The More You Know
The Affordable Care Act
The Affordable Care Act was enacted in 2010 and mandates health insurance reforms that impact small businesses. This section is dedicated to providing Paysmart clients with our current understanding of some of the key points of the ACA and how they may affect your business’s payroll reporting requirement.
This legislation’s rules and regulations change often so Paysmart recommends you discuss ACA provisions with your accountant, attorney, or HR rep.
When it comes to payroll and the ACA, there are two main questions that employers have to answer.
Are You a Controlled Group?
This controlled group exists when one or more businesses are connected through stock ownership with a common parent corporation (i.e. a chain), and
- 80% of each corporation’s stock (except the common parent) is owned by one or more corporations in the group.
- The parent corporation must own 80% of at least one other corporation.
This controlled group occurs in cases of two or more corporations where five or fewer common owners (individual, trust, estate) own directly or indirectly a “controlling interest” of each group and have “effective control.”
- Controlling interest: Generally, this means 80 percent or more of the stock of each corporation (but only if such common owner owns stock in each corporation).
- Effective control: Generally more than 50 percent of the stock of each corporation, but only to the extent such stock ownership is identical with respect to such corporation.
This controlled group consists of three or more organizations that are organized as follows:
- Each organization is a member of either a parent-subsidiary or brother-sister group.
- At least one corporation is the common parent of a parent-subsidiary, and also a member of a brother-sister group.
What Size Employer Are You?
Plan Requirement: Employers who employ less than 25 full-time equivalent employees are not required to offer a plan.
Reporting Requirement:
- Employers who offer an employer-sponsored plan are not required to meet any reporting requirements at this time.
- Effective March 10, 2014, employers offering a self-insured plan must file section 6055.
Tax Credit: Employers with less than 25 FTEs may qualify for a tax credit.
- To be eligible for the credit a small employer must pay premiums on behalf of its employees enrolled in a qualified health plan offered through the Small Business Health Options Program (SHOP) Marketplace.
- The credit is available to eligible employers for two consecutive taxable years.
- For more information on the tax credit visit www.IRS.gov.
Plan Requirement: Employers who employ less than 50 full-time equivalent employees are not required to offer a plan.
Reporting Requirement:
- Employers who offer an employer-sponsored plan are not required to meet any reporting requirements at this time.
- Effective March 10, 2014, employers offering a self-insured plan must file section 6055.
Plan Requirement: Employers with more than 50 FTEs are required to offer a plan to FTEs and may face a penalty if one is not offered.
Reporting Requirement:
- Employers who offer an employer-sponsored plan are required to report the value of employer and employee cost in box 12 of form W-2.
- Employers offering a self-insured plan must file section 6055.
- ALEs need to provide Form 1095-C to their employees by January 31 every year to use when filing tax returns. Form 1094-C needs to be provided to be filed with the IRS as a summary of aggregate employer-level data, including FTE counts by month. Contact your payroll vendor for help with the monthly tracking.
Employer-Sponsored Plan
Self-Insured Group Health Plan
Some employers choose to operate their own health insurance plan instead of going through an insurance carrier to purchase a fully-insured plan. The employer pays a third-party administrator to manage the plan while keeping the premium and paying the cost of claims and administration themselves.
Applicable Large Employer (ALE)
Minimum Essential Coverage (MEC)
Qualifying health care coverage under an employer-sponsored plan.
Minimum Essential Coverage (MEC)
Qualifying health care coverage under an employer-sponsored plan.
Employer-sponsored coverage
- Group health insurance coverage for employees under a governmental plan, plan offered in the state’s small or large group market, or grandfathered health plan)
- Self-insured group health plan for employees
- COBRA coverage
- Retiree coverage
Individual health coverage
- Insurance you purchase directly from an insurance company
- Insurance purchased through the Marketplace
- Insurance provided through a student health plan or university-funded student health plan
- Catastrophic plans
Coverage under government-sponsored programs
- Most Medicaid coverage
- Children’s Health Insurance Program (CHIP)
- TRICARE coverage (most types)
- Comprehensive programs offered by the Department of Veterans Affairs
Employer Shared Responsibility
Helpful Resource Links
- Health Insurance Information: HealthCare.gov
- Small Business Resources: SBA.gov/HealthCare
- Legal Guidance – Labor Provisions: DOL.gov/ebsa/HealthReform
- US Government Business Portal: Business.USA.gov