What Employers Need to Know About ACA 'Pay or Play' Mandates

Lorman Education Services

Clear up any confusion about the ACA 'Pay or Play' mandates and avoid penalties.

Employers that offer employer-sponsored insured or self-insured plans, including small businesses that offer SHOP plans, remain confused about the effect of the repeal of the individual mandate penalty and about the muddled state of the Administration's executive actions to ‘implode' the ACA. Lawsuits brought by several states, insurers, employers, and individuals have challenged those executive actions as unlawful and as likely to cause the cost of employer-provided health care coverage and the cost of coverage on the public exchanges to spike.

This topic should help those persons responsible for employer compliance with the ACA and for cost issues associated with offering employer-sponsored health plans. The material will assist employers in avoiding the substantial penalties that the IRS has and will assess against employers whose health plans do not comply with ACA Pay or Play Mandates that survive even after Congress phased out the individual penalty to zero at the end of 2017. This topic will also describe the procedures for challenging IRS 226J Letters assessing employer shared responsibility penalties. Finally, the topic will address the ‘unintended consequences' of the Administration's executive actions: potential increased costs for employer-sponsored plans.

Learning Objectives:

• You will be able to explain why elimination of the individual mandate penalty did not eliminate the individual mandate.
• You will be able to discuss how an employer-sponsored plan satisfies the three requirements of minimum essential coverage, minimum value, and affordability.
• You will be able to describe the IRS 226J Letter and the procedure for challenging such a letter if the employer receives one.
• You will be able to recognize litigation risks associated with eliminating certain mandates or employee protections in the ACA.

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