The following Health Reform Checklist is intended to guide you through the general compliance requirements of the Affordable Care Act (ACA) as you prepare now for 2015 and beyond. In general, these items apply to all employers. Items marked with a ‘+’ only apply to employers with 50 or more

Plan Design and Notice Requirements1. Grandfathered Health Plans

Grandfathered Plans are exempt from certain marketprovisions of ACA. Review the triggers that would causeyour plan to lose grandfathered status now and into 2015to determine whether your plan still meets or will meetguidelines.

Make sure the Notice of your plan’s intent to remaingrandfathered is included in all plan materials.

2. Annual Limits on Essential Health Benefits

Ensure your plan and plan documents have no annuallimits for essential health benefits (EHBs) for planyears beginning on or after January 1, 2014.

8. 60-Day Advanced Notice of Benefit Changes

3. Review Waiting Periods for Health Plan Coverage

Review all waiting periods for enrollment to ensure theydo not exceed 90 days (applicable to all health plansrenewing or after January 1, 2014). Certain restrictionscan apply, such as orientation period, 1200 hour require-ment or the lookback requirement.

Consider the impact on non-discrimination testing if youhave different waiting periods for specific classes ofemployees.

4. Eliminate Pre-Existing Conditions Language

Ensure that any pre-existing conditions clauses have beenremoved from all health plans for 2014 plan years goingforward.

6. Amend FSA Plan Documents

Consider whether to amend your FSA plan such that the-annual indexed account limit ($2,500 for 2014) will auto-matically adjust in conjunction with any IRS cost of livingadjustment (you must track and modify your open enroll-ment materials).

If elections are mistakenly made that are over the$2,500 limit, the IRS has allowed for the additionalfunds to be included on the employee’s W-2 as taxableincome for the year in which the plan ends.

Are an employee and spouse both enrolled in theiremployers’ health FSAs? If so, both may elect up to the$2,500 maximum.

7. Summary of Benefits and Coverage (SBC)

Ensure that all eligible new hires are provided SBC upon-initial enrollment into the health plan.

Ensure that SBCs are provided during open enrollmentor at least 30 days before renewal of coverage.

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Provide written notice of any material modification ofplan terms or coverage that affects SBC content not reflectedin the most recently provided SBC, and that occurs other thanin connection with a renewal or reissuance of coverage. Thisnotice must be provided to plan participants no later than 60days prior to the effective date of the change.

9. Notice Of Public Marketplaces (Exchanges)

Ensure that notices are provided within 14 days of dateof hire. This notice must be provided to all employees,without regard to whether they are eligiblefor coverage under the health plan.

10. Cost Sharing and Out-Of-Pocket Limits

For plan years beginning in 2014, the ACA imposes cost-sharerestrictions on essential health benefits provided by non-grandfathered group health plans. For 2014, the annualout-of-pocket limits applicable to both insured and self-funded plans offered through and outside the Marketplaceare $6,350 for single coverage and $12,700 for coveragefor more than one. In 2015, the out-of-pocket limits HHShas proposed will be $6,600 for self-only coverageand $13,200 for family coverage.

5. Wellness Program Incentives

For 2014 and beyond, there is an Increased limit incontingent (outcome-based or activity-based) incentives/disincentives permitted in wellness programs from 20 to30%; or up to 50% for tobacco-free programs.

Fees, Filings and Reporting for 2014 and Beyond

11. Patient-Centered Outcomes Research(PCOR) Fee

PCOR fees are paid once a year in connection with IRS Form720, Quarterly Federal Excise Tax Return. Amount of fee: $1per covered life for plan years ending after 9/30/12 and before10/1/13. $2 per covered life (indexed) for plan years endingafter 9/30/13 and before 10/1/14.

For insured plans, Form 720 is due by July 31st followingthe close of the policy year from the insurer, who includesthe fee in premiums.

For self-funded plans, Form 720 is due by July 31st of thecalendar year following the plan year end.

12. Transitional Reinsurance Fee

There is an annual fee beginning in 2014 through 2016,for all fully-insured and self-funded health plans.

Annual fee beginning in 2014 through 2016, imposed onall-sized fully-insured and self-funded group health plans.Fee based on covered lives, payable by the insurer for fully-insured plans or plan sponsor for self-funded plans. For 2014,the contribution rate is $5.25 per covered life per month, orapproximately $63, annually. For 2015, the fee to be collectedis $44 per covered life.

