Affordable Health Care Act & Department of Labor Initiative What Employer’s Don’t Know Will Hurt Them Robert J Simandl, Esq.
The Affordable Health Care Act will impact virtually every employer that offers group health plan coverages to its employees. Whether by legal compliance obligation or benefit cost change, the law will touch every employer and every employee. The question is whether it be a positive or negative experience. While compliance responsibilities will be implemented over a number of years, there are certain essentials which employers need to look at now to determine their compliance strategies for the future. These include: 1. Maintaining grandfathered status. 2. Creating plans with “essential benefits.” 3. Establishing and coordinating claims and review procedures for benefit disputes. 4. Evaluation of the impact of the “nondiscrimination rules” on the employer and its benefit offerings. 5. Reporting and disclosure requirements of the plan including the summary of benefits and coverage, summary plan description, plan document and other plan related reporting and disclosure information. 6. Coordination and planning for benefit plan changes and communications with employees. 7. Establishment of automatic enrollment procedures (for employers with 200 or more employees). 8. Amending Cafeteria Plan for new Flexible Spending Account limitations. 9. Evaluating “pay or play” obligations and legal and financial vulnerabilities. While the above is only a partial listing of the issues and obligations which need to be evaluated by employers for purposes of legal compliance, these issues form the basis for plan operation decision making. With many of the key 2014 provisions being based upon 2013 operational realities, it is important for employers to immediately begin their evaluation of “next steps.” These next steps include: 1. Evaluation of group health plan(s) and the satisfaction of availability and affordability components of the law. 2. Evaluation of the impact of the non-discrimination rules on key employee benefit offerings and the potential for vulnerability. 3. Evaluation of alternative plan designs/configurations which will provide legal protections for plans which marginally meet or fail to satisfy the affordability requirements of the law. 4. Evaluation of the state of plan documentation and the need for amendment or revision. 5. Evaluation of employment obligations and the “30 or more hour per week” threshold for employment. 6. Evaluation of “penalty v. coverage” and coordinate with third party administrators and carriers to be certain of roles and responsibilities under the law, including non-discrimination testing.