Although the ACA does not obligate an employer to provide health insurance coverage to its employees, in certain circumstances an employer may be required to pay shared responsibility penalties if it either does not offer minimum essential coverage or if the coverage offered is unaffordable. The ACA also contains rules that impact plan design and administration. Key issues currently affecting employers include:
- Cost and plan design changes required by insurance reforms.
- Decisions about grandfathering health plans, and maintaining grandfathered plan status.
- Requirement to provide summary of benefits and coverage.
- Changes in insurance claim and appeal procedures.
- Limitations on employee compensation payable by certain medical insurers.
- Limitations on the use of flexible spending accounts to purchase over the counter medicine (a prescription is required).
- Requirement to provide coverage for adult dependent children until age 26.
Guidance is pending on a number of key issues that will affect employers as the provisions of the ACA continue to take effect over the coming years, including:
- The amount and mechanics for assessing employer shared responsibility payments.
- The calculations of actuarial values for plans to determine compliance with penalty provisions and other requirements.
- The application of nondiscrimination rules to insured health plans.
- The definition of minimum essential benefits.
- The requirement to automatically enroll employees in employer health plans.