15. Health Insurance Provider Fees(Imposed on Insurers)

An annual fee imposed on “covered entities” such asinsurers covering U.S. health risks. Assessed fees areapportioned among all applicable insurers, based on aratio of net premiums for insuring U.S. risks during thepreceding calendar year as compared to the aggregatenet premiums for that same year. The Fee is assessed whennet premiums covering US risks exceed $25 million for theprevious year.

Covered entities include state-licensed health insurancecompanies, federal or state-licensed HMOs, entitiesproviding health insurance under Medicare Advantage,Medicare Part D, Medicaid, and self-funded multipleemployer welfare arrangements (MEWA).While employersare not subject to this fee, insurers may pass some ofthe cost on to policy-holders.

16. Federal Marketplace User Fees (Appliesto Individual and Small Group Market Only)

In states where a state-based marketplace has not beenestablished (currently 26 states), a federal marketplaceis available to individuals and small businesses. Wherethis is the case, regulations impose a monthly user feeof 3.5% of premium spread across all qualified health plansoffered in the state by that insurer to help fund thefederal marketplace. A state Marketplace may assess a feeas well. This fee is paid by the insurer.

13. F ilings for ERISA Plans Unless an exception applies, certain group health plans

subject to ERISA are required to file a Form 5500 AnnualReport filing, due the last day of the 7th month followingthe end of the plan year. A Summary Annual Report (SAR)for ERISA plans is due on the last day of the 9th monthafter the plan year ends to participants.

Multiple Employer Welfare Arrangements (MEWAs) aresubject Form 5500 filings, and to an annual M-1 reportingrequirement which is due March 1.

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17. Certification of Compliance with ElectronicTransaction Requirements (Self-Funded Plans Only)ACA modifies certain aspects of HIPAA electronic transactionrules to require a controlling health plan (CHP) and any sub-health plan (SHP) to obtain a unique health plan identifier(HPID) through CMS Enterprise Portal. The CHP or SHP mustcertify that it is in compliance with certain standards forelectronic transactions and operating procedures for purposesof processing: 1) eligibility for health plan transactions;2) health care claim status transactions; and 3) health careelectronic funds transfers (EFT) and remittance advice transactions.

The CHP or SHP should work with its TPA to ensure compliancewith these processes.

Obtaining HPID:

Large health plans (annual receipts $5M+) must obtain

HPID by 11/5/2014Small plans (annual receipts <$5M) must obtain HPID by11/5/2015All plans must use HPID by 11/7/2016

CHP with HPID obtained prior to 1/1/15 must certify compliance by 12/31/15CHP with HPID as of 1/1/15 must certify compliance by 1/1/16

CHP Certification Schedule:

14. MLR Rebate (Imposed on Insurers and Payableto Policyholders and Subscribers)

Large group insured plans (over 100 employees) mustspend at least 85% of premiums paid on medical claims.Small groups (100 or fewer employees) and individualmarkets must spend at least 80% on medical claims. Ifnot, a rebate is owed to the policyholder and subscriber,based on pre-established pools. Policyholders and subscribersmust be notified by September 30, 2014 (for 2013 reportingyear and all subsequent years)..

18. Report Health Plan Aggregate Cost on W-2

All employers filing 250 or more W-2 forms must report thecost of health coverage (both employer and employee cost)in Box 12 of the W-2, using Code DD. Employers issuing lessthan 250 W-2 forms are exempt until further guidance is issued.

Reporting and paying the fee: Submit annual enrollment count(based on first 9 months of year) to HHS by November 15th ofeach year on form available via www.pay.gov. Reporting formwill auto-calculate contribution amounts and allow paymentsto be made. Contributions paid in two installments: 1st install-ment due within 30 days of invoice reflects actual reinsurancecontribution (plus HHS’s administrative costs); 2nd installmentwill be invoiced in 4th quarter following the year of submission and reflects amounts allocated to U.S. Treasury.

Shared Responsibility Employer Preparation 19. Determine Whether You Are a Large Employer

- Do you have 50 or more full-time equivalent employees (FTEEs)? Note, the IRC Section 414 control group rules apply for purposes of determining employer size.

