If a company offers coverage with a mid-calendar plan year date, does the company need to offer qualified coverage to all full-time employees on January 1 to avoid penalties or can the employer transition coverage at the start of the plan year?
How does the “no offer” penalty work with a controlled group? For example, what if one company within a controlled group offers minimum value and affordable coverage to all eligible employees and another company does not offer employees coverage at all?
How will the hours of part-time professors at colleges be counted for the application of the employer shared responsibility requirements? If a professor teaches six hours a week, does the prep time for that class have to be included? If so, how and who determines the number of hours to assign to them?
Our agency insures numerous restaurant and hospitality businesses. They have expressed concern over tip income. Most employees who work on a cash tip basis do not report 100% of their wages. How can employers protect themselves when calculating affordability if workers do not report 100% of their wages? The difference in a small amount of income could be the difference in the employer getting a penalty for offering unaffordable coverage.
We have a group that is out of compliance on the single rate so he is adjusting his deductions to meet the 9.5% affordable mark. My question is this: He was paying 50% on the family rate and now is going to payroll-deduct the entire difference in the single and family rate so it will be a large amount. I thought I read somewhere that if the family portion being deducted is more than eight percent of their household income they could possibly get the subsidy. I realize if the other spouse is working and all of the other requirements, but let’s just say the spouse is not working and the deduction would be more than eight percent. Could they qualify for a subsidy?
What happens if you have a company domiciled in Canada that has 200 employees but they have a facility here in the states with 10 employees, and they offer the US employees benefits. Is the company subject to Play or Pay rules for the employees located in the US?
I have a client who is using the measurement periods for variable hour employees. One variable hour employee that was eligible declined because she was still on her parent’s plan. Mid-way through the year she is losing their coverage (age 26) and now needs coverage. It is in the middle of the next measurement period. Does she have to wait until she is measured again or since she would have already qualified for this year, but declined, is this a qualifying event to come on mid-year?
Subsidies and Individual Penalties
If a family has a household income that is below 400% of the FPL, but the husband has employer-sponsored coverage (that meets the minimum value and affordability requirements) offered to him and his family, would the spouse and children still be eligible to receive a subsidy if they (the spouse and children) purchase health insurance on the state (federally facilitated) exchange?
An individual goes to the exchange and qualifies for some form of subsidy due to family income meeting the guidelines. In that year, their income situation improves which now disqualifies them for a subsidy on the premium. This is either charged back to them on their income tax or withheld from their refund if they have one, correct?
Small Business Tax Credit
In 2014, the small-business tax credit will only be available to those small businesses that purchase their insurance through the public exchange. Since at least 26 states will not have a public exchange available until 2015, doesn’t this mean the tax credit is not available in 2014 for those small businesses in those 26 states? Would the law need to be amended through Congress to allow for an extension?
If a group decides to cancel group coverage due to health care reform, is there a required notification period the employer needs to notify the employee in advance? If so, what do they need to provide to employee? (I’m mainly thinking about groups under 50 not subject to mandate.)
My client is moving into a new building and will no longer be in a closed office. She is concerned about HIPAA as it relates to assisting employees with claim issues. They are looking for something within the HIPAA law that will confirm the need for a closed-door space for these discussions. Can you point me in the right direction?
Are large groups (with more than 50 employees) required to offer pediatric dental? If the group does not offer the rider, if it is not mandated to, are individuals required to meet the responsibility if they have children on their plan (court orders, etc.)?
Essential Health Benefits
Has NAHU done any research on what obesity coverage will be covered under the new healthcare law? I am looking to see what types of new benefits will be available to the various groups based on what type of plan they have in place. I know it’s covered under the preventive portion and the U.S. Preventive Task Force has some things in place. I’m also interested in small groups/individuals — what coverage will be under the essential benefits section.
HSAs and HRAs
Is it true that beginning with plan years in 2016, that an HDHP can have a family deductible, for example $10,000, but the plan must still observe a maximum individual out-of-pocket of $6,600 for an individual?