The $38K Question..

Last week we talked alternatives to traditional insurance plans like self-insuring for compliance under the Affordable Care Act. Unfortunately a large portion of employers have chosen to take a different approach…to do nothing. So you may be thinking, what are the consequences if you choose not to do anything?

For employers, the Affordable Care Act presents 2 possible penalties for not complying.

  1. The first is a $2,000 per employee penalty for not supplying a health plan offering 63 Minimum Essential Coverages. For our purposes we will call that Penalty A.
  2. The ACA also imposes a $3,000 per employee penalty if the employer supplies a plan but it does not offer coverage as generous as a Bronze Plan. We will call this one Penalty B.

To determine how much that really is, lets say your company has 200 full-time employees. If just one of those employees is not offered coverage and receives a subsidy or tax credit on the exchange, you are on the hook for Penalty A which equals $240,000! ($2,000 x (200 employees – 80 (the law allows for a deduction of 80))

The $38k Question

You could end up paying this entire amount even if you are offering insurance to the majority of your employees. On top of Penalties A and B, there is a Catch-All Penalty of $100 per employee per day for numerous kinds of violations that do not fall under Penalty A or B.

There are multiple ways to trigger this Catch All Penalty:

  • Your plan excludes people for pre-existing conditions or otherwise discriminates based on health status.
  • Your “Out of Pocket” limits are higher than allowed by the ACA.
  • You incorporate a waiting period of longer than the 90 calendar days without properly enacting and calculating an additional 30 day orientation period.
  • Your plan includes annual or lifetime limits on essential health benefits.
  • You are not properly offering dependent coverage to children up to age 26.
  • You do not properly provide a Summary of Benefits and Coverage.
  • You do not have adequate claims appeal and external review processes.

The Catch All Penalty would apply to every single affected individual as long as the violation exists. This is calculated on top of Penalties A & B. Calculated over an entire year, the Catch All Penalty would cost an employer $36,500 for one employee. Using our example above, if you have 200 employees and you are in violation for the entire year, your penalties would be too outrageous to even contemplate..over $7 Million! So what are the total amount of possible penalties and excise taxes employers could face per employee?

That is the $38k Question.

To make things worse, these penalties are excise taxes and are not tax deductible like health plan contributions would have been. Does it seem like it’s a good idea to choose not to do anything? It’s not to late to mitigate your losses, check out our previous post about Self-Insuring your benefits to begin exploring alternatives to traditional insurance and choosing not to do anything.

Employers face Thousands in Tax Penalties

2015 is here, it’s a new year and as with most new years, we have all made resolutions to get healthy, save more money and other improvements to our lives. Unfortunately, I have some bad news, the dreaded Employer Mandate of the Affordable Care Act is now enforceable and it comes with hefty fines. You or your clients will be feeling the pressure if you haven’t worked to already have your compliant benefits plan in place. The penalties start in the thousands and only go up from there. If you have 70 or more full time employees you could be facing over $6,000 a month in fines alone. The fines aren't just on you either, your employees are also facing them.

Now let’s get to the good news, the fines are enforced each month and you can still mitigate your losses by acting sooner rather than later. If you just stumbled onto our blog or if you still have questions about what really happens during an IRS audit, start here by educating yourself of what the possibilities are.

We sponsored a very informative webinar series with Kaya Bromley of Your Obamacare Advisors in 2014 that was a huge success. Your Obamacare Advisors has archived all of those webinars for you to view at your own convenience. The topics include, "The Lookback Method, want to know what happens if you get it wrong?" "Common Questions about Self-Insuring" and more. If you are an employer, these are a must see or if you have clients who could benefit from these videos, you might want to do yourself a favor and pass them along.

Are you sure your business is safe

So now that you are facing these penalties..what can you expect in 2015? Well here at FreedomCare we will keep you updated with the latest breaking information regarding the Affordable Care Act with facts and opinions brought to you by our team of legal experts, seasoned insurance professionals and more. We will bring you weekly updates along with a series of very exciting Webinars. Stay tuned.