Add your full-time employees and part-time employees (add part-time together, then divide by 120, then divide by number of months used) to determine this.

Use special rules for counting seasonal workers.

May use any consecutive 6-month period in 2014 for determining Large Employer status.

20. Large Employers (100 or more FTEEs), or

Employers with between 50 and 99 FTEEs: Shared Res-ponsibility rules do not apply until plan years beginning on or after January 1, 2016, if employee size and plan design is maintained as of 2/09/14.

Workforce size and hours worked must be maintained

Employer may not change plan year after 2/09/14

Employers with 100 or more FTEEs: Shared Responsibility rules apply for plan years on or after January 1, 2015

21. Large Employers – Review Health Plan to Ensure Affordability and Minimum Value

Standards

Ensure that the employee’s contribution to premium does not exceed 9.5% of household income (affordability standard).

Choose one of these three methods of calculating:

Form W-2 method;

Rate of Pay method; or

Federal Poverty Level (FPL) standard

Does coverage meet at least 60% of the total allowed costsof benefits expected to be incurred under the plan (minimum value standard)?

Minimum value calculator supplied by HHS Safe harbor plan design Actuary determination

23. Large Employers – How is a Penalty Triggered?

A non-deductible excise tax is assessed on large employers who donot provide minimum essential coverage (MEC), or adequate or affordable coverage to their full-time employees. Two types ofpotential penalties:

No Coverage Excise Tax Penalty [IRC Section 4980H(a)]: If employer fails to offer MEC to minimum of 95% (70% for 2015) of its full-time employees (employees plus dependentsbeginning 2015) for any calendar month and employs at least one credit employee*, the excise tax penalty calculatedmonthly as: Number of FTEs - 30 [-80 for 2015] X $166.67** (= $2000/yr**).

Inadequate or unaffordable Excise Tax Penalty [IRC Section 4980H(b)]: If an employer offers health coverageto at least 95% (70% for 2015) of its full-time employees andemploys at least one credit employee*, and coverage fails to meet minimum value standard or is unaffordable, then monthly excise tax penalty is the lesser of: Number of creditemployees multiplied by $250** (= $3000/yr**), or Number of FTEs - 30 (-80 for 2015) X $166.67**(= $2000/yr**).

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*A credit employee is one who works at least 30 hours per week and who is eligible for a premium tax credit or cost sharing assistance for buying insurance through a marketplace. **These penalties are indexed beginning in 2015.

ACA Provisions Beyond 2014/2015

24. Employers With 200 or More Employees Must Provide Automatic Enrollment in Health Plans

Awaiting further guidance on this provision.

25. Non-Discrimination Rules for Insured Plans

Awaiting further guidance, but assume these will be similar to the Section 105 self-insured rules.

26. Cadillac Tax – Excise Tax on Rich Health Plans

A 40% non-deductible excise tax will be imposed on the value of high cost employer sponsored health coverage – awaiting further guidance on this provision.

Applies to employers with 50 or more full-time equivalent employees as defined by the law.

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Employers (50-99 FTEEs) - What Rules Apply by Employer Size in 2015?

To maintain its level of benefits, the employer mustcontinue its contribution toward single coverage (the employer contribution must be maintained to at least95% of its level as of 2/09/14).

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22. Large Employers – Who Must Be Offered Coverage to Avoid Excise Tax in 2015?

Offer coverage to all employees scheduled to work 30 or more hoursper week or 130 hours per month by the first day of the 4th month ofhire (however, the waiting period requirements of the ACA must be satisfied) to avoid the risk of excise tax.Choose the monthly measurement method or the look backmethod. If look back method is chosen, then:

The information contained herein is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations. The information contained herein is provided as general guidance and may be affected by changes in law or regulation. The information contained herein is not intended to replace or substitute for accounting or other professional advice. Attorneys or tax advisors must be consulted for assistance in specific situations. This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.

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Establish a look back measurement/stability period to reviewongoing variable/seasonal employees in 2014.Establish an initial look back measurement/stability period fornewly hired variable employees (those who may be seasonal, or hired to work less than 30 hours per week, or individuals for whom hours worked is not known at the time of hire). This period may be between 3 and 12 months.Establish a look back measurement/stability period to reviewongoing variable/seasonal employees in 2014.