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Delayed or Still
to be Determined
Provisions
Small Employer Size Definition
Under the Affordable Care Act, a small employer is defined as 100 or fewer employees. Still,
states may choose to define a small employer as 50 or fewer employees until January 1, 2016.
Currently, most states define a small employer as having no more than 50 employees.
SHOP Marketplace Open to Large Employers
States have the option to expand the SHOP Marketplace to large employers with more than
100 employees effective January 1, 2017.
Cadillac Tax
Effective January 1, 2018, a 40 percent non-deductible tax will be imposed for health plans
with a total value of more than $10,200 for individual and $27,500 for family coverage. This
tax applies to the aggregate value of employer-sponsored coverage, as well as employer
and employee contributions to Health Reimbursement Accounts (HRAs) or Flexible Spending
Accounts (FSAs), employer contributions to Health Savings Accounts (HSAs), and coverage
for on-site clinics. Separate vision and dental coverage will generally be exempt. Accident and
disability coverage are also exempt. Other supplemental policies, such as Aflac products that
provide hospital or other fixed indemnity coverage, or coverage for a specified disease or illness
are exempt if paid for by employees on an after-tax basis.
Auto-enrollment
Employers with more than 200 full-time employees must automatically enroll new, full-time
employees into a health plan and continue enrollment for current employees. Enrollment may
be subject to applicable compliant waiting periods. Employers must provide adequate notice
and an opt-out option. This requirement applies to both fully- and self-insured employers. The
effective date is unknown at this time, and employers do not need to comply until guidance is
provided.
Non-discrimination testing for fully insured plans
Non-discrimination testing prohibits employers from discriminating in favor of highly
compensated individuals for eligibility and benefits. This rule already applies to self-insured
plans and will also apply to fully insured employers. Further guidance is expected regarding
when this provision will take effect for fully insured plans.
Quality reporting
Health care reform requires employer health plans and health insurers to report care quality
and health outcomes. The Department of Health and Human Services is expected to issue
further guidance on this reporting requirement for group and individual health plans. Guidance
is expected to include covered benefits and provider reimbursement structures that improve
health outcomes, prevent hospital readmissions, improve patient safety, reduce medical errors,
and implement wellness and health promotion activities.
