Sibson Reminds Employers of ACA Action Items

However, in a Capital Checkup report, Sibson Consulting reminds employers there is still much to do:

• Employers must send the required notice about exchange marketplace coverage to all current employees by October 1, (and to new hires starting then). The second page of the government’s model notice requires the employer to state whether the plan meets the 60% minimum value standard and whether coverage is “intended” to be affordable for employees. The plan must be tested under the government’s minimum value testing guidelines in order to complete the notice.
• Plan sponsors preparing their second Summary of Benefits and Coverage (SBC) for this fall’s open enrollment materials will need to state in the SBC whether the coverage meets the 60% minimum value standard.
• Employers should continue to gather information about employees who may work full time but who are not currently offered coverage in order to devise a strategy for approaching the employer penalty. Those employers who decide to take advantage of the safe harbor methods for determining full-time status and choose a 12-month measurement period (followed by a short administrative period) could need to begin their first official measurement period as early as the fall of 2013. Employees determined to be working full time during this 12-month measurement period would need to be offered coverage during the 2015 stability period.
• Employers should watch for any proposed rules issued by the Internal Revenue Service (IRS) that detail the reporting requirements for employers, as well as final rules on the employer penalty itself.
• Plan sponsors will need to comply with the group health plan requirements that apply with the plan year beginning on or after January 1, 2014. These include the ban on waiting periods that exceed 90 days. Waivers, dollar limits and waiting periods that exceed 90 days will no longer be permitted.
• For non-grandfathered plans, additional requirements apply for the plan year beginning on or after January 1, 2014, such as the new out-of-pocket maximum, which may not exceed $6,350 (single)/$12,700 (family), new requirements on coverage of routine costs related to approved clinical trials, and new rules on provider nondiscrimination.

Sibson also reminded employers to continue to be diligent about managing plan costs in order to avoid the excise tax that will take effect in 2018.

The complete Capital Checkup report is here.