Employer Check List Health Care Reform
Content
2016 EMPLOYER CHECKLIST : HEALTHCARE REFORM
Distribute Summary Benefit Coverage (SBC)
What is it?
Summary of benefits provided by each plan offered.
When given?
Annually to all eligible employees before enrollment.
To new hires before eligible for medical benefits.
Who has to comply?
All employers offering medical benefits regardless of number of eligible employees.
Penalties?
$1,000 per employee not given notice.
Provide CHIPRA Notice ("Children's Health Insurance Program Reauthorization Act")
What is it?
Notice of potential public assistance for health care costs.
When given?
Before the first day of the next plan year.
To new hires before eligible for medical benefits.
Who has to comply?
All employers offering medical benefits regardless of number of eligible employees.
Penalties?
$110 per day per violation.
Other
Employer should get proof of distribution.
Distribute Patient Protection Act Notice
What is it?
When given?
Summary of patient rights.
Annually to all enrolled employees including COBRA members on enrollment date.
New Hires upon enrollment.
Who has to comply?
All employers offering medical benefits regardless of number of eligible employees.
MLR ("Medical Loss Ratio") Rebate Policy update
MLR is a Rebate given by insurance companies that do not spend a specific amount of
premiums on medical care.
What is it?
If a rebate is received it must be distributed within 90 days to employees in the plan
as a reduction of current year premiums or a cash payout. (in proportion to the
premium amount paid by the enrollee.
Who has to comply?
All employers that have received an MLR, regardless of number of eligible employees
Other
Company policy on how to distribute MLR should be added to a company handbook
W‐2 Reporting the VALUE of employee health coverage
Reporting of the value of employee health coverage on W‐2's
What is it?
When?
How to Calculate?
Large Employers‐(over 250 employees) ‐ Begins with 2012 W‐2's issued in 2013
Small Employers ‐ (under 250 employees) ‐ not required at this time.
https://www.irs.gov/Affordable‐Care‐Act/Form‐W‐2‐Reporting‐of‐Employer‐
Sponsored‐Health‐Coverage
Page 1 of 2
2016 EMPLOYER CHECKLIST : HEALTHCARE REFORM
Waiver Forms
What is it?
An employee signed form waiving/opting out of the employer sponsored plan.
When given?
At the beginning of the plan year.
Who has to comply?
All employers offering health care, regardless of the number of eligible employees.
Healthcare Exchange Notices
A notice to all eligible employees of the future existence of the health care exchange
What is it?
in the state
Upon hire to each new employee. Current employees should have already received
When given?
this form.
Who has to comply?
All employers.
Notice for employers who offer a health plan to some or all employees:
http://www.dol.gov/ebsa/pdf/flsawithplans.pdf
Notice for employers who do not offer a health plan:
http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf
COBRA/State Continuation Notices
A notice to all employees of their right to receive COBRA (continuing benefits) when
What is it?
they are terminated.
A short notice is given when the employee is eligible for benefits and another longer
When given?
notice is given when the employee is terminated regardless if the termination was
voluntary or non‐voluntary.
Who has to comply?
All employers offering medical benefits regardless of number of eligible employees
Check with Dept of Labor for updated version of each letter.
Mental Health Parity Rider (Under 50 employees)
What is it?
When given?
Who has to comply?
A rider that may be added at cost to small group plans
Employer decision to add to the healthcare plans must be done before plan goes into
effect
Optional for groups under 50 employees, all group plans of 50 or more are included
in the plan which is federally mandated.
Flex Spending Account Limit $2,550
What is it?
Flex spending account limits used to be set by employers, it is now federally
mandated at a cap of $2,500 per year. Employee and spouse may each have a plan.
Transit benefit available, max. limit $250/month for parking and $130/month for
transit.
Dependent care benefit, max limit $5,000 per year per family
Page 2 of 2
Distribute Summary Benefit Coverage (SBC)
What is it?
Summary of benefits provided by each plan offered.
When given?
Annually to all eligible employees before enrollment.
To new hires before eligible for medical benefits.
Who has to comply?
All employers offering medical benefits regardless of number of eligible employees.
Penalties?
$1,000 per employee not given notice.
Provide CHIPRA Notice ("Children's Health Insurance Program Reauthorization Act")
What is it?
Notice of potential public assistance for health care costs.
When given?
Before the first day of the next plan year.
To new hires before eligible for medical benefits.
Who has to comply?
All employers offering medical benefits regardless of number of eligible employees.
Penalties?
$110 per day per violation.
Other
Employer should get proof of distribution.
Distribute Patient Protection Act Notice
What is it?
When given?
Summary of patient rights.
Annually to all enrolled employees including COBRA members on enrollment date.
New Hires upon enrollment.
Who has to comply?
All employers offering medical benefits regardless of number of eligible employees.
MLR ("Medical Loss Ratio") Rebate Policy update
MLR is a Rebate given by insurance companies that do not spend a specific amount of
premiums on medical care.
What is it?
If a rebate is received it must be distributed within 90 days to employees in the plan
as a reduction of current year premiums or a cash payout. (in proportion to the
premium amount paid by the enrollee.
Who has to comply?
All employers that have received an MLR, regardless of number of eligible employees
Other
Company policy on how to distribute MLR should be added to a company handbook
W‐2 Reporting the VALUE of employee health coverage
Reporting of the value of employee health coverage on W‐2's
What is it?
When?
How to Calculate?
Large Employers‐(over 250 employees) ‐ Begins with 2012 W‐2's issued in 2013
Small Employers ‐ (under 250 employees) ‐ not required at this time.
https://www.irs.gov/Affordable‐Care‐Act/Form‐W‐2‐Reporting‐of‐Employer‐
Sponsored‐Health‐Coverage
Page 1 of 2
2016 EMPLOYER CHECKLIST : HEALTHCARE REFORM
Waiver Forms
What is it?
An employee signed form waiving/opting out of the employer sponsored plan.
When given?
At the beginning of the plan year.
Who has to comply?
All employers offering health care, regardless of the number of eligible employees.
Healthcare Exchange Notices
A notice to all eligible employees of the future existence of the health care exchange
What is it?
in the state
Upon hire to each new employee. Current employees should have already received
When given?
this form.
Who has to comply?
All employers.
Notice for employers who offer a health plan to some or all employees:
http://www.dol.gov/ebsa/pdf/flsawithplans.pdf
Notice for employers who do not offer a health plan:
http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf
COBRA/State Continuation Notices
A notice to all employees of their right to receive COBRA (continuing benefits) when
What is it?
they are terminated.
A short notice is given when the employee is eligible for benefits and another longer
When given?
notice is given when the employee is terminated regardless if the termination was
voluntary or non‐voluntary.
Who has to comply?
All employers offering medical benefits regardless of number of eligible employees
Check with Dept of Labor for updated version of each letter.
Mental Health Parity Rider (Under 50 employees)
What is it?
When given?
Who has to comply?
A rider that may be added at cost to small group plans
Employer decision to add to the healthcare plans must be done before plan goes into
effect
Optional for groups under 50 employees, all group plans of 50 or more are included
in the plan which is federally mandated.
Flex Spending Account Limit $2,550
What is it?
Flex spending account limits used to be set by employers, it is now federally
mandated at a cap of $2,500 per year. Employee and spouse may each have a plan.
Transit benefit available, max. limit $250/month for parking and $130/month for
transit.
Dependent care benefit, max limit $5,000 per year per family
Page 2 of 2
