Volume 4 - HR Policy Association
Transcript of Volume 4 - HR Policy Association
i
Enactment of the Affordable Care Act has launched a massive restructuring of the American
health care system which is likely to continue until at least the end of the decade.
The member companies of HR Policy Association, all of whom are large employers who
collectively spend more than $75 billion annually on health care in the U.S., are in the process of
assessing their company's current health care strategy and formulating new ones in response.
This Decision Framework has been created under the direction of the Association's Health
Care Policy Steering Committee, chaired by Marc C. Reed, Chief Administrative Officer,
Verizon Communications Inc.
Its purpose is to serve as a tool that Chief Human Resource Officers and other senior
corporate executives can use to:
• Understand both historical and current trends in American health care impacting large
employers;
• Determine long-term objectives with respect to health care for employees, dependents,
and retirees;
• Identify various options available in considering potential changes to company health
care strategies; and
• Support formulation of the company’s long-term health care strategy by its senior
management and board of directors.
This Framework was developed for the Association's CHRO Summit on March 15-16, 2013,
which involved the Chief Human Resource Officers from more than 200 large corporations. It
has been updated utilizing the valuable input the Association has received since the Summit.
HR Policy Association is the lead organization representing chief human resource officers of
major employers. The Association consists of more than 350 of the largest corporations doing
business in the United States and globally, and these employers are represented in the
organization by their most senior human resource executive. Collectively, their companies
employ more than ten million employees in the United States, nearly nine percent of the private
sector workforce, and 20 million employees worldwide. They have a combined market
capitalization of more than $7.5 trillion. These senior corporate officers participate in the
Association because of their commitment to improving the direction of human resource policy.
Their objective is to use the combined power of the membership to act as a positive influence
to better public policy, the HR marketplace, and the human resource profession.
For more information, contact HR Policy Association at 202-789-8670.
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Marc C. Reed, Chair
Chief Administrative Officer
Verizon Communications Inc.
William A. Blase, Jr.
Senior Executive Vice President, Human Resources
AT&T Inc.
Lynnette M. Cavalier
Senior Vice President, Human Resources
FirstEnergy Corporation
L. Kevin Cox
Chief Human Resources Officer
American Express Company
Timothy M. Crow
Executive Vice President, Human Resources
The Home Depot, USA Inc.
Michael L. Davis
Senior Vice President, Global Human Resources
General Mills, Inc.
Richard R. Floersch
Executive Vice President, Chief Human Resources Officer
McDonald's Corporation
Mark R. James
Senior Vice President, Human Resources and Communications
Honeywell International Inc.
Daisy Ng
Senior Vice President, Chief Human Resources Officer
Darden Restaurants, Inc.
David A. Rodriguez
Executive Vice President and Chief Human Resources Officer
Marriott International, Inc.
iii
Volume 1
Formulating a Company's Future Long-Term Health Benefits Strategy:
Considerations, Options and Decision Points
Volume 2
The Current State of Employer-Provided Health Care in America
Volume 3
Public and Private Sector Attempts to Reform Health Care
Volume 4
The Affordable Care Act and Large Employers
Volume 5
Emerging Forms of Health Care Delivery Following Enactment of the ACA
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Volume 4 provides information intended to inform the discussion of the issues in Volume 1.
It provides key information on the requirements of the Affordable Care Act that large employers
need to comply with including the mandate to provide coverage, the provisions impacting plan
design, and other reporting and compliance requirements. Volume 4 also covers the individual
mandate requirement.
Volumes 2, 3, and 5 also provide additional information intended to inform the discussion of
the issues raised in Volume 1. Volumes 2 and 3 provide data on health care cost and benefit
coverage trends, and information on a variety of private sector initiatives by employers to control
rising health care costs. While Volume 5 provides information on the emerging forms of health
care delivery that are appearing following enactment of the ACA.
