 for the year 2014.
- If you have more than 200 employees, prepare to automatically enroll all new workers in your health plan, giving them the choice of opting out rather than opting in. Because regulations have not been finalized, this requirement will not go into effect until at least 2015.
- Decide whether you want to offer expanded wellness incentives. Starting in 2014, businesses can offer discounts of up to 30% off insurance premiums to employees who take part in employer-sponsored wellness programs. This is an increase from the 20% discount previously allowed. Find more information here.
* Requirements don’t apply to grandfathered plans — those that were in effect on March 23, 2010, and have not changed substantially. For information on grandfathered plans, see this government website.