ERISA/DOL Resources

ERISA basics – https://www.dol.gov/general/topic/health-plans/erisa

Model language for notices required for health benefit plans – https://www.dol.gov/ebsa/pdf/cagappc.pdf

DOL guide for required disclosures – https://www.dol.gov/ebsa/pdf/rdguide.pdf

DOL Guide for Employers for COBRA – https://www.dol.gov/ebsa/pdf/cobraemployer.pdf

DOL Basic information on FMLA – https://www.dol.gov/whd/regs/compliance/whdfs28.htm

Uniform Glossary of Health Benefit and Medical Terms – https://www.dol.gov/ebsa/pdf/SBCUniformGlossary.pdf


Affordable Care Act Resources

Internal Revenue Service’s Q&A regarding employer’s responsibilities under the Affordable Care Act

https://www.irs.gov/affordable-care-act/employers/questions-and-answers-on-employer-shared-responsibility-provisions-under-the-affordable-care-act

IRS regulations covering ALE determination, hours of service, the look-back method, affordability safe harbors, and calculation of employer shared responsibility penalties.

  • ALE Determination (Pages 36-37)
  • Hours of Service (Page 38)
  • Lookback Method(Page 44)
  • Affordability Safe Harbors (Page 57)
  • Calculation of Penalties (Page 55)
  • Definitions of all terms relevant to these penalties (Pages 36-40)

https://www.gpo.gov/fdsys/pkg/FR-2014-02-12/pdf/2014-03082.pdf 

Minimum essential coverage guide –

https://www.irs.gov/affordable-care-act/individuals-and-families/aca-individual-shared-responsibility-provision-minimum-essential-coverage

Minimum Value/Affordability guide – 

https://www.irs.gov/affordable-care-act/employers/minimum-value-and-affordability

IRS Notice Regarding Health Plans now prohibited by the ACA – 

https://www.irs.gov/pub/irs-drop/n-15-17.pdf


Affordable Care Act Employer Compliance

I recently attended a professional CFO roundtable as a subject matter expert on Obamacare (Affordable Care Act) compliance issues for employers.  It was an excellent discussion included CFOs from firms ranging in size from less than 50, to more than 250 employees.

Coming out of the CFO roundtable, the biggest challenge centers around tracking employees with precision so as to ensure the employer avoids the excise taxes (penalties) under IRC § 4980H.  Several participants echoed this sentiment saying: “It’s not practical for us to even know how many employees we have at any given moment right now.  How am I supposed to make sure I’ve offered coverage to everyone I am supposed to?”

What’s clear is that working to comply with Obamacare’s Employer Shared Responsibility provisions, and the Notice and Reporting provisions, will require a significant change in how Applicable Large Employers’ HR, Finance, and Legal departments interact with one another.  Behind Obamacare’s requirements lie employers’ continuing responsibilities under ERISA, HIPAA and state labor laws. Organizations that don’t formulate their Obamacare compliance systems with those other rules in mind can build significant amounts of risk into their business.

Many businesses seemed to be still in the first stages of figuring out how to work Affordable Care Act compliance into their organizations.  Other organizations have already decided it’s impractical to work compliance in-house and plan to outsource the tasks to third-parties.

News reporters like to highlight those employers looking at “manipulating hours” (i.e. reducing or controlling hours to control employees’ entitlement to employer-sponsored health insurance).  However this strategy poses a lot of risks and must be executed almost flawlessly to obtain its benefits.  Employers manipulating hours run the risks of incurring overtime (for those employees picking up the slack), or worse yet, the risk of exempt employees becoming non-exempt under state wage & hour laws that could result in very expensive litigation and penalties.