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The Affordable Care Act and Large Employers
1. Overview: Role of Employer-Sponsored Coverage ..............................................................1
2. Employer Mandate to Provide Coverage ..............................................................................3
3. Grandfathered Plans ...............................................................................................................9
4. Benefit and Coverage Requirements ....................................................................................11
5. Essential Health Benefits .......................................................................................................13
6. Provisions Impacting Plan Design ........................................................................................15
7. Administrative Requirements ...............................................................................................17
8. Reporting and Compliance Requirements ..........................................................................19
9. Additional Employer Tax Penalties .....................................................................................21
10. Individual Mandate ...............................................................................................................23
HR Policy Association Staff and Consultant Contributors .................................................... 26
Endnotes ........................................................................................................................................27
©2013 HR Policy Association 1
The ACA’s primary goal is to lower the number of uninsured
Americans, but the law does not meaningfully address dysfunctions in the
U.S. health care system
Key elements of the ACA
The law requires almost all Americans to maintain a minimum
level of health coverage or face a modest tax penalty1
Large employers must offer coverage to full-time employees or
pay a penalty
– “Full-time” is defined as an average of 30 or more hours
per week or 130 hours per month2
Insurers must accept applicants regardless of pre-existing
conditions or health status, which means that employees and
retirees no longer need an employment relationship to gain access
to health coverage
State- or federally-operated health insurance exchanges provide
new insurance markets for individuals and small groups to shop for
federally-approved health insurance in 2014
Premium assistance is made available to individuals in certain
households such that health care can be purchased more readily
outside the employment relationship
– Low- and middle-income individuals may be eligible for
federal premium tax credits and cost-sharing reductions to
purchase coverage in ACA exchanges
Medicaid coverage expanded to cover those up to 133 percent of
federal poverty level in adopting states
Financing for the new system comes from new taxes and fees on
employers, insurers, drug and device makers, upper-income
individuals, and potential cuts to future Medicare spending
©2013 HR Policy Association 3
Failure to Offer Coverage
Beginning in 2014, large employers are subject to an assessment
for not offering minimum essential coverage to at least 95 percent
of full-time employees, if at least one full-time employee receives
premium assistance to purchase coverage on an exchange3
– Premium assistance consists of either a premium tax credit
or a cost-sharing reduction from an ACA exchange
– Maximum employer assessment for failure to offer
coverage is $2,000 per full-time employee per year
(assessed monthly)
Failure to Offer Affordable, Minimum Value Coverage
Beginning in 2014, large employers offering coverage to full-time
employees may still be subject to an assessment if coverage fails to
meet affordability and minimum value standards, and if an
employee receives premium assistance to purchase coverage on an
exchange4
– Maximum employer penalty for failing to offer
affordable/minimum essential coverage is $3,000 for each
such full-time employee per year (assessed monthly)
– Determination made on a employee-by-employee basis
– Penalty is capped at maximum penalty for failing to
provide coverage
Employee Eligibility for Premium Assistance
Only employees who are eligible to receive premium assistance
can trigger an employer assessable payment
To be eligible for premium assistance, an individual must:5
– Have income between 100% and 400% of the federal
poverty level (2013: up to $94,200/family of four,
$45,960/individual);
– Not have access employer-sponsored health care that meets
affordability and minimum value requirements
– Enroll in ACA exchange coverage
Decision Framework: Volume 4
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Regardless of income level, individuals are not eligible for
premium assistance if they are eligible for qualifying “minimum
essential coverage” such as employer-sponsored health coverage or
government-provided health care
Full-Time vs. Part-Time Status
Employers are not subject to penalty for not offering coverage to
part-time employees, or for offering coverage to part-time
employees that is unaffordable or doesn’t provide minimum value6
– Part-time employees are not counted in calculating any
penalty
Generally, a “full-time employee” is one who works on average 30
or more hours per week or 130 hours per month7
– When a new employee is reasonably expected to work full-
time, the new employee must be offered coverage within 90
days8
When it is unclear if a new employee will work full-time, or if the
new employee is a seasonal employee, an employer may use a
look-back stability “safe harbor” to determine the employee’s
status before offering coverage
– The look-back stability safe harbor involves a complex
administrative evaluation of hours worked over a prior 3, 6,
or 12-month period9
• Beginning in 2014, no employer may discharge or discriminate
against any full-time employee with respect to their compensation,
terms, conditions, or other privileges of employment because the
employee received subsidized coverage in an exchange
The Affordable Care Act and Large Employers
©2013 HR Policy Association 5
Dependents
Under the ACA, an employer is subject to a penalty for failing to
offer coverage to “its full-time employees and their dependents”10
– However, no penalty is actually triggered for failing to
offer coverage to such dependents—the penalty is triggered
only when a full-time employee receives premium
assistance
– The penalty is calculated based on the number of full-time
employees, not dependents11
– Recent IRS guidance confirmed that employers must offer
coverage but still did not directly identify a penalty for
failing to do so12
Affordability Requirements
To avoid penalties, an employer offering coverage to its full-time
employees must satisfy an affordability standard
If a full-time employee’s share of the self-only premium for the
employer’s lowest-cost plan exceeds 9.5 percent of the employee’s
household income, the employee may be eligible for a premium
tax credit and the employer may be subject to an assessment13
– Because an employer will not know its employees’
