With Much PPACA Guidance Still to Come, Employers Must Be Nimble, Speaker Says

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By Nancy Bonanno  

Employers need to be prepared to act quickly when regulatory guidance is issued on new health care rules that go into effect in 2014 under the Obama administration's health care overhaul, as there are a number of uncertainties that the federal government must still clear up by then, a health care analyst said July 12 in a Mercer webcast.

“We don't have any proposed or final regulatory guidance on [certain plan requirements] … We have some ideas, some frequently asked questions that regulators have floated out there," said Amy Bergner, a partner in the Washington office of Mercer.

For example, she said, government guidance on the definition of a “full-time” employee has yet to be released, and it is possible that the term could be defined to include employees who work as few as 30 hours a week. As a result, employers with a large population of hourly, part-time, or seasonal employees may suddenly find that these workers are now considered full time and face new eligibility and penalty issues.

Under the Patient Protection and Affordable Care Act, employers with 50 or more full-time employees that do not offer coverage that meets affordability and value requirements could be subject to a penalty of up to $2,000 for each full-time employee (minus 30 employees) if even one full-time employee received income-based assistance to buy coverage on an insurance exchange.

Another area of uncertainty, Bergner said, involves PPACA imperatives that employers meet health plan affordability requirements based on employee household income.

“Obviously, employers don't have access to an employee's household income, and the test here is that the employer coverage cannot exceed 9.5 percent of the employee's household income for single coverage,” Bergner said. “Regulators have said they intend to allow employers to use a worker's [Form] W-2 wages as the basis for determining that affordability, but again, we need some more definitive guidance from the regulators about that before we can really come to a comfortable landing spot in terms of how an employer can definitively assess its exposure here,” she said.

Other examples of areas in which there is uncertainty, Bergner said, include the 90-day limit on waiting periods for new full-time employees to be deemed eligible for health care coverage and the automatic enrollment mandate, which is slated to begin sometime after 2014 because regulators have said they won't be ready with guidance until then. Under the auto-enrollment mandate, employers with more than 200 employees that offer one or more health plans must automatically enroll new full-time employees in one of the plans.

By Nancy Bonanno  

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