Small businesses are the innovators, modernizers and visionaries that transform today’s workplace and – when it comes to the changing health care landscape – these leaders know the importance of benefits in attracting and retaining the best employees.

With the Affordable Care Act (ACA) in full swing, this guide helps to answer important questions facing small businesses and offers solutions to help strike the right benefits balance – one that is budget friendly while also meeting the health care needs and requirements of employees.


Important dates and milestones

March 23, 2010

  • The Affordable Care Act is signed into law.

Jan. 1, 2014

  • Individual Marketplace and Small Business Health Options Program (SHOP): Individuals and small businesses have the opportunity to participate in federal- and state-facilitated health insurance marketplaces. Employers with 25 or fewer full-time equivalent employees may be eligible for the Small Business Health Care Tax Credit.

Jan. 1, 2015

  • Shared-responsibility payment phase I: Employers with at least 100 full-time equivalent employees must offer affordable, minimum-value health coverage to at least 70 percent of their full-time employees and their dependents, unless the employer qualifies for 2015 dependent coverage transition relief, or face a penalty.

Jan. 1, 2016

  • Shared-responsibility payment phase II: Employers with at least 50 full-time equivalent employees must offer affordable, minimum-value health coverage to at least 95 percent of their full-time employees and their dependents or face a penalty.
  • Small-business definition grows from 50 or fewer to 100 or fewer FTEs: Employers with 100 or fewer full-time equivalent employees (FTEs) will be considered a small employer. This means these employers may be eligible to purchase health insurance for employees through the Small Business Health Options Program (SHOP).
  • IRS reporting requirements for employers: Applicable large employers and businesses with self-funded health plans are required to report information regarding the health coverage of your employees, including basic employee data, dates and type of coverage; cost-sharing; and any other information required by the IRS. These requirements apply to coverage offered on or after January 1, 2015, but the first report will not be due until 2016.

Jan. 1, 2018

  • Cadillac Tax: A tax will be imposed on insurers and employers with self-funded health plans with annual premiums that exceed $10,200 for individuals and $27,500 for families. The Cadillac Tax is 40 percent of the excess of the annual value of a health plan’s cost above the threshold amounts set forth above.

Pay, play or play differently?

4 strategies for employers to provide employee benefits options while avoiding out-of-control costs

There’s plenty of talk surrounding health care reform and whether employers should “pay or play.” The popular phrase refers to a business’s choice to either offer health care benefits that meet the law’s standards or yield to fines for dropping coverage. Though savvy employers know their benefits package can help boost workplace retention, satisfaction and productivity, many are faced with a difficult decision as health care costs continue to rise. What if there was a way for employers to play differently? By understanding rising costs, employers can take advantage of key solutions and take control of their employee benefits options.

When it comes to benefits, employers face an imperative choice

In the current health care system with rising health care costs, employers facing the “pay or play” decision can:

  • Stay the course: Keep group health insurance and pay inevitable annual renewal rates, while looking for options to keep costs down through employee cost.
  • Pay and exit: Drop group health insurance and all employer-sponsored health benefits and pay the penalty. Employers with 100 or more full-time equivalent employees can choose to pay applicable tax penalties, and employers of all sizes who exit from offering health insurance may “pay” with difficulty in recruitment and retention.
  • Play differently: Choose a different course of action to allow their company to provide health care options the workforce needs while also minimizing health care costs.

4 ways employers can play differently

Employers who want to have greater control of their benefits options have several alternatives. Companies may choose one strategy or a combination to fit their workforce and their budgets.

Consider discussing the following four strategies with your benefits consultant:

