HealthCare Reform . . . What's around the corner

Here is a limited view of those items around the corner:

  • Group health plans must distribute a standard summary of benefits and coverage explanation developed by the Department of Health and Human Services.  Failure to do so can result in a $1,000 fine per enrollee. (2012)  
  • 2014 - Employer Coverage Mandate - Employers with 50+ "Full Time Equivalent" (FTE) employees must offer “minimum essential coverage” health coverage to all full-time employees (and their dependents). "Minimum essential coverage" means that employers must cover no less than 60 percent of the cost of the benefits.  FTE employees include those who work an average of 30 hours per week.  Part-time employees are counted based on the number of hours worked in a month divided by 120. 

Here are the penalties for non-compliance with the Employer Coverage Mandate:

  • If employers do not offer "minimum essential coverage," and if at least one employee receives a tax credit or cost sharing reduction through an Exchange: $2,000 per year fee, assessed monthly, per full-time employee (first 30 employees are excluded)
  • If employers offer "minimum essential coverage" that is unaffordable (the sponsored plan’s share of the total allowed benefits cost is less than 60%, or if the employee's premium is more than 9.5% of his/her household income): the lesser of $3,000 per employee receiving a tax credit or cost-sharing subsidy, or $2,000 fee per full-time employee.

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