Businesses & Non-Profits

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General Information

Employers covered under the Fair Labor Standards Act must notify employees about the new health insurance marketplace. Sample letters can be found for employers that offer health insurance (1) and for employers that do not offer health insurance (2).

Additionally, employers are required to provide employees with a summary of their benefits and coverage under their plan (3).

Insurance companies, under the ACA, are required to spend 80 percent of the premium dollars they receive on medical care. Companies that do not meet this ratio must provide a rebate to policy holders. This is known as the 80/20 Rule (4).

The ACA caps employee contributions to Flexible Spending Accounts at $2500 (5). It also adds additional Medicare withholding on wages for some people. Employees with incomes over $200,000 (single filers) and married joint filers with incomes over $250,000 will see their portion of Medicare Part A Hospital Insurance rise from 1.45 to 2.35 percent. The employer’s portion does not change; however, they are required to withhold this additional tax.

The ACA also puts limits on the waiting period for new employees to receive health care coverage. The wait is limited to 90 days starting on January 1, 2014. This is known as the 90 Day Rule (6). It also creates a program designed to reimburse insurers in the individual insurance market for high claim costs. This will result in employers (for self-insured plans) and insurers paying a monthly fee from 2014 to 2016.

Workplace Wellness Programs (7) implemented by employers are also incentivized under this plan. Employers can receive rewards from 20 to 50 percent of the cost of health coverage for plans that encourage employees to decrease cholesterol and tobacco usage.

Starting January 1, 2014, employers with self-insured plans will be required to submit reports to the IRS detailing information about each covered individual. The first reports will be filed in 2015.

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Self-Employed Individuals

Under the Affordable Care Act, individuals who do not have basic health insurance coverage or qualify for an exemption will be required to make an individual shared responsibility payment when they file a federal income tax return. What is minimum essential coverage? What is the fee for not having coverage? Do you qualify for an exemption? Find out (8).

For more information, please consult our Individuals page.


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Less than 25 Employees

Beginning in 2014, some small businesses will be eligible for Small Business Health Care Tax Credits under PPACA. To find out if your small business will qualify for these credits (9) and to estimate the size of your business’s tax credit (10). Non-profits, since they are tax-exempt, would receive refunds in place of tax credits.

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Up to 50 Employees

Starting in 2014, small businesses with up to 50 employees will be able to participate in the Small Business Health Options Program (SHOP). When small businesses SHOP, they are able to pool their risks with other small businesses. Enrollment for SHOP begins on October 1, 2013. For more information visit SHOP, or call 1-800-706-7893 (Monday-Friday, 9am-5pm EST) (11).


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50 or more Employees

Under the Affordable Care Act (ACA), employers with 50 or more full-time or full-time equivalent employees that fail to offer affordable health insurance to full-time employees and their dependants will have to pay an assessment if at least one of their full-time employees is able to receive a premium tax credit in an individual health insurance marketplace.

Full-time employees are employed an average of at least 30 hours per week. Employers  can calculate if they have 50 or more full-time or full-time equivalent employees (12). Employers with more than 100 full-time employees in most states will be able to take advantage of insurance exchanges beginning in 2017. More information on the Employer Shared Responsibility Payment, including what is affordable coverage and what the payment would cost, can be found at www.healthcare.gov. (13)

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Sources:

  1. http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf
  2. http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf
  3. https://www.healthcare.gov/how-does-the-health-care-law-protect-me/#part=4
  4. https://www.healthcare.gov/how-does-the-health-care-law-protect-me/#part=10
  5. https://www.healthcare.gov/can-i-use-a-flexible-spending-account-fsa/
  6. http://www.irs.gov/pub/irs-drop/n-12-59.pdf
  7. http://www.sba.gov/community/blogs/workplace-wellness-improving-health-and-controlling-health-care-spending
  8. https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/
  9. https://www.healthcare.gov/will-i-qualify-for-small-business-health-care-tax-credits/
  10. http://www.taxpayeradvocate.irs.gov/calculator/SBHCTC.htm
  11. https://www.healthcare.gov/what-is-the-shop-marketplace/
  12. http://www.sba.gov/sites/default/files/files/Slides_re_Calculating_FTEs
    _for_Employer_Shared_Responsiblity_(August%202013).pdf
  13. https://www.healthcare.gov/what-is-the-employer-shared-responsibility-payment/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Gallery

August 4, 2017: Senator Blake joined a number of local officials to welcome Governor Tom Wolf back to Scranton to tour the success story that is the United Neighborhood Centers' community revitalization effort along Cedar Avenue in South Scranton. August 4, 2017: Senator Blake joined a number of local officials to welcome Governor Tom Wolf back to Scranton to tour the success story that is the United Neighborhood Centers' community revitalization effort along Cedar Avenue in South Scranton. August 4, 2017: Senator Blake joined a number of local officials to welcome Governor Tom Wolf back to Scranton to tour the success story that is the United Neighborhood Centers' community revitalization effort along Cedar Avenue in South Scranton. August 3, 2017: Senator Blake and State Rep. Mike Carroll joined Dupont resident Stanley Knick for his swearing-in ceremony to the Pennsylvania Board of Game Commissioners.

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