  1. Employer-sponsored account-based health plans: An account-based health plan is a consumer-directed strategy that can pair a choice of group health insurance plans with a tax-advantaged medical spending account. Options include:
    • Health Savings Account (HSA) - HSAs are individual bank accounts owned by employees that allow tax-free medical expense reimbursement. It’s required to be paired with a high-deductible health plan.
    • Health Reimbursement Arrangement (HRA) – An HRA is an employer-funded, tax-advantaged employer health benefit plan that reimburses employees for out-of-pocket medical expenses.
    • Health Flexible Spending Account (FSA) – Health FSAs offer a tax-free way for employees to save for qualified medical expenses during a single year. FSAs can be paired with any health plan or used alone.
    • Health Incentive Account (HIA) – HIAs are designed for the employee to solely earn funding for out-of-pocket health care expenses by participating in and completing a health rewards program.
  2. Private and public exchanges: Health insurance exchanges (also called marketplaces) are Web portals where individuals and businesses can shop for and buy health insurance. They’re gaining popularity and can make benefits administration easier for businesses. Plus, they give employees the option to purchase health care coverage that fits their needs and their budget. Regardless of your company’s size, private exchanges can help your company offer a variety of benefits options, including major medical and voluntary products. And if your company has fewer than 25 full-time equivalent (FTE) employees, you may be able to take advantage of tax credits through a government exchange option called the Small Business Health Options Program (SHOP).
  3. Voluntary insurance: Another way employers can help provide an extra layer of financial benefits protection and a broader benefits package to their employees is by adding voluntary benefits to their employees’ benefits package. Unlike major medical insurance, voluntary policies pay cash benefits directly to the policyholder (unless assigned otherwise) if they get sick or injured. Research shows that employees who are offered and enrolled in voluntary benefits by their employer are more likely to say their current benefits package meets their family’s needs extremely or very well than those who aren’t offered voluntary benefits through their employer.1
  4. Outcomes-based initiatives: Companies are beginning to establish ways to keep providers and employees accountable for health outcomes. For providers, employers can look to bundled pricing arrangements with their insurer so employees get the best rates with doctors and hospitals with proven track records for success. For employees, companies are increasingly looking to health screenings and incentives. In 2015, 16 percent of businesses expected to introduce health care incentives, and more than 3 in 5 (64 percent) of businesses with wellness programs include a wellness screening component.1

Note: Health insurance exchanges are gaining popularity and can make benefits administration easier for businesses.

Build a road to compliance that works for your business

Although every business and workforce is different, the importance of having employees who are adequately protected by their health care coverage is increasingly a constant. Savvy leaders find a way for their businesses to succeed and build a health benefits package that meets their employees’ needs while actively controlling rising health care costs. New innovations in the health care market and trusted consumer-directed strategies can help employers to play differently.

Sources

1The 2015 Aflac WorkForces Report, conducted on behalf of Aflac in January and February 2015 by Research Now, captured responses from 1,977 benefits decision-makers and 5,337 employees from across the United States. To learn more about the Aflac WorkForces Report, visit AflacWorkForcesReport.com.


5 things to know—and do—to guard against health care reform penalties

Straightforward facts and actionable steps to protect your business and comply with health care reform’s Employer Shared-Responsibility Requirement

Is your company ready for potential penalties due to health care reform? As part of the Employer Shared-Responsibility Requirement, penalties phase in starting Jan. 1, 2015. We’ve outlined five actionable steps to help your business understand the details of the law, assess the risk and severity of potential penalties and develop a strategy to meet compliance standards.

  1. Know: Whether your company is accountable for the Employer Shared-Responsibility Requirement. First things first: Does your company need to comply? Only employers with 50 or more full-time equivalent (FTE) employees are responsible for the Shared-Responsibility Requirement. Additionally, while larger employers with 100 or more FTEs must comply by 2015, employers with 50 to 99 FTEs are given a grace period until 2016. Employers with 50 or more FTEs are also referred to as “Applicable Large Employers” (ALEs).

    Do: Calculate the number of FTEs your company has.

    It’s easy to confuse “full-time equivalent” (FTE) with “full time,” but these terms are distinctly different. Full-time employees are those working at least 30 hours a week, while the number of FTEs a company has is based on an equation including both the number of full-time employees and all part-time employee hours. Use this equation to accurately establish your FTE count:

    Total collective hours worked in a month by all part-time employees working fewer than 30 hours per week ÷ 120 + total number of full-time employees working at least 30 hours per week = Full-time equivalent employees.

  2. Know: The type of coverage that meets compliance standards.

    Health care reform requires insurance coverage under the Shared-Responsibility Requirement to meet two criteria:

    • Coverage must be considered affordable: The cost of the coverage to employees can’t exceed 9.5 percent of employees’ household income. Since employers can’t know for certain an employee’s household income, employers may use the employee’s W-2 income to calculate this percentage.
    • Coverage must offer minimum value: The coverage must have at least a 60 percent actuarial value (AV). This means it pays on average 60 percent of the cost of covered benefits and is equivalent to a “bronze” plan in the individual market.

    Do: Determine if your employee benefits options meet the requirements.

    You’ll need to know your employees’ W-2 incomes, the cost of the health care plan to each employee and the actuarial value of the plan. Check with your benefits consultant or broker if you have specific questions about whether or not your plan meets these requirements.