household incomes, the employee may use one of three
affordability safe harbors:14
W-2 safe harbor: If annual cost does not exceed
9.5% of the employee’s W-2 wages
“Rate of Pay” safe harbor: If monthly cost does not
exceed 9.5% of the employee’s average monthly
wage
o Also involves salary reduction restrictions
Federal Poverty Line safe harbor: if annual cost
does not exceed 9.5% of federal poverty level for a
single individual
Decision Framework: Volume 4
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Minimum Value Standard
To avoid penalties, an employer offering coverage to its full-time
employees must also satisfy a minimum value standard
An employer’s plan fails to provide minimum value if the plan
pays less than 60 percent of the benefits provided under the plan15
– Employers can use three methods to determine if they meet
the standard:16
A minimum value calculator to be provided by the
IRS and HHS
A safe harbor checklist to be provided by the IRS
and HHS, or
Actuarial certification as to whether the employer’s
plan provides minimum value
Controlled Group Rules
Members of a controlled group of corporations are considered
separately for determining whether an employer is subject to a
penalty and the amount17
– This means that if an employer is part of a 10-member
controlled group, each subsidiary could only be subject to
penalties associated with its FTEs and not those of another
member of the controlled group
Contributions to HSAs and HRAs
Employer contributions will be counted for measuring the
affordability of an employer’s plan if the contribution may only be
used to pay for plan premiums18
– HSA: Employer contributions will not be credited because
such contributions cannot be used to pay for plan premiums
– HRA: Employer contributions may only be credited for a
premium-only HRA
Employer contributions to HSAs and HRAs will generally be
credited toward minimum value19
– Employer contributions to receive the same credit as it
would for the same amount of first dollar coverage
Employee HSA contributions are not included in
measuring minimum value
The Affordable Care Act and Large Employers
©2013 HR Policy Association 7
Employer Mandate to Provide Coverage: Impact on Employers
• While the ACA may cause certain employers to consider
discontinuing employer-sponsored health coverage, there are
certain financial and liability disincentives associated with exiting
the system:
– If just a few full-time employees receive a premium
subsidy or cost-sharing reduction, the assessment is
triggered for all full-time employees20
– An employer may violate the complex IRS non-
discrimination rules which generally prohibit treating
highly-compensated individuals more favorably for health
care coverage21
– Assessment costs may quickly increase, making long-term
market exit costs unpredictable
Retirees
Because the ACA requires employers to offer coverage to full-time
employees, retirees are not included in this mandate because they
are not employees22
– However, there are other provisions in the ACA that do
impact retiree coverage
– If an employer’s plan for active employees also offers
coverage to retirees, the entire plan must comply with the
ACA’s mandates
– Key distinction is whether the retiree plan is a retiree-only
plan
• Retiree-only plans are defined as plans with fewer than two active
workers23
– Employer plans that cover only retirees are not subject to
most of the ACA’s insurance reforms, coverage mandates,
or new plan fees
– Separating retirees from active plans allows employers to
avoid numerous administrative requirements and
compliance costs
– Retiree plans that also cover disabled inactive employees
may also qualify for this exception
©2013 HR Policy Association 9
Grandfathered plans are plans that were in existence on March 23,
2010 (date of enactment of the ACA) and have not been
significantly changed since that date24
Grandfathered health plans are exempt from some, but not all, of
the ACA’s insurance reforms and coverage mandates
Rules on maintaining grandfathered plan status are stringent,
prohibiting employers from minor plan design changes such as
increasing cost-sharing (co-insurance) for plan participants or
changing carriers so that the same or a higher quality coverage can
be obtained at a lower cost
Most large employers have decided to forgo grandfathered status
for their plans
– The grandfathering rules significantly limit employers’
ability to effectively manage their plans
– Employers’ need for flexibility to control costs often
trumps advantages of grandfathering
– Many large employer-sponsored plans met ACA market
reform requirements for non-grandfathered plans prior to
ACA
©2013 HR Policy Association 11
Expansion of dependent coverage
– The ACA requires coverage of children up to age 2625
One of the most costly, but most popular, mandates
– Spouses are not considered “dependents”
– Grandfathered plans must allow coverage for adult children
up to age 26 except if they are eligible for coverage from
another employer
No eligibility waiting periods beyond 90 days26
– However, nothing prohibits employers from maintaining
other reasonable plan eligibility criteria based on, among
other things, employee classifications or hours of service27
No pre-existing condition exclusions regardless of age
– Individuals cannot be excluded from coverage based on a
pre-existing health condition regardless of prior coverage28
Rescission of coverage prohibited29
– Except in cases of intentional misrepresentation of material
fact30
Emergency room services provided by an out-of-network provider
must be covered31
Plans must cover approved clinical trials
– Federally-funded trials conducted in connection with the
prevention or treatment of cancer or other life-threatening
disease, clinical trials conducted under an FDA
investigational new drug application, or certain FDA
exempt drug trials32
Coverage of preventive care services must be provided with no
cost-sharing for plan enrollees (“first-dollar preventive care”)33
– HHS periodically reviews and determines the covered
preventative care services based on recommendations from
U.S. Preventive Services Task Force, CDC, and HRSA
Decision Framework: Volume 4
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No annual or lifetime dollar limits on coverage for “essential
health benefits” (see below)
The prohibition on annual dollar limits restricts employer plan
design options
– Guidance indicates that “stand-alone” HRAs (i.e., funded
by employer contributions but not part of a more
comprehensive group medical plan) would violate the
annual limit restrictions34
– Some “Mini-med” plans, which are low-cost limited benefit
health plans that cover accident and sickness-related
expenses, were granted an exemption from the annual limit
restrictions until as late as 2014 when such plans will no
longer be permitted35
©2013 HR Policy Association 13
Because no annual or lifetime dollar limits can be imposed on the
coverage of benefits in a health care plan that are deemed to be
"essential health benefits," having a good understanding of what
constitutes essential health benefits is necessary for long term
financial planning of self-insured plans.
