WSGR ALERT

U.S. Treasury Department Delays Enforcement of Employer Mandate and Reporting Requirements Under PPACA

July 22, 2013

As seen in many mainstream press reports, the Obama administration announced in early July that (1) the employer mandate and (2) certain reporting requirements under the Patient Protection and Affordable Care Act (PPACA) will be delayed until January 1, 2015. On July 9, 2013, the Internal Revenue Service (IRS) issued further guidance on the delay.

The delay in enforcement is very welcome news to large employers, as many have commented to the Obama administration that more time was needed to comply with the new rules.1

Background

The Employer Mandate

The employer mandate requires large employers to provide full-time employees with qualifying health coverage that meets certain affordability and minimum-benefit requirements. To the extent that an employer fails to provide qualifying health coverage to its full-time employees, various penalties can be imposed on the employer based on the percentage of full-time employees who are eligible to receive such coverage.2

Due to the delay in enforcement of the employer mandate, employers will have more time to assess how to determine compliance with the affordability and minimum-benefit requirements. The delay also will provide employers more time to design coverage for full-time employees under their health plans so as to either avoid or mitigate health coverage penalties.

Reporting Requirements

PPACA requires large employers to provide health coverage reports and certain health insurance information to the IRS. In particular, a large employer is required to report the number of its full-time employees, whether it offers “minimum essential benefits” under its health plan(s), and its share of the total cost of benefits under its health plan(s).

The IRS has indicated that proposed rules for these reporting requirements are expected to be published in the summer of 2013, and the proposed rules will reflect the fact that enforcement will not occur during 2014.

Conclusion

The Treasury Department has indicated that proposed rules on the reporting requirements are forthcoming. While we await the new guidance, the enforcement delay should allow employers to take a breath and evaluate how to comply with health plan reporting rules and the changes that may be required by the employer mandate to existing health plans with respect to affordability, minimum benefits, and coverage.

For practical and cost-effective assistance navigating the changes required by PPACA, please contact any member of the employee benefits and compensation practice of Wilson Sonsini Goodrich & Rosati.

John Aguirre (650) 565-3603    Melody Barker (415) 947-2029
Jessica Bliss (650) 849-3470 Madeleine Boshart (415) 947-2057
Mark Cornillez-Ty (650) 849-3384 Brandon Gantus (415) 947-2138
Michael Klippert (650) 849-3276 Sriram Krishnamurthy (212) 497-7721
Scott McCall (650) 320-4547 Michael Montfort (202) 973-8815
Cisco Palao-Ricketts (650) 565-3617 Christa Sanchez (650) 849-3382
Roger Stern (650) 320-4818 David Thomas (650) 849-3261
Jackie Tokuda (650) 565-3904 Michelle Wallin (650) 565-3620


1 Generally, a large employer is an employer that employs 50 or more full-time employees (which includes full-time equivalent employees).

2 If an employer offers qualifying health coverage to at least 95 percent of its full-time employees, the employer would be subject to only a penalty of $3,000 for each employee who receives a premium credit when enrolling in an exchange-provided health plan. If an employer fails to offer qualifying health coverage to at least 95 percent of its full-time employees, and one employee receives a premium credit when enrolling in an exchange-provided health plan, the employer would be subject to a $2,000 per year penalty for all of its employees, including those who are eligible for health coverage.