  3. Know: Whom your company is required to cover. ALEs are only required to extend compliant coverage to full-time employees working at least 30 hours of service each week and their dependent children under the age of 26. Hours of service include hours worked and hours that an employee is paid but does not work, such as vacation, holiday, illness or disability, jury duty and military duty. Health care reform doesn’t require employers to offer coverage to spouses of employees or part-time employees.

    To help businesses gradually phase in compliance with the law, they’re permitted to offer compliant coverage to at least 70 percent of their full-time employees and dependent children in 2015. In 2016, coverage must be extended to 95 percent of full-time employees and their dependent children. Additionally, employers who didn’t offer dependent coverage previously in 2013 or 2014 are given an additional grace period and won’t be penalized in 2015 for failing to offer dependent coverage as long as the companies can show they’re working to make this coverage available in 2016.

    Do: Keep track.

    Though your company may not be required to offer compliant coverage to part-time employees, you’re still responsible for keeping detailed records of employment status and hours worked. Tracking involves important details issued by the federal government, including measurement periods and reassessment. To learn more, visit the IRS Q&A: irs.gov/uac/Newsroom/Questions-and-Answers-on-Employer-Shared-Responsibility-Provisions-Under-the-Affordable-Care-Act#Identification

  4. Know: The likelihood your company will be penalized. Penalties aren’t automatically activated if a company doesn’t offer compliant health care coverage. In actuality, penalties under the Employer Shared-Responsibility Requirement are triggered when ALEs don’t meet the compliance standards and at least one of their full-time employees qualifies for and receives a premium subsidy in the individual insurance market through a federal or state exchange. Though it may be less likely your company will trigger penalties if you offer compliant coverage to substantially all full-time employees or employees don’t qualify for and receive premium subsidies, it’s important not to roll the dice when it comes to protecting your workforce. If your company feels it can’t afford compliant coverage, it’s important to consider lower-cost health care options and out-of-pocket cost protection through voluntary insurance.

    Do: Determine if your company could trigger penalties.

    To activate a penalty, both triggers must occur:

    Trigger 1 (at least one of these is true for your company):

    • Your company doesn’t offer health care coverage to 70 percent of all full-time employees and their dependent children in 2015 and 95 percent in 2016.
    • Your company offers coverage that isn’t considered affordable.
    • Your company offers coverage that doesn’t meet minimum value standards.

    Trigger 2: At least one employee or their dependent child receives a subsidy through a federal or state insurance exchange to help offset the cost of purchasing health care coverage. To learn more about tax subsidies and which employees qualify, visit: http://healthcare.gov/will-i-qualify-to-save-on-monthly-premiums.

  5. Know: The severity of potential penalties. If your company doesn’t offer compliant health care coverage which meets the affordable and minimum value standards to substantially all full-time employees and their dependent children under the age of 26, it’s important to prepare for the potential amount your company could be fined. Your business may be penalized in one of two ways based on whether your company chooses not to offer health care coverage at all or offers noncompliant coverage. The penalty for not offering health coverage at all is sometimes considered more severe. The penalty for offering coverage that isn’t compliant may be less so; however, it can be substantial nonetheless.

    Do: Consider the impact of potential penalties, as well as indirect costs.

    Calculate potential penalties your company could encounter under the law to weigh whether the fine will be more than the cost of offering compliant coverage.

    Potential penalties are as follows:

    • $2,000 penalty per full-time employee - Think of this as the sledgehammer penalty: If an employer doesn’t offer any type of health care coverage to substantially all of its full-time employees and their dependents, the employer is penalized a fee of $2,000 for each of its full-time employees, excluding the first 30, if at least one of their full-time employees qualifies for and receives a premium subsidy in the individual insurance market through a federal or state exchange.
    • $3,000 penalty per full-time employee or dependent receiving a subsidy - Think of this as the tack hammer penalty: If an employer offers coverage that is either unaffordable or doesn’t meet minimum value requirements, the employer is penalized $3,000 for each full-time employee or dependent who purchases health care coverage in the individual market through a federal or state exchange and receives a premium subsidy.

    Keep in mind intangible factors such as the benefits of offering employees health care coverage, including improved job satisfaction, loyalty and morale.

    Workplace factors to consider:1

    • The majority of employees (90 percent) say their overall benefits packages are important2 to engagement on the job and with their organizations.
    • 80 percent agree3 a well-communicated benefits package would make them less likely to leave their jobs.
    • 59 percent of employees are at least somewhat likely to accept jobs with slightly lower compensation but better benefits.