Definition of Essential Health Benefits
Essential health benefits (EHB) include health care related items
and services in 10 categories:36
– Ambulatory Services
– Emergency Services
– Hospitalization
– Maternity and Newborn Care
– Mental Health and Substance Abuse
– Prescription Drugs
– Rehabilitative and Habilitative services/Devices
– Laboratory Services
– Preventive and Wellness Services and Chronic Disease
Management
– Pediatric Services, Including Oral and Vision Care
Federal regulations do not define what specific health care related
items and services must be included in the 10 EHB categories –
generally left to states to decide
States designate an EHB “benchmark plan” that identifies what
health care expenses must be covered by plans in the small group
and individual markets in that state37
– Benchmark plans vary from state to state
Decision Framework: Volume 4
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Requirements for Self-Insured Plans
Self-insured and large group plans need not include all of the
health care related items and services in a state EHB “benchmark”
plan38
– However, if a self-insured plan includes benefits that are in
a state’s EHB benchmark plan, there can be no annual or
lifetime dollar limits on those benefits in the employer’s
plan
Self-insured and large group plans may use each
state’s benchmark plan to determine what EHBs are
in their plans, or make a good faith effort to comply
with a reasonable interpretation of what they think
EHBs are to ensure there are no annual or lifetime
dollar limits on EHB in the employer’s plan39
– Although HHS and DOL intend to work with self-insured
plans that make a good faith effort to ensure that there are
no annual or lifetime dollar limits on EHBs in their plans,
such plans may still be subject to different state standards
on annual or lifetime limits
Example: A large self-insured employer with
operations in all 50 states that has an annual limit of
$1,500 per year for acupuncture would be in
violation of the prohibition on annual dollar limits
in California and Washington (which include
acupuncture as an essential health benefit in their
state benchmark plans), but may not be in violation
in other states
– This problem for self-insured employers effectively erodes
traditional notions of ERISA preemption
©2013 HR Policy Association 15
In 2014, the ACA imposes an annual limitation on cost-sharing for
“deductibles, coinsurance, copayments, or similar charges”
– Applies to large group health plans, including self-insured
– Annual cost-sharing limitation for “deductibles,
coinsurance, copayments, or similar charges” cannot
exceed out-of-pocket expenses for HSA compatible high
deductible health plans40
– Amounts for 2014 are expected to be released by the IRS
in the spring of 2013
2013 amount $6,250 for self-only coverage and
$12,500 for non-self-only
In 2014, the ACA also imposes an annual limitation on deductibles
for individual and small group plans and individual offered both in
and out of ACA exchanges41
– Does NOT apply to large group health plans, including
self-insured
BUT in 2017 it may apply to fully-insured large
group plans in states that allow large employers to
purchase coverage through ACA exchanges
– Annual limitation prohibits deductibles for individual and
small group plans from exceeding:
$2,000 for self-only coverage; or
$4,000 for other than self-only coverage42
New internal appeals and external review processes for benefit
claim disputes in addition to existing ERISA claims requirements
will cause employers to alter current appeals processes43
– Among other requirements, employer plans must contract
with 3 independent review organizations which conduct
independent reviews of claim disputes in order to satisfy
DOL safe harbor requirements
Decision Framework: Volume 4
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New non-discrimination rules forbid fully-insured plans from
discriminating in favor of highly-compensated individuals44
– These rules will impact employers by:
Eliminating the tax exclusion for executive “top-
hat” health insurance policies; and
Apply to fully-insured coverage purchased by
employers through private exchanges
– Similar to self-insured plan discrimination rules under
Internal Revenue Code
– Will not be enforced until final regulations are effective,
likely post-2014
To encourage employers to reduce health care costs and curb
employee spending, the ACA revises the tax treatment of certain
health benefits and imposes new taxes, most notably on high-cost
health plans
– Tax penalty on nonqualified HSA withdrawals doubled to
20 percent (effective 2012)45
– Over-the-counter medicine not eligible for FSA, HSA, or
HRA reimbursement unless prescribed (effective 2011)46
– FSA contributions capped at $2,500 starting 201347
Automatic enrollment requirement48
– Large employers must automatically enroll new full-time
employees in one of their health plans if a plan is offered
– Enforced by the Department of Labor, but not effective
until final regulations issued, post 2013
– Enrolled employees may opt-out of the employer’s
coverage, post-2014
©2013 HR Policy Association 17
Employers to provide Summary of Benefits and Coverage (SBC)
to all enrollees (effective for open enrollment periods beginning on
or after 9/23/2012) in addition to information already required
under ERISA49
– SBC must be issued for each benefit option offered by the
employer which may result in dozens of different SBCs50
– SBC must describe any plan cost-sharing, exceptions or
limitations on coverage, and provide examples of common
benefit scenarios51
– SBC must conform to specific formatting requirements,
such as 4-page limit (double-sided), and be presented in a
culturally and linguistically appropriate manner52
Prior to October 1, 2013, employers must provide all employees
(and new hires) with information about ACA exchanges
including:53
– Detailed information about purchasing health insurance
through, and contact information for, ACA exchanges;
– A statement about the employer’s health plan and whether
the employer is offering affordable health benefits; and
– An explanation about potential eligibility for premium tax
credits for purchasing insurance in ACA exchanges if the
employer’s benefits do not meet certain standards
– The Department of Labor has provided a model employer
notice in both English and Spanish54
©2013 HR Policy Association 19
W-2 reporting of value of health benefits (effective for tax year
2012)
– Employer-sponsored plans must report the aggregate cost
of each employee’s health benefits55
– May be the first step toward taxing employer-sponsored
health benefits56
Employer plans must disclose claims payment practices and
policies to HHS and state insurance commissioners57
– Details of what must be reported and whether there will be
specific limits on how the information may be used remain
unclear
– Uncertain effective date, regulations pending but likely in
2014
Self-Insured and Issuers of Fully-Insured Plans
Self-insured employers and the issuers of fully-insured plans for
large employers must annually report to the IRS58
– The name, address, and taxpayer identification number of
the primary insured and each other individual covered
under the policy or plan
– The dates each individual was covered during the calendar
year
– The employers name, address, and employer identification
number
– The portion of the premium paid by the employer; and
– Other information the IRS may require for administering
the exchange subsidies
• Applies to coverage provided on or after January 1, 2014
• First report due 2015
• Self-insured employers and the issuers of fully-insured plans for
large employers must also furnish a written statement to each
individual listed on the IRS report showing what information is
being reported to the IRS for that individual
Decision Framework: Volume 4
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Large Employers
Large employers must annually report to the IRS59
– The name and employer identification number of the
applicable large employer
– A certification the applicable large employer offers its full-
time employees (and their dependents) the opportunity to
enroll in an employer-sponsored plan
– The duration of any waiting period
– The months during the calendar year when coverage under
the plan was available
– The monthly premium for the lowest cost option in each
enrollment category under the plan
– The employer’s share of the total allowed costs of benefits
provided under the plan
– The number of full-time employees for each month of the
calendar year
– The name, address, and taxpayer identification number of
the full-time employees and the months (if any) during
which the full-time employee (or any dependents) were
covered
– Other information the IRS may require
• Applies to coverage provided on or after January 1, 2014
• First report due 2015
• Large employers must also furnish a written statement to each
individual listed on the IRS report showing what information being
reported to the IRS for that individual
Labor Department Compliance Audits
• Employers who receive an audit letter the Department of Labor
must also provide:
– General plan documents, including copies of plans and
amendments
– Summary plan descriptions and summaries of material
modifications
– Documents sent to participants regarding plan benefits and
claims
– Contracts with third-party providers
– Any documents describing wellness or disease management
programs offered by the plan.
