Tag Archives: Pay or Play

Avoid Surprises – Employers Need to Double Check Their ACA Penalty Exposure

We are five years into our ACA compliance journey. Dependent children to age 26? Check. Preventive care covered at 100%? Check. No dollar maximums? Check. Understanding market reforms? Check.  Since we are heading toward the 2014 tax year reporting due date, state marketplaces have issued their 1095-A’s for individual mandate reporting and are also issuing appeal letters to employers for 2015.

In addition, the 6055 and 6056 reporting requirements (which will support mandate compliance and subsidy substantiation) are fully underway and the first round of reporting is in less than 12 months. Plan sponsors are re-reviewing the details of the Employer Shared Responsibility (ESR) provisions — and some are making a startling discovery. Continue reading Avoid Surprises – Employers Need to Double Check Their ACA Penalty Exposure

Compliance Update: Reporting Requirements

Action required*

2015 is right around the corner and while we have provided a summary of what is coming down the pike (2014 ACA Compliance Checklist) you will want to pay extra attention to the Employer Shared Responsibility Provisions (a.k.a. Pay or Play) and the associated Reporting Requirements. You may recall that the reporting requirements and their complexity drove the delay of “Pay or Play” for 2014, since the intent of the reporting was to streamline the management of both the individual mandate, employer shared responsibility and the status of subsidy eligibility in the state marketplaces – Quite a broad reach! In light of the complexity of the new information reporting requirements, employers should take note and review the following.

SUMMARY:   The new reporting system will be similar to the current Form W-2 reporting process. A health coverage information return (Form 1095-B or 1095-C) must be provided to each applicable employee, and then these returns will be submitted to the IRS via a single transmittal form (Form 1094-B or 1094-C) Continue reading Compliance Update: Reporting Requirements

Health Care Reform Has Imposed Mandated Reporting Requirements Beginning in 2015. Are You Prepared?

The Affordable Care Act (ACA) has added employer reporting requirements to the IRS code, and on March 5, 2014 the final reporting rules were released. The regulations are being imposed to assist the IRS with enforcing the employer “Pay or Play” penalty, and to help employees determine if they could qualify for a premium credit.

The IRS requires two reports. The first is Form 6055. This annual report requires health insurers and self-funded employers to report to both the IRS and their employees if the coverage offered meets minimum essential coverage requirements. This report will help the IRS enforce the individual mandate penalty. The data elements of this report are as follows: Continue reading Health Care Reform Has Imposed Mandated Reporting Requirements Beginning in 2015. Are You Prepared?

Ovation Shines a Light on the Newest Players in the Connecticut Health Plan Market

Executives representing more than 60 Hartford-area companies joined the Ovation team for a thought leadership event last week. The event was the third in the organization’s Chief Executive Series which takes place in May and November each year. The focus was on “Emerging Market Forces in the New World of Connecticut Health Plans” and featured a panel of leaders from Harvard Pilgrim Healthcare, HealthyCT, ProHealth Physicians and Rogers Benefit Group. Ovation Managing Principals Bill Carew and Brian Driscoll acted as panel moderators.

Continue reading Ovation Shines a Light on the Newest Players in the Connecticut Health Plan Market