Sources

1The 2015 Aflac WorkForces Report, conducted on behalf of Aflac in January and February 2015 by Research Now, captured responses from 1,977 benefits decision-makers and 5,337 employees from across the United States. To learn more about the Aflac WorkForces Report, visit AflacWorkForcesReport.com.

2Somewhat important, very important or extremely important.

3Somewhat agree, strongly agree or completely agree.


IRS reporting for employers with self-funded plans

Need-to-know details about minimum essential coverage reporting

Under the Affordable Care Act, employers who self-fund their employee health care are required to submit informational reporting about minimum essential coverage to the Internal Revenue Service beginning January 2016. Below are details to help businesses comply with this requirement.

Who is required to submit information reporting of minimum essential coverage?

Among those required to submit information reporting of minimum essential coverage are:

  • Self-funded employers.
  • Insurers.

Note: Applicable large employers that self-fund their health care are also required to submit employer-sponsored coverage reporting to the IRS. To learn more, see Employer-Sponsored Coverage to the IRS Information Reporting.

What does the report include?

Employers are required to submit a separate report for each individual health care recipient on Forms 1095-B and 1094-B that specifically provides:

  • The name of each individual enrolled in minimum essential coverage as well as the name and address of the primary insured or other related person (for example, a parent or spouse) who submits the application for coverage.
  • The return also must report the taxpayer identification number (TIN) and months of coverage for each individual who is covered under the policy or program.
  • The name, address and employer identification number (EIN) of the employer maintaining the plan and whether coverage was enrolled in through the government marketplace.

The employer must also provide a written statement to the covered individual(s) that includes:

  • The policy number.
  • The name, address and a contact number for the reporting entity.
  • The information required to be reported to the IRS.

What is the deadline?

Statements are to be provided annually to employees by Jan. 31. Forms must be provided to the IRS by Feb. 28 (March 31 if filed electronically) for the previous calendar year. Employers are encouraged to voluntarily report starting in 2015 for the 2014 plan year, but official annual reporting begins in 2016 for the 2015 plan year.

How do I submit the report?

Employers are required to provide the IRS with Form 1094-C, which is the transmittal form, and Form 1095-C, which is the employee statement. Employers can file electronically, and draft forms are expected to be available from the IRS as the reporting deadline approaches.

Can a third-party organization file the report?

Yes, the law allows employers to use a third party to assist with filing IRS reporting and providing statements to individuals insured by the health plan.

Is there a penalty for not filing the report?

Currently, employers may face penalties for not filing informational reporting. However, the law explains that these fines may be waived for employers that do not file due to reasonable cause, or fines reduced for errors that are corrected in a timely manner that are not due to reasonable cause.

Note: Fines may be waived for employers that do not file due to reasonable cause.


Tax rules for voluntary insurance under the ACA

Need-to-know details about compliance concerns for offering voluntary insurance products

The Affordable Care Act (ACA) is primarily intended to apply to group health plans and health insurers offering group or individual health insurance coverage. Because Aflac products are classified under the law as “excepted benefits,” many of the regulations don’t apply. Below are frequently asked questions and answers about taxes related to offering these products to employees.

Can employees purchase supplemental, voluntary health care coverage on a pretax basis under health care reform?

Yes. Voluntary benefits options such as accident, cancer, hospital indemnity and other excepted benefit coverage (e.g., vision and dental) can be funded through a pretax arrangement offered by an employer. While market reforms apply to certain types of group health plans, they don’t impact an individual’s ability to payroll deduct premiums for voluntary products on a pretax basis.

IRS Notice 2013-54 takes away an employer’s ability to provide individual health insurance coverage on a pretax basis to active employees. Does this apply to Aflac products?

No. Supplemental insurance coverage, such as Aflac’s products, is not subject to the Affordable Care Act market reforms. This means individual supplemental products such as accident, cancer, hospital indemnity and other excepted benefit coverage (e.g., vision and dental) can still be funded on a pretax basis. This particular IRS notice restricts employers from using payment plans and group health plans to purchase individual major medical insurance, among other things, but is not applicable to Aflac products.

Is there a change in the taxability of employer-paid premiums on Aflac products?

No. Employer-paid premiums for Aflac policies are still exempt from income tax. ACA regulations apply mainly to primary health insurance providers and coverage.