©2013 HR Policy Association 21
Penalty for violating the ACA’s insurance reform and coverage
mandates
– The general penalty on employer plans for violations of the
ACA’s reforms and mandates is an excise tax penalty of
$100 per-day per-individual impacted, which includes
dependents60
– Enforced by Departments of Treasury, Health and Human
Services, and Labor; also subject to state enforcement
Excise Tax on High-Cost Plans
Excise tax on high-cost employer plans (effective 2018)61
– 40% excise tax on plan cost in excess of threshold
– For active workers, the threshold limit is $10,200 for
singles, $27,500 for families
– Multi-employer/union threshold is $27,500 whether the
employee has individual or family coverage
– For retirees and certain high-risk employees, limit $11,850
for singles, $30,950 for families
– Thresholds indexed after 2018
Accounting Treatment
Although the excise tax on high-cost employer plans is not payable
until 2018, under the Financial Accounting Standards Board
statement 106 (FAS 106) several accountants and auditing firms
have required employers to book the liability associated with the
tax for retiree health plans as early as 2010
Elimination of Medicare Part D subsidy
Effective 2013
Tax deduction eliminated for employers who receive the Retiree
Drug Subsidy under Medicare Part D for continuing to provide a
qualified retiree drug benefit62
Decision Framework: Volume 4
22
Transitional Reinsurance Fee
The ACA imposes a new “transitional reinsurance fee” on
employer-sponsored fully- and self-insured plans (effective 2014-
2016)63
– Used to subsidize insurance carriers providing coverage to
“high-risk individuals” in ACA exchanges
– Group plans must pay the fee but are not eligible for the
benefit
– HHS will collect the fee annually from self-insured/self-
administered employers, although a third-party
administrator may be utilized to transfer the reinsurance fee
on behalf of a self-insured group health plan if one is used
by the plan
– HHS will also collect the fee annually from health
insurance issuers of fully-insured plans
Federal Reinsurance Fee
– $63 per covered life in 2014 (est.)
– $42 per covered life in 2015 (est.)
– $26 per covered life in 2016 (est.)
– States may impose their own reinsurance fees after 2016,
but rules still pending
Comparative Effectiveness (PCORI) Fee
Employer plans required to pay the annual Patient-Centered
Outcomes Research Institute (PCORI) comparative effectiveness
study fee64
– $1 X the average number of covered lives for plan years
ending 10/1/2012 through 9/30/2013
– $2 X the average number of covered lives for plan years
ending after 9/30/2013
– Includes dependents and retirees
– Indexed to increase in national health expenditures after
2014
– The PCORI fee is paid to HHS and calculated like the
reinsurance fee
©2013 HR Policy Association 23
Beginning January 1, 2014, ACA requires most individuals to have
minimum essential health coverage for themselves and their
dependents or pay a penalty, though some individuals are exempt
from the penalty65
– Minimum essential coverage is generally defined as
coverage under
• A government-sponsored plan
• An employer-sponsored plan
• Plans in the individual market
• Grandfathered plans
– Individuals and their dependents exempt from the penalty
generally include
• Individuals whose family income is less than the
IRS tax filing threshold ($9,350 for an individual
and $18,700 for a family in 2010)
• An individual who has to pay more than eight
percent of their income for health insurance after
employer contributions or exchange subsidies
• Hardship cases as determined by HHS
• Individuals with religious objections
The penalty for not maintaining coverage in 2014 is the greater of
either $95 per adult and $47.50 per child (up to $285 per family),
or 1.0 percent of family income66
– In 2015, the penalty increases to the greater of either $325
per adult and $162.50 per child (up to $975 per family), or
2.0 percent of family income
– In 2016, the penalty increases to the greater of either $695
per adult and $347.50 per child (up to $2,085 per family),
or 2.5 percent of family income
There is no penalty for a single gap in coverage of less than three
months, and the penalty cannot exceed the national average
premium for bronze level health plans offered through exchanges
(for the relevant family size)
Decision Framework: Volume 4
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Enforcement
– Individuals who are required to pay a penalty but fail to do
so will receive a notice from the IRS
– If they still do not pay the penalty, the IRS can attempt to
collect the funds by reducing the amount of their future tax
refunds, if any
– However, individuals who fail to pay the penalty will not
be subject to any criminal prosecution or penalty, and the
IRS cannot place a lien or levy on any property
Decision Framework: Volume 4
26
The following members of the HR Policy Association staff and consultants
participated in the preparation and update of the Decision Framework:
Jeffrey C. McGuiness
Walter Dawson
Kendra L. Kosko
Colleen A. McHugh
Marie L. Murphy
Michael D. Peterson
Vanessa A. Scott
Michael Thompson
Alec R. Wescott
Steve A. Wetzell
D. Mark Wilson
Daniel V. Yager
©2013 HR Policy Association 27
1 "Requirement to maintain minimum essential coverage." Title 26 U.S. Code § 5000A: 2892. GPO Access. Web. 20 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-
subtitleD-chap48-sec5000A.pdf>.
