May 18, 2021 | By Wendy Katz
In March 2010, Congress passed the Affordable Care Act (ACA) in hopes of reforming the American healthcare system and provide affordable insurance to more citizens. The law came with a lot of controversies. While the law is more than a decade old, your company might be unintentionally breaking some terms, leaving you vulnerable.
In 2019, Congress removed the individual mandate — this created a penalty for individuals without healthcare — but the employer mandate remains in effect. It's essential for employers to know the potential pitfalls of ACA compliance and the penalties you face.
While the government might give you some wiggle room for a first offense, you need to be prepared if they don't. Here's a look at the most common penalties.
An excise tax is a regulated tax placed on a good or product. In the case of the $100 excise tax, Code Section 4980D of the ACA creates an excise tax of $100 per person and per day if you aren't in compliance with certain aspects of the law.
You may face penalties under the Employee Retirement Income Security Act of 1974 (ERISA). There are sections in the act that cover healthcare for employees, and each year, the Department of Labor adjusts the amount of the penalties. In 2020, an employer might be penalized $119 per person, per day for non-compliance.
Some codes in the ACA only apply in certain situations and for certain employers. This is a look at the way all employers accidentally violate the ACA.
The amended section 7 of the Fair Labor Standards Act ("FLSA") requires you to provide adequate break time for nursing mothers to express their breast milk for a year after the birth of their child. If you're an employer with less than 50 employees, you are exempt if you can show that adhering to the law would cause the business an undue hardship.
While you pay Medicare tax for all of your employees, as part of the ACA, you're required to pay an additional 0.9 percent for incomes in excess of:
If you fail to pay the additional Medicare taxes for high earners, the Internal Revenue Service (IRS) will determine the penalty on each instance.
If you run a larger company, there are specific laws within the ACA that apply to you and don't offer any real exceptions. Here are the most common ways you might accidentally violate the ACA.
If you aren't offering affordable insurance with the minimum level of coverage, your full-time equivalent employees receive a premium tax credit to purchase their own on the Health Insurance Exchange. Your employees must get certification through the IRS to do this. In 2020, the penalty for this failure ranged between $2,570 to $3860.
As part of the ACA, you're required to report to the IRS about the health insurance coverage you offer to your employees. You need to report the cost of coverage on each employee's tax documents. It's easy to forget these reports. The penalty for this oversight ranges from $50-$270 per return with a maximum penalty of over $3 million per year.
No matter the size of your company, there are some laws in the ACA you must follow when you offer group health insurance. Here are some most commonly violated ones:
Sometimes, an employer offers an employee a cash reimbursement for the staff member's cost of an individual healthcare plan. This isn't allowed under IRS Notice 2013-54. The penalty for offering employer payment plans is $100 per person, per day, which can add up to $36,500 per employee over the course of a year.
Each healthcare plan that you offer to your employees must include a Summary of Benefits and Coverage (SBC). This essential document outlines the benefits and coverage of the plan. You must include the SBC with the application, upon enrollment and special enrollment periods, and when an employee requests it. According to the ACA, you might be required to pay $1,000 each time you failed to provide the SBC.
In the past, some employers have offered better benefits and healthcare plans to their high-earning employees. Under the ACA, you can no longer do this. However, it is okay to charge a high-earning staff member more for their medical coverage. Breaking this rule can cost you $100 per day, per person.
With so many rules and regulations, an employer may accidentally find themselves in non-compliance with the ACA. In most cases, the government won't immediately pursue penalties and instead give you a chance to get your health coverage into compliance. However, repeated violations without an attempt to rectify issues could result in these penalties being applied.
Wendy Katz is the Chief Financial Officer at Questco Companies. Wendy is aiding our clients’ drive for profitability and compliance by providing pragmatic insights and sound financial solutions to constantly evolving HR challenges.