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A T T O R N E Y S A T L A W
JUNE, 2012
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For example, if an Employer employs 100 employees and fails to provide health insurance coverage, and at least one of its full-time employees receives a federal subsidy to purchase health insurance coverage, the Employer will have to pay an annual fine of $2,000 for every one of its full-time employees, minus the first 30. Therefore, for 70 of its full-time employees the Employer will have to pay a $2,000 fine per person, equaling $140,000.
The law does not give any clear guidance on unaffordable coverage. Unaffordable coverage must be determined on a case-by-case basis depending on the income of the employee. This is highly problematic and is highly subjective for most Employers. Moreover, if an Employer chooses to provide health insurance coverage to its employees, but a particular employee finds the coverage offered through the Employer to be too expensive in comparison to the percentage of their income, the Employer will be required to take further action to assist this employee in purchasing health insurance coverage. The Employer will have to provide vouchers to employees who opt to purchase their own coverage in the amount that the Employer would have covered had the employee accepted the company plan.
be issued to corporations as well, and that the form be issued to individuals and corporations that provide property to the Company. Only business related payments are reportable, personal payments not. There are a number of exceptions: payments for merchandise, telephone, freight, storage, and payments of rent to real estate agents are excluded.
Why small businesses might want to consider providing health insurance coverage to their employees and why they may not.
Although small businesses that employ 50 or fewer workers are exempt from the provisions of the health care reform law, there are tax incentives offered through the law, which might persuade small businesses to offer health insurance coverage to their employees. Beginning in 2010 and lasting through 2013, small businesses which employ less than 26 full-time employees and have an average annual income of less than $50,000, will receive a tax credit of up to 35% of the Employers contribution toward the employees premium, as long as the Employer contributes 50% or more of the total premium costs. A full tax credit will be available to Employers who employ less than 10 workers with an average annual income of less than $25,000. As of 2014, small businesses will be able to sign up for health exchanges that will be setup through the law. If a small business signs up for one of the health exchanges, it can receive a tax credit of up to 50% of its costs, similar to the 2010-2013 programs. That all sounds good but the Congressional Budget Office estimates that this brief tax credit period will impact at most 12 percent of businesses with 25 or fewer employees and expire after two years beginning in 2014. As for the full tax credit option for Employers who employ less than 10 workers with an average annual income of less than
$25,000, most of these workers will qualify for premium subsidies in the state exchanges anyway. So even with the significant incentives these small businesses probably have no benefit to offering coverage.
Insurers are prohibited from charging co-payments or deductibles for Level A or Level B preventive care and medical screenings on all new insurance plans. Insurers' abilities to enforce annual spending caps will be restricted, and completely prohibited by 2014. Insurers are required to reveal details about administrative and executive expenditures. Health insurance companies become subject to a new excise tax based on their market share; the rate gradually rises between 2014 and 2018 and thereafter increases at the rate of inflation. Insurers are required to implement an appeals process for coverage determination and claims on all new plans. Given the avalanche of new requirements for insurers, expect insurers to pass the
costs of these requirements onto consumers. In fact, most experts project that premiums and health costs will continue to rise for Employers and individuals. For just one specific example, a study on the issue of deductibles projected that deductibles may run as high as $400 or more because the Health Care Reform law does not control the rate of medical cost inflation. Employees may be shocked when Employers present such health care plans to the employees during open enrollment periods.
insurance costs. 2. Consider increasing employee contributions for health insurance coverage
to help offset the costs. In a recent survey of 700 employers over 30 industries, almost 42% responded that they intend to increase employee contributions to help defray costs. It may not make a business owner popular with employees, but it should help save the company money. 3. Consider plans that have higher deductibles and higher co-pays such as
pre-managed care benefit systems. Most experts predict that the Health Care Reform Law will help pull down the cost of prescription drugs, thus easing the burden of co-pays on employees. Finally, any Employer should read the Health Care Reform Law and consult with an HR professional. Many of the provisions discussed in this article go into effect over the next eight years. Any strategic decisions by Employers with respect to health plans should also bear in mind that 2018 is the magic date when Cadillac health plans will be
subject to higher taxes. The labor attorneys of Flamm Walton would be happy to discuss your needs with you.
Robert J. Krandel is an Attorney in the Labor and Employment Group at Flamm Walton PC. Irene Montero, a Summer Intern with the Firm, provided assistance with this article.
The EMPLOYMENT LAW NEWSLETTER is produced and published solely to inform and not to provide any advice, legal or otherwise. Although this newsletter is based on existing case law, the statements herein are general, for information only and are not intended to be relied on for any purpose. Individual facts in a given case may alter the procedural necessities or substantive issues involved in addressing a specific legal issue or prosecuting or defending a claim. Should you have an issue that you believe is similar to one of those discussed herein, we urge you to consult an experienced attorney. If you have any additional questions on the EMPLOYMENT LAW NEWSLETTER, or the topics discussed herein, please contact the FLAMM WALTON PC Labor and Employment Law Group.