2 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78.1 (2
January 2013): 241. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>. 3 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 233. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-02/pdf/2012-31269.pdf>.
4 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2 January 2013): 218-253. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>.
5 "Health Insurance Premium Tax Credit; Final Regulations." Federal Register 77. 100 (23 May 2012): 30377-
30400. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-05-23/pdf/2012-
12421.pdf>.
"Health Insurance Premium Tax Credit; Final Regulations." Federal Register 78. 22 (1 February 2013): 7264-
7765. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-01/pdf/2013-02136.pdf >. 6 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 223. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-02/pdf/2012-31269.pdf>.
7 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 223. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>. 8 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 223. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>.
9 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2 January 2013): 227. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>.
"Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 227. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>.
"Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 226. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-02/pdf/2012-31269.pdf>.
10 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2 January 2013): 231. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>.
11 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 232. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>. 12 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 218. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-02/pdf/2012-31269.pdf>.
13 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2 January 2013): 233. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>.
14 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 234. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>.
Decision Framework: Volume 4
28
"Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 235. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-02/pdf/2012-31269.pdf>.
"Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2 January 2013): 235. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>.
15 "Refundable Credit for Coverage Under a Qualified Health Plan." Title 26 U.S. Code § 36B (c) (2) (C) (ii):
141. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-
2011-title26-subtitleA-chap1-subchapA-partIV-subpartC-sec36B.pdf>. 16 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,
and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web. 25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>.
17 Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2 January 2013): 218-253. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>.
18 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,
and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web.
25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>.
Department of the Treasury. Internal Revenue Service. "Minimum Value of an Employer-Sponsored Health Plan, Notice 2012-31." Internal Revenue Bulletin: 2012-20. 14 May 2012. <http://www.irs.gov/pub/irs-drop/n-
12-31.pdf>.
Department of Health and Human Services. Office of Consumer Information and Insurance Oversight.
"Actuarial Value and Cost-Sharing Reductions Bulletin." 24 February 2012.
<http://cciio.cms.gov/resources/files/Files2/02242012/Av-csr-bulletin.pdf>. 19 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,
and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web. 25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>.
Department of the Treasury. Internal Revenue Service. "Minimum Value of an Employer-Sponsored Health
Plan, Notice 2012-31." Internal Revenue Bulletin: 2012-20. 14 May 2012. <http://www.irs.gov/pub/irs-drop/n-
12-31.pdf>.
20 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 226. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>. 21 "Amounts Received Under Accident and Health Plans." Title 26 U.S. Code § 105 (h) (2) (a): 106. GPO
Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleA-chap1-subchapB-partIII-sec105.pdf>.
Department of Treasury. Internal Revenue Service. "Affordable Care Act Nondiscrimination Provisions Applicable to Insured Group Health Plans, Notice 2011-1." Internal Revenue Bulletin: 2011-2. 10 January
2011. <http://www.irs.gov/pub/irs-drop/n-11-01.pdf>.
22 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2
January 2013): 218-253. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-
02/pdf/2012-31269.pdf>. 23 Towers Watson. Health Care Reform: Overview and Implications; A presentation to New York Business
Group on Health (NYBGH). 15 July 2010. <http://www.nebgh.org/pdf/presentations/071510smithstone.pdf>.
Aetna. Aetna.com. "Retiree-Only Plans Q&A - Aetna Health Reform Connection." 2010. Web. 25 Feb 2013.
<https://www.aetna.com/health-reform-connection/questions-answers/retiree-only-plans.html>. 24 "Preservation of Right to Maintain Existing Coverage." Title 26 U.S. Code §18011: 8123. GPO Access. Web.
21 Feb 2013. <http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf>. 25 "Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26
Under the Patient Protection and Affordable Care Act; Interim Final Rule and Proposed Rule." Federal Register 75. 123 (13 May 2010): 27124. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-05-
13/pdf/2010-11391.pdf>.
"Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review; Final Rule."
Federal Register 78 (27 February 2013).
End Notes
©2013 HR Policy Association 29
26 "Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions,
Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule." Federal
Register.75.123 (28 June 2010): 37188-37241. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-06-28/pdf/2010-15278.pdf>.
