Column 34 Employer Mandate Extensions

Nothing is so constant as change and that continues to be the motto of the new world of insurance. 

It was announced this week that the deadline for the implementation of the health care mandate for medium sized businesses will be extended to 2016. 

Employers with 50 - 99 workers are given a two year reprieve on offering health care to their full-time employees. Requirements for companies with 100 or more workers are reduced by 25%.  There are some caveats.

Employers must be able to certify that: 1) They are not reducing the size of their workforces or the overall hours of service of their employees between February 9, 2014 and December 31, 2014, and 2: They are not eliminating or materially reducing the health coverage, if any, offered as of February 9, 2014. The final regulations provide rules and examples as to what constitutes "material reduction" of health insurance coverage. 

Larger employers (over 100 employees) are also seeing the requirement to offer health care to their full-time employees reduced from 95% to 70%.  This means that qualified affordable coverage must be offered to full-time employees in 2015, but there will be no assessment in 2015 if affordable, qualified health insurance is offered to at least 70 percent of their full-time employees. As of 2016, the qualified, affordable coverage must be offered to at least 95 percent of all full-time employees to avoid triggering the need to calculate whether there will be an assessment.


Let's review the terms "affordable" and minimum value.  Affordable means that the employee's share of premium for employee ONLY coverage does not exceed 9.5% of the employee's W2 wages with the employer.  Minimum Value means that the plan covers 60% of total covered costs.


The administration claims that the two phase-ins for businesses will ease the financial and administrative burdens for employers who have not offered health insurance benefits in the past. Most believe the postponements will allow employers additional time to understand the applicable rulings that will affect their businesses. Further there is additional legislation pending that would change the definition of full time employee to 40 hours per week rather than 30.


Currently we see many restaurants and retail outlets beginning to manage their employees to less than 30 hours per week to show a pattern that will comply with the law and not require them to provide benefits.  The problem for employees is that they now must try to manage two 28 hour per week jobs. 


Further "clarifications" from the US Treasure Department Fact Sheet are:

·         Bona fide volunteer workers for government and tax-exempt entities, such as firefighters and emergency responders, are not considered full-time employees.

·         Teachers and other education employees are considered full-time employees even if they don't work full-time year-round.

·         Seasonal employees who typically work six months or less are not considered full-time employees; this includes retail workers employed exclusively during holiday seasons. This will effect our local resorts.

·         Schools with adjunct faculty may credit 2¼ hours of service per week for each hour of teaching or classroom time.

*Work done by students in federal or state-sponsored work-study programs will not be counted in determining if they are full-time employees.

*On a one time basis, in 2014 preparing for 2015, plans may use a measurement period of six months even with respect to a stability period (the time during which an employee with variable hours must be offered coverage) of up to 12 months.

So, we can be sure that employers want to be working with a qualified broker that can assist them in preparing for the implementation of the new law.  We just have a little bit more time to prepare. Again, we must be flexible and patient.


For individuals we are again told that if two individuals choose different plans, one will lose their subsidy.  I was hopeful we could help our clients use the H.S.A. eligible plans but not have an aggregate deductible of $9000.  That does not appear to be the case.


If you are covered by Anthem they have a new link for things like a temporary ID and/or pharmacy card, plus a lot of FAQ's.  It's a bit long but here goes:


Big news for those that want to enroll in Covered CA.  Tuesday 2/18 is a special Covered CA Enrollment Day.  Multiple offices are providing special open house and enrollments all day. Check out for details!


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