The decision by the Obama Administration to delay implementation of a key requirement of the Patient Protection and Affordable Care Act underscores the necessity for employers to keep up to date with the law’s provisions, revisions and changing deadlines.
The U.S. Treasury has announced it will postpone for one year the “shared responsibility” mandate that employers of more than 50 full-time workers – those working an average of 30 or more hours per week – provide them with health insurance or pay a penalty. The decision postponed the deadline until Jan. 1, 2015.
The Internal Revenue Service will not assess penalties on qualifying employers who do not provide health insurance in 2014. The IRS also said it would offer further guidance in the coming weeks.
The deferral was applied to allow the federal government to consider ways to simplify the law’s reporting requirements and to give employers more preparation time.
Despite the postponement, certain major components of the health care law have not been delayed and remain as originally scheduled:
• The one-year extension of the employer mandate did not delay the scheduled implementation of the individual mandate, which requires individuals to obtain health insurance by Jan. 1, 2014, or pay a penalty.
• The new individual health care exchanges, where eligible individuals can purchase health insurance, are still scheduled to begin open enrollment on Oct. 1, 2013. The exchanges are expected to provide federally subsidized health coverage for 7 million people in 2014 and for 22 million by 2016. The federal government will operate the exchanges in 34 states, including Pennsylvania, while the remainder will run their own.
• By Oct. 1, 2013, qualifying employers with more than 50 full-time workers are still obliged to provide notification to all employees and new hires of the health insurance options that will be available to them in 2014.
• New individual and group health plan requirements that will still take effect for the 2014 plan year include: elimination of annual dollar limits on essential health benefits; a 90-day limit on the waiting period for eligible employees; removal of all pre-existing condition limitations; and establishing new out-of-pocket maximums of $6,350 for individual and $12,700 for family employer-provided coverage.
• Employer plans still must include coverage for recommended preventive care, including contraceptive services, for women with no deductibles or co-payments.
Another recently announced deferral in the health care law affects individuals seeking to buy health insurance from federal- and state-run exchanges. They have received temporary relief from stringent procedures that will be used to verify their income to determine their eligibility for subsidies.
The Department of Health and Human Services has ruled that the exchanges can rely heavily on self-reported information from applicants at least until 2015, when stronger verification guidelines may be used.
Employers can use the one-year reprieve from the reporting requirements and potential penalties to make necessary adjustments to their health care plans. It also gives them more time to educate employees about their own obligations under the law and the health care options that will be available to them.
Dr. Emil J. DiIorio is a recognized orthopaedic surgeon and the founder, president and CEO of Coordinated Health, which has a strong presence in the Lehigh Valley and surrounding areas. For more information, visit www.coordinatedhealth.com.