‘Play or pay’ and other important PPACA fee updates
The Patient Protection and Affordable Care Act (PPACA) effective on January 1, 2014 mandates that an employer with at least 50 full-time employees offer affordable, minimum essential coverage or face a penalty, with the rule defining a full-time employee as working 30 or more hours per week. With the deadline approaching, many companies are trying to determine how to avoid or absorb the penalties associated with the “play or pay” provision as it goes into effect. In order to make the decision, WGA’s Health Reform Advisory Team has developed some material to outline the guidelines and regulations that each employers should to be aware of:
- The Employer Shared Responsibility Pay or Play Provision includes guidance on how to determine who is a full-time employee for purposes of this mandate. Explanations are provided for both on-going and new employees, so employers should review these terms and conditions carefully to be sure they are in compliance.
- In addition to the Employer Shared Responsibility Penalty, PPACA will bring about other fees for employers. These fees, paid by employers, insurers and/or health plans, will support various initiatives such as efficacy of care and the development of the insurance marketplace. Our Summary of PPACA Fees explains three specific fees that will impact employer groups: the Patient-Centered Outcomes Research Fee (PCOR), the Transitional Reinsurance Program (TRP) Fee and The Health Insurance Industry Fee, also known as the “Health Insurance Tax” (HIT).
- The newly updated National Health Care Reform Timeline provides a chronological outline of several key PPACA provisions, from those that have already gone into effect (Grandfathered Plans, Mandated Patient Protection Protections, Small Business Tax Credits, and W2 Reporting for Large Employers ) to those that are scheduled for implementation in 2014 (the Individual Mandate and Employer Shared Responsibility).
All of these items, along with a library of other materials, are available on the WGA Health Reform Advisory Corner. And we encourage you to please forward any of your questions to our team at healthreform@WGAins.com, or contact your WGA Client Executive or Client Manager with questions regarding your specific program. And remember to routinely check back at our Corner on our website for regular updates and important PPACA information, or follow our team https://twitter.com/PPACAPros.
About the Author
Sara LaVallee is a Senior Vice President at WGA’s Employee Benefits Practice, where she focuses on full-scale service to large groups. Her role involves the handling of all lines of coverage in an account management and retention capacity. She is also a key member of the Health Reform Advisory team at WGA.