Cadillac Tax FAQ

Frequently asked questions and answers about the Affordable Care Act’s excise tax

Named after America’s luxury automobile, a 40 percent “Cadillac Tax” is scheduled to take effect for applicable coverage with plan years beginning on or after Jan. 1, 2018. Although the tax is still several years away and regulations may evolve before it is implemented, employers can begin to determine how their plans may be affected when the tax goes into effect. Below are common questions and answers about the tax and its potential effect on businesses.

Q: How is the tax calculated?

A: The tax is calculated based on premiums spent on “applicable employer-sponsored coverage.” In 2018, the 40 percent tax is applied to the value of an employer’s plan that exceeds the thresholds of $10,200 for individual coverage, and $27,500 for other than self-only coverage. These thresholds will increase in future years since they are indexed for inflation.

Q: What products are included in the calculation?

A: The tax applies to pretax group employer-sponsored coverage, including employer- and employee-paid portions. This includes:

  • Health coverage, including medical, behavioral and prescription drugs.
  • Health flexible spending accounts (FSAs).
  • Health savings accounts (HSAs).
  • Archer Medical Savings Accounts (MSAs).
  • Governmental plans, with the exception of military coverage.
  • On-site medical clinics, with exception of clinics that provide minimal medical care.
  • Retiree coverage.
  • Multiemployer plans.
  • Specified disease or illness and hospital indemnity or other fixed indemnity insurance.

Q: Which Aflac products are included?

A: Aflac specified disease and hospital indemnity products are currently included in the tax calculation if paid on a pretax basis, but an account may opt to have their employees pay these premiums on an after-tax basis, which would exclude the premiums from the tax calculation.

Q: What products are excluded from the tax calculation?

A: The following insurance products are not factored into the tax:

  • Accident Insurance.
  • Disability insurance.
  • Life insurance.
  • Supplemental liability insurance.
  • Liability insurance, including general and automobile liability insurance.
  • Workers’ compensation or similar insurance.
  • Automobile medical payment insurance.
  • Credit-only insurance.
  • Stand-alone Vision.
  • Stand-alone Dental.
  • Specified Disease and Hospital Fixed Indemnity are excluded only if not sponsored by the employer and paid for on an after-tax basis.

Q: Who is responsible for paying the tax?

A: The tax is technically paid by the insurance provider or carrier. If there is more than one carrier, each carrier pays the percentage of the excise tax commensurate with their percentage of the total premiums. And if a group is self-insured, then they are responsible for their portion of the tax based on the self-insured premiums. The details surrounding how the tax is reported and paid are awaiting clarification and final regulations, but since the tax is based on their employees’ total benefits packages, employers are currently responsible for calculating the tax and reporting each benefits administrator’s portion of the tax to the IRS. Employers, not benefits providers, may be penalized for incorrectly calculating the tax.

Q: Will my plan be affected?

A: Since the tax is still several years away, there’s a real possibility that the scope, application and time frame may change. For now, it’s estimated that approximately 16 percent of all plans could be affected by the excise tax when it takes effect in 2018. Since the tax thresholds are linked to inflation, and medical spending and premiums historically grow faster than inflation, as the law stands today, eventually more plans will likely be affected. As the law stands, 75 percent of plans could be influenced by the tax within a decade.1

Q: What can my company do now?

A: Employers can begin to assess their current health plans and talk with their benefits providers or brokers about cost-saving and cost-accountability measures. Long-term solutions will be critical to managing health plan costs.

Example Cadillac Tax calculation in 2018

In 2018, Employee A has the following benefits package that is individual coverage, paid for on a pretax basis. In this example, the Aflac accident insurance policy would be excluded from the applicable premiums, but the Aflac cancer insurance policy is included as it is paid for on a pretax basis.

The excise tax will be 40 percent of $1,000, or $400. Each carrier’s responsibility for the tax is as follows:

For the full IRS notice, visit: http://www.irs.gov/pub/irs-drop/n-15-16.pdf?WT.z_nav=health-care-reform%2Fnews%2Firs-issues-request-for-information-on-the-cadillac-tax%3BBody%3Bview%20the%20notice

Source

1Health Affairs (2013). Excise Tax on Cadillac Plans. Accessed on June 26, 2015, from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=99.

For more information

As you continue to navigate health care reform, you can rely on Aflac to provide updates and helpful information at: aflac.com/healthcare_reform To learn more, visit: healthcare.gov, sba.gov/healthcare, cciio.cms.gov and irs.gov.