27 Department of Treasury. Internal Revenue Service. "Guidance on 90-day Waiting Period Limitation Under Public Health Service Act Section 2708; Notice 2012-59." Internal Revenue Bulletin 2012-41. 9 October 2012.
<http://www.irs.gov/pub/irs-drop/n-12-59.pdf>.
Department of Health and Human Services. Centers for Medicare and Medicaid Services. "Guidance on 90-Day
Waiting Period Limitation under Public Health Service Act § 2708." 31 August 2012.
<http://cciio.cms.gov/resources/files/Files2/2708-guidance-8-31-2012.pdf>.
Department of Labor. Employee Benefits Security Administration. "Guidance on 90-Day Waiting Period
Limitation under Public Health Service Act § 2708; Technical Release 2012-02." 31 August 2012. <http://www.dol.gov/ebsa/newsroom/tr12-02.html>.
28 "Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions,
Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule." Federal
Register 75. 123 (28 June 2010): 37192. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-06-28/pdf/2010-15278.pdf >.
29 "Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions,
Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule." Federal Register.75.123 (28 June 2010): 37192. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-
2010-06-28/pdf/2010-15278.pdf>.
30 "Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance
Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions,
Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule." Federal Register 75. 123 (28 June 2010): 37188-37241. GPO Access. Web. 14 Feb 2013.
<http://www.gpo.gov/fdsys/pkg/FR-2010-06-28/pdf/2010-15278.pdf >.
31 "Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance
Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions,
Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule." Federal Register 75. 123 (28 June 2010): 37212. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-
2010-06-28/pdf/2010-15278.pdf >.
32 "Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a
Grandfathered Health Plan Under the Patient Protection and Affordable Care Act." Federal Register 75. 116 (17
June 2010): 34559-34568. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-06-17/pdf/2010-14488.pdf>.
33 "Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act." Federal Register 75. 137 (19 July 2010):
41726-41760. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-07-19/pdf/2010-
17242.pdf>.
"Coverage of Certain Preventive Services Under the Affordable Care Act; Proposed Rules." Federal Register
78. 25 (6 February 2013): 8456-8476. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-06/pdf/2013-02420.pdf>.
34 Department of Labor. Employee Benefits Security Administration. "FAQs about Affordable Care Act Implementation Part XI." 24 January 2013. <http://www.dol.gov/ebsa/pdf/faq-aca11.pdf>.
35 "Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions,
Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule." Federal
Register.75.123 (28 June 2010): 37188-37241. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-06-28/pdf/2010-15278.pdf>.
36 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web.
25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>.
37 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,
and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web.
25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>.
Decision Framework: Volume 4
30
38 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web.
25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>.
39 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,
and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web.
25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>. 40 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,
and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web. 25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>.
41 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web.
25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>.
42 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,
and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12847. GPO Access. Web. 25 Feb
2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>. 43 "Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and
External Review Processes." Federal Register 76. 122 (24 June 2011): 37208-37234. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2011-06-24/pdf/2011-15890.pdf>.
"Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and External
Review Processes, Correction." Federal Register 76.143 (26 July 2011): 44491-44493. GPO Access. Web. 14
Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2011-07-26/pdf/2011-18820.pdf>. 44 Department of Treasury. Internal Revenue Service. "Affordable Care Act Nondiscrimination Provisions
Applicable to Insured Group Health Plans, Notice 2011-1." Internal Revenue Bulletin: 2011-2. 10 January 2011. <http://www.irs.gov/pub/irs-drop/n-11-01.pdf>.
45 Department of the Treasury. Internal Revenue Service. "Section 105 — Amounts Received Under Accident and Health Plans, Section 106 — Contributions by Employers to Accident and Health Plans, Section 125 —
Cafeteria Plans, Section 220 — Archer MSAs, Section 223 — Health Savings Accounts; Notice 2010-59."
Internal Revenue Bulletin: 2010-39. 27 September 2010. <http://www.irs.gov/pub/irs-drop/n-10-59.pdf>.
46 Department of the Treasury. Internal Revenue Service. "Section 105 — Amounts Received Under Accident
and Health Plans, Section 106 — Contributions by Employers to Accident and Health Plans, Section 125 — Cafeteria Plans, Section 220 — Archer MSAs, Section 223 — Health Savings Accounts; Notice 2010-59."
Internal Revenue Bulletin: 2010-39. 27 September 2010. <http://www.irs.gov/pub/irs-drop/n-10-59.pdf>.
47 Department of the Treasury. Internal Revenue Service. "Health Flexible Spending Arrangements not Subject
to $2,500 Limit on Salary Reduction Contributions for Plan Years Beginning before 2013 and Comments
Requested on Potential Modification of Use-or-Lose Rule, Notice 2012-40." Internal Revenue Bulletin: 2012-26. 25 June 2012. <http://www.irs.gov/pub/irs-drop/n-12-40.pdf>.
48 Department of Health and Human Services. Center for Consumer Information and Insurance Oversight. "Frequently Asked Questions from Employers Regarding Automatic Enrollment, Employer Shared
Responsibility, and Waiting Periods." 9 February 2012.
