For the Long Haul: SCOTUS Ruling Means ACA Coverage and Reporting Rules Here to Stay

Matthew P. Chiarello • July 14, 2021

Despite myriad legal challenges, the Affordable Care Act (“ACA”) remains the law of the land. We previously reported on the Supreme Court’s latest validation of the law in our SW Benefits Update, “ Three Strikes You’re Out – The Affordable Care Act Survives a Third Legal Challenge . ”

The Court’s ruling means that employers and their group health plans must continue to comply with the requirements of the ACA, including its large employer shared responsibility provisions. For employers evaluating their ACA compliance strategies, here is a short refresher:

Large Employer Shared Responsibility Payments : Large employers can be subject to penalties if any full-time employee receives a premium tax credit and either (a) the employer fails to offer minimum essential coverage (“MEC”) to 95% of its full-time employees (and their dependents) or (b) the coverage is either not affordable or does not provide minimum value. The rules are explained in more detail in our  Health Care Reform’s Employer Shared Responsibility Penalties: A Checklist for Employers.

All Employers with Self-Insured Health Plans are Required to Report MEC : All employers providing MEC are required to submit health coverage information to the IRS and to certain covered individuals for each calendar year.

Large Employers are Required to Report on Health Coverage Offered to Full-Time Employees:  Applicable large employers are required to report to the IRS information regarding health coverage offered to full-time employees for each calendar year. Additionally, applicable large employers are required to provide individual statements to each full-time employee regarding the coverage offered. All applicable large employers are required to comply with these reporting requirements, regardless of whether they sponsor a self-insured, a fully insured health plan, or do not offer any health coverage to their employees.

Record Retention:  The IRS has not provided specific guidance about records employers should keep to demonstrate compliance with the above requirements. Nevertheless, employers should give careful consideration to all potential records they might need to defend against penalty assessments. For more information about record retention in this context, see our SW Benefits Blog, “ IRS Letters 226J: Having the Right Section 4980H Records Can Be Worth a Small Fortune. ”

More information about the requirements of the ACA can be found in our SW Benefits Update, “ 2020 End of Year Plan Sponsor ‘To Do’ (Part 1) Health and Welfare. ”

Employee burnout: what it is and how to prevent it

By Mardy Gould • May 24, 2024
Employee burnout has become an epidemic in today’s modern workplace. So much so that the World Health Organization (WHO) officially recognizes it as an “occupational phenomenon.”1 While many used to consider mounting workplace stress an individual employee problem, these days, it’s become an employer’s responsibility to prevent burnout before it hurts productivity and business performance—not to mention your employees’ physical and mental health. Luckily, you can prevent burnout from affecting your workforce in several ways. This article will explore the causes and signs of employee burnout and the steps you can take to create a positive work environment where employees feel safe from toxic stress levels.

Form 720 and PCORI fee FAQs

By Mardy Gould • May 23, 2024
If you're a small business owner, you may have heard of the acronym PCORI and the fees that come with it. But what is PCORI, and how does it apply to your organization? Under the Affordable Care Act (ACA), sponsors of self-insured health plans must pay a fee to fund the federal Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent organization the ACA created to conduct research to help healthcare consumers make better decisions for their specific needs and outcomes. It also performs research related to clinical effectiveness. Employers offering a self-insured medical reimbursement health plan, such as a health reimbursement arrangement (HRA), must pay this fee by July 31 each year via Form 7201. This fee was initially set to expire in 2019, but Congress extended it through September 30, 20292, due to the Further Consolidated Appropriations Act of 20203.
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