leevena

I agree that the employer probably can't know if the daughters are eligible for the subsidy, because the employer doesn't know whether either of their parents has affordable coverage, but I don't understanding why they are eligible for the subsidy in this example. By law the daughters are both eligible for your plan until age 26, regardless of their employment status, etc. Does your plan not provide "affordable" care coverage? Is it grandfathered? Or am I missing something else? Thanks for the clarification. Sorry, I may have been a bit confusing. I was trying to prove my point that it would be difficult to identify who would and would not be eligible. On their own, they each would be eligible for some kind of subsidy. Otherwise, what you have said is correct.

Took me awhile, and a few readings, but I think I understand the question now. Sorry. 1. The wording is "offers to 95% of the FT employees (30 hours or more), so I don't see how the employer could not count the 6% you referenced. 2. I don't agree with your premise that these 6% would not qualify for the subsidy. How could you possible tell? I looked at this from my perspective, I have two grown daughters, one on my plan, the other not. If they both worked at this employer how would the employer know if they were eligible for the subsidy or not? The fact is that both are eligible for the subsidy. The youngest is now eligible for her company's plan and the other has been covered by her company for 3 years. 3. I don't agree with the your comment "unfair that counting these young people would cause the employer to fail the 95% test and be thrown in a possible 4980H tax situation when the young people would never get a tax credit or cost-sharing reduction". I have tried to do the math, but I don't see where it would cause the employer extra dollars.

Either an attorney, or see if the vendor has it. All of our vendors for self-funded medical provide these services in their fee.

The first step is for an employer to determine if they are a large group or small group as defined by PPACA. If they are a small group it stops here, if they are a large group, then they need to consider the play or pay issue. A large group who decides to play, and wants to avoid the $3,000 penalty, will need to; 1) offer coverage that is qualified, and, 2) at a cost that is affordable (9.5% of the employees’ w-2 wages). If the group does not satisfy either one of requirements, there is not an automatic penalty imposed. The $3,000 penalty is applied to each employee that obtains subsidized coverage at the exchange. It would be very difficult for most employers to know who is eligible for the subsidy and then to legally make them not qualified for coverage. I am sure there are some employers who will be able, but it will be the exception. And don’t forget, the $3,000 penalty is only applied to the individual(s) who get the subsidy. So if a group of 80 has one person get the subsidy, the employer is paying $3,000. Does this help? Sorry, just saw that Chaz posted a similar answer a few moments before mine.

Don't know, I would go with Chaz reply too.

If you are referring to the PPACA non-discrimination rule, yes it is still on hold.

thanks, just learned something new.

You stopped their contributions? Isn't this a problem for the employees becasue it was not a permitted change?

Don't hold me to this, I am fairly confident that I am correct though. I would like to hear others opinions. There is no penalty just because the employer violated the design requirements. The penalty is applied/levied when an employee goes to the exchange for a plan and recieves a subsidy.

Sorry, but you lost me somewhat. As a general rule, FSA's are not subject to the PCORI tax, so I believe you are ok without paying the tax on them. Take a look at the IRS (http://www.irs.gov/uac/Patient-Centered-Outcomes-Research-Trust-Fund-Fee:-Questions-and-Answers ) information. I believe it may be your answer. Lee

Seems to me that you have a choose between her going in for a few hours and getting paid, or risk suspension/loss of job.

I am not an attorney, labor or otherwise so there may be some others who should chime in. And keep in mind, some of this may be covered by state law too. As a general rule of thumb, employers can require an employee to attend a meeting, even if it's during their time off. A non-exempt employee needs to be paid for their time though. Your assumption about the meeting (opportunity for the vendor) is more than likely correct, and yes there is a somewhat incentive for them to retain the business. But you should really look at it as an opportunity to hear what they have, what if they have something better to offer? Hope this helps.

Forksnknives is correct. You need to check the plan documents first because there is no requirement that a plan allow for changes. If your plan does allow for these types of changes (costs) then the participant can make the change.

More than likely there is nothing you can do about it. Whether the plan is self-funded or fully-insured, both can drop a drug from it's formulary.

Very few groups ask for this type of proof, but more and more are beginning to ask for proof of not just spouse, but other dependents. Proof could include marriage certificates, birth, adoptions, domestic partnerships, guardianship and others. If not provided the employer could (and should) deny coverage. If it were me, I would design a process that requries everyone to submit and no exceptions. Once you allow one an "exception" you open up the flood gates. Same answer for self-funded and fully-insured.

Criteria is simple, they check to see if the person has Minimum Essential Coverage, that the plan meets the 60% AV level, and if it is affordable. Employers are required to submit data/information to a govt data base so that the exchanges can verify and make a decision. Sorry, I don't keep up to date with the mechanics so I cannot give you a detailed explanation. But I hear you about your concern.

Your desire to help by adding the additional wording/information is commendable. But personally I would not do it, too many potential problems may arise from it. Your notice should include a section about how they can learn more about the employer sponsored plan, in which you should point them in the direction of your plan documents. You may want to run this idea by your attorney and see what he/she thinks. Just my two cents. Good luck with it.

I believe so, but I am not 100% confident. Good thing here is that no one needs to make the decision except the state exchange that the kid goes to for coverage.

I do not know the legal answer to this question. But let me give you a practical one. Let's assume that you can do deny coverage to others who are either eligible or covered elsewhere, how in the world would you administer it? An employee is covered elsewhere but tells you they are not, now what? How do you prove they are lying to you? Personally, if I were you I would offer a cash incentive for those who decline coverage due to coverage elsewhere. This would require you to ask for proof of coverage on a yearly basis, but is much easier.

Yes, the employer can continue to offer cash in lieu of coverage. The PPACA penalty of $3,000 is applied to a large group, when an employee of that group enrolls for individual coverage at the exchange and receives the subsidy. The key is the subsidy. The subsidy is available to an employee becasue the employer failed to either provide a "qualified" level of benefits at an "affordable" cost. So if an employer has met those two requirements, the employee will not be able to receive a subsidy. If the employer has failed and the employee receives a subsidy, the fact that the employer offered cash for opting out means nothing. Did I understand the question and answer it?