<http://cciio.cms.gov/resources/files/Files2/02102012/employer_faq_bulletin_2_9_12_final.pdf>. 49 "Summary of Benefits and Coverage and the Uniform Glossary; Final Rule." Federal Register 77. 30 (14
February 2012): 8668-8706. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-02-14/pdf/2012-3228.pdf>.
50 "Summary of Benefits and Coverage and the Uniform Glossary; Final Rule." Federal Register 77. 30 (14 February 2012): 8673. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-02-
14/pdf/2012-3228.pdf>.
51 "Summary of Benefits and Coverage and the Uniform Glossary; Final Rule." Federal Register 77. 30 (14
February 2012): 8673. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-02-
14/pdf/2012-3228.pdf>. 52 "Summary of Benefits and Coverage and the Uniform Glossary; Final Rule." Federal Register 77. 30 (14
February 2012): 8673-8676. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-02-14/pdf/2012-3228.pdf>.
53 "Notice to employees." Title 29 U.S. Code § 218b (a): 97. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title29/pdf/USCODE-2011-title29-chap8-sec218b.pdf >.
End Notes
©2013 HR Policy Association 31
54 Department of Labor. Employee Benefits Security Administration. "Guidance on the Notice to Employees of
Coverage Options under Fair Labor Standards Act §18B and Updated Model Election Notice under the Consolidated Omnibus Budget Reconciliation Act of 1985." Technical Release No. 2013-02, 8 May 2013.
<http://www.dol.gov/ebsa/pdf/tr13-02.pdf >.
55 Department of Treasury. Internal Revenue Service. "Interim Guidance on Informational Reporting to
Employees of the Cost of Their Group Health Insurance Coverage, Notice 2012-9." Internal Revenue Bulletin:
2012-4. 3 January 2012. <http://www.irs.gov/pub/irs-drop/n-12-09.pdf>. 56 Saunders, Laura. "Is Taxing Health Plans Next?" Wall Street Journal. 1 February. 2013. Web. 14th Feb 2013.
<http://online.wsj.com/article/SB10001424127887323926104578276322541021826.html>. 57 "Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans;
Exchange Standards for Employers; Final Rule and Interim Final Rule." Federal Register 77. 59 (27 March 2012): 18470. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-03-27/pdf/2012-
6125.pdf>.
58 Department of Treasury. Internal Revenue Service. "Request for Comments on Reporting of Health Insurance
Coverage, Notice 2012-32." Internal Revenue Bulletin: 2012-20. 14 May 2012. <http://www.irs.gov/pub/irs-
drop/n-12-32.pdf>. 59 Department of Treasury. Internal Revenue Service."Request for Comments on Reporting by Applicable Large
Employers on Health Insurance Coverage Under Employer-Sponsored Plans, Notice 2012-33." Internal Revenue Bulletin: 2012-20. 14 May 2012. <http://www.irs.gov/pub/irs-drop/n-12-33.pdf>.
60 "Enforcement." Title 42 U.S. Code § 300gg-22 (b) (2): 1316. GPO Access. Web. 20 Feb 2013.
<http://www.gpo.gov/fdsys/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap6A-subchapXXV-
partA-subpart2-sec300gg-22.pdf>. 61 Department of the Treasury. Internal Revenue Service. "Health Flexible Spending Arrangements not Subject
to $2,500 Limit on Salary Reduction Contributions for Plan Years Beginning before 2013 and Comments Requested on Potential Modification of Use-or-Lose Rule, Notice 2012-40." Internal Revenue Bulletin: 2012-
26. 25 June 2012. <http://www.irs.gov/pub/irs-drop/n-12-40.pdf>.
"Excise Tax on High Cost Employer-sponsored Health Coverage." Title 26 U.S. Code § 4980I - (a) (2): 2881.
Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-
subtitleD-chap43-sec4980I.pdf>.
62 Department of Treasury. Internal Revenue Service. Irs.gov. "Frequently Asked Questions: Retiree Drug
Subsidy." 2013. Web. 14 Feb 2013. <http://www.irs.gov/uac/Newsroom/Frequently-Asked-Questions:-Retiree-Drug-Subsidy>.
63 "Health Insurance." Title 26 U.S. Code§ 4375: 2748. GPO Access. Web. 20 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleD-chap34-
subchapB-sec4375.pdf>.
"Self-insured health plans." Title 26 U.S. Code§ 4376: 2748. GPO Access. Web. 20 Feb 2013.
<http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleD-chap34-
subchapB-sec4375.pdf>.
"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014;
Proposed Rule." Federal Register 77. 236 (7 December 2012): 73118-73218. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-12-07/pdf/2012-29184.pdf>.
Department of the Treasury. Internal Revenue Service. Irs.gov. "ACA Section 1341 Transitional Reinsurance Program FAQs." 2012. Web. 14 Feb 2013. <http://www.irs.gov/uac/Newsroom/ACA-Section-1341-
Transitional-Reinsurance-Program-FAQs>.
64 "Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes Research Trust
Fund, Final Regulations." Federal Register 77. 235 (6 December 2012): 72721. GPO Access. Web. 14 Feb
2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-12-06/pdf/2012-29325.pdf>. 65 "Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage."Federal Register 78. 22
(1February 2013): 7314-7331. GPO Access. Web. 25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-01/pdf/2013-02141.pdf>.
66 "Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage."Federal Register 78. 22 (1February 2013): 7316. GPO Access. Web. 25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-
01/pdf/2013-02141.pdf>.