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IRS Previews Employer PPACA Regs

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The Employee Benefits Security Administration (EBSA) is promising employers and their benefits advisors that it and sister federal agencies will be coming out with batches of guidance to answer many, many questions.

EBSA, an arm of the U.S. Labor Department, talks about the guidance projects in Technical Release Number 2012-01, a collection of 7 answers to 7 questions about the interaction of Patient Protection and Affordable Care Act of 2010 (PPACA) rules and employer plans.

EBSA officials note in the release that they developed the technical release together with officials at the other departments responsible for implementing the PPACA employer plan provisions — the  U.S. Treasury Department, and the U.S. Department of Health and Human Services.

Some of the questions and answers have to do with PPACA provisions that will affect how large employers will comply with a requirement that they provide affordable group health coverage to full-time employees or else pay a penalty.

Others have to do with matters such as a requirement that employees who are eligible for group health coverage be enrolled in plans automatically and a requirement that employers limit any waiting periods that employees must go through before getting coverage to 90 days.

EBSA is asking for comments on the release. The comments are due April 9.

Group coverage affordability requirements have been an especially hot topic.

PPACA requires employers to pay penalties if any employees eligible for group coverage find that the employee share of premiums exceeds 9.5% of their income and the employees then buy individual coverage through a new system of health insurance exchanges, or Web supermarkets, that is supposed to open up in 2014.

Regulators at the Internal Revenue Service (IRS), an arm of the Treasury Department, have suggested that they may create a safe harbor that would let an employer satisfy the requirement if the employee’s share of the cost of individual coverage is less than 9.5% of that employee’s W-2 wages from that employer.

Employers and plan administrators contend that any other safe harbor would be difficult to administer. 

Some have suggested that employers might cope with the requirement by making individual coverage inexpensive but pushing the employee’s share of the cost of family coverage sky high.

The IRS and the Treasury Department still plan to issue guidance permitting employers to use an employee’s W-2 wages as a safe harbor in determining the affordability of employer coverage, EBSA officials say in the technical release.

EBSA officials also talk about upcoming guidance relating to definitions, such as how an employer will determine whether a worker is a full-time worker, and when.

The group coverage mandate, or “employer shared responsibility provisions,” are supposed to apply to an employer with 50 or more full-time equivalent employees.

The IRS is thinking about creating a “look-back/stability period safe harbor” method that employers can use to decide whether current employees are full-time employees, EBSA officials say.

“Comments were also requested on potential rules for determining full-time status of new employees and employees who move into full-time status mid-year,” officials say.

EBSA officials give several examples of the approach employers might use to determine whether a newly-hired employee is a full-time employee.


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