ACA Compliance

If you have at least 50 Full-Time Equivalents (FTEs), by law you are considered an Applicable Large Employer (ALE).

All Applicable Large Employers are required to offer affordable health insurance for its employees.

As an ALE with at least 50 FTEs, you are mandated by law to:

• Use 1094-C and 1095-C to report to the IRS information about the health care coverage, if any, offered to full-time employees.

• Furnish 1095-C to employees providing the same information reported to the IRS.

• Prepare to offer affordable health care coverage to full-time employees.

• Provide affordable health care coverage to full-time employees for the entire calendar year

The process needs to be tracked and then you need to submit a report to the federal government at the end of each year.

Whether an employer is an ALE is determined each calendar year, and generally depends on the average size of an employer’s workforce during the prior year.

If an employer has fewer than 50 full-time employees, including full-time equivalent employees, on average during the prior year, the employer is not an ALE for the current calendar year. Therefore, the employer is not subject to the employer shared responsibility provisions or the employer information reporting provisions for the current year. Employers who are not ALEs may be eligible for the Small Business Health Care Tax Credit and can find more information about how the Affordable Care Act affects them on the ACA Tax Provisions for Small Employers page.

If an employer has at least 50 full-time employees, including full-time equivalent employees, on average during the prior year, the employer is an ALE for the current calendar year, and is therefore subject to the employer shared responsibility provisions and the employer information reporting provisions.

To determine its workforce size for a year an employer adds its total number of full-time employees for each month of the prior calendar year to the total number of full-time equivalent employees for each calendar month of the prior calendar year and divides that total number by 12.

The Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 provides that an employee will not be counted toward the 50-employee threshold for a month in which the employee has medical care through the military, including Tricare or Veterans’ coverage. This is solely for the purpose of determining whether an employer is an “applicable large employer” subject to the employer shared responsibility rules of § 4980H. For more information, see IRC § 4980H(c)(2) subparagraph (F) “Exemption for Health Coverage Under Tricare or the Veterans Administration.”

Under the employer shared responsibility provision, a full-time employee is, for a calendar month, an employee employed on average at least 30 hours of service per week or 130 hours of service for that month.

This definition of full-time employee is central to the employer shared responsibility provision. You must identify your full-time employees to:

• Determine your applicable large employer status and

• Determine which employees to whom you need to offer coverage in order avoid a potential employer shared responsibility payment.

There are two designated measurement methods for determining your employees' full-time status: the monthly measurement method and the look-back measurement method. The look-back measurement method for identifying full-time employees is available only for purposes of determining and computing liability under section 4980H and not for purposes of determining status as an applicable large employer.

The term 'hours of service' and both measurement methods are explained in the ESRB regulations, on IRS.gov, and within the provision section of the estimator. You may choose to use either method and you may use different methods for different specified classes of employees - so long as the methods are used consistently.

Under the Affordable Care Act, governments, insurers, employers and individuals are given shared responsibility to reform and improve the availability, quality and affordability of health insurance coverage in the United States. The estimator is specifically designed to help you determine if the employer shared responsibility provision (IRC Section 4980H) applies to you and, if it does, will help you determine the maximum amount of the employer shared responsibility payment that could apply to you under either section 4980H(a) or 4980H(b) based on the number of full-time employees that you report.

The provision applies to employers called applicable large employers that employ on average at least 50 full-time employees (including FTEs) during the preceding calendar year. If you are an applicable large employer, you may owe the payment if at least one of your full-time employees receives the premium tax credit because:

• You don't offer health coverage to at least 95% your full-time employees (and their dependents) or

• You do offer health coverage to at least 95% of your full-time employees (and their dependents), but the offer of coverage doesn't provide minimum value or is unaffordable to a particular employee, or a full-time employee that was not offered coverage receives the premium tax credit.

The size of your workforce in the previous calendar year determines whether you are an applicable large employer. In most cases, you determine your “workforce size” by looking at your employees in the previous calendar year and computing if you employed on average 50 or more full-time employees, including your full-time equivalent employees, across all 12 months of the year. You must look at all of your employees, including seasonal workers, when determining if the provision applies to you; however, you may exclude employees who are covered by TRICARE or certain health programs for veterans.

Employers with a common owner or that are otherwise related (that is, employers that are part of an aggregated group) must count all full-time employees and full-time equivalent employees of all members of the aggregated group to determine if the employer is an applicable large employer. If the combined members of the aggregated group together employed an average of 50 or more full-time employees (including FTEs) in the preceding calendar year, the provision applies separately to each employer that is a member of the aggregated group (each ALE member). If an ALE member owes an assessable payment under the provision, the amount of the assessable payment would be determined based only on the full-time employees of that ALE member, and not full-time employees of any other member of the aggregated group.

If you are an applicable large employer, you could be required to pay an assessable payment if you do not offer minimum essential coverage to at least 70% (for 2015) or 95% (for 2016 and future years) of your full-time employees, or if you offer coverage that does not provide minimum value or that is not affordable to one or more full-time employees, and at least one full-time employee receives the premium tax credit. Generally, the provision is effective beginning in 2015.

What does the ESRP require?

If you are an applicable large employer, you may be required to make an ESRP payment to the IRS if you:

• Do not offer minimum essential coverage to your full-time employees (and their dependents), or

• Do offer coverage to your full-time employees (and their dependents) that is not affordable or does not provide minimum value.

If you are an applicable large employer, you are also required to file information returns with the IRS and furnish statements to your full-time employees containing details about the coverage that you offered in each month. See Information Reporting by Applicable Large Employers on IRS.gov for more information.

There are two types of penalties (the law calls them payments):

• The payment under section 4980H(a): You may be liable for this if you do not offer minimum essential coverage to at least 95 percent of your full-time employees (and their dependents) and at least one employee receives the premium tax credit. The amount of this payment is based on your total number of full-time employees (with certain adjustments), not only on the number of full-time employees who receive the premium tax credit.

• The payment under section 4980H(b): You may be liable for this if you do offer minimum essential coverage to at least 95 percent of your full-time employees (and their dependents), but at least one of your full-time employees receives the premium tax credit because that coverage is not affordable to the employee, doesn't provide minimum value, or that employee did not receive an offer of coverage. The amount of this payment is based solely on the number of full-time employees who receive the premium tax credit.

To be liable for an ESRP payment under section 4980H, one of your full-time employees must receive a premium tax credit.

The calculation for the section 4980H(a) payment is significantly different from the calculation for the section 4980H(b) payment. If you are liable for the employer shared responsibility payment, you will only be liable for one of the two payments.

More information on both payments can be found in the ESRP Regulation and from the IRS:

• Payment under 4980H(a)

• Payment under 4980H(b)

• Types of employer payments and how they are calculated

Contact PayNortheast to learn more.

631-306-4929

support@paynortheast.com