Posts Tagged ‘ACA’


May 5th, 2017

Effective January 1, 2017, small employers (less than 50 employees) can offer employees reimbursement of medical expenses to include personal health insurance premiums on a tax-free basis.  These new programs are called “qualified small employer health reimbursement arrangements”, or “QSEHRA’s” for short.

Many smaller employers had previously reimbursed employees for personal health insurance premiums on a tax-free basis until the Affordable Care Act/Obamacare required that tax-free HRA accounts be “paired” with employee group insurance offered by the employer.  Most employers who had been reimbursing employees for their personal health insurance premiums were not also offering group insurance.  Tax-free reimbursement of health insurance premiums had been used by employers for over 50 years based on IRS Revenue Ruling 61-146.  This long-used benefit strategy was essentially “killed” January 1, 2014 by various provisions of the ACA.


Congress passed legislation late 2016 which created “Qualified Small Employer HRA’s”, effective in 2017.  Employers eligible for the new QSEHRA program need to meet the following conditions:

  • The employer must employ less than 50 employees;
  • The employer must not be offering an employee group insurance plan;
  • The employer must offer the HRA reimbursements on “similar terms/similar reimbursement amounts” to all full-time (30+ hours per week) employees who have been with the employer for at least 90 days and are at least age 25;
  • The employer must provide “notices” to employees about the QSEHRA benefits and also report the annual reimbursement amounts on the employee W-2 forms (as non-taxable HRA benefits).
UNLIKE THE FORMER TAX-FREE PERSONAL INSURANCE PREMIUM REIMBURSEMENTS BEFORE THE ACA, the brand new QSEHRA’s have a few significant disadvantages as follows:
  • An employer must offer the reimbursements to virtually all full-time employees “on the same terms” — Gone are the days of negotiating customized tax-free insurance reimbursements with specific employees.  A very defined “non-discriminatory” theme permeates the new 2017 version of health reimbursement arrangements.  All for one, one for all (which could “beg the question”, why not traditional group insurance instead of QSEHRA’s?);
  • Employees who are purchasing personal health insurance from the “marketplaces/exchanges” must reduce their subsidies/premium tax credit amounts by the amounts of the offered QSEHRA program.  An employer considering a QSEHRA program needs to survey their employees to determine which employees would lose federal tax credit subsidy amounts based on their offered QSEHRA amounts.  This program is generally not advisable for an employer who has several employees who qualify for insurance premium subsidy on the ACA exchanges; and
  • The old Revenue Ruling 61-146 tax-free insurance reimbursements involved minimal “red tape.”  The new QSEHRA program involves notices from employers to employees, reporting of HRA benefits on employee W-2s (a new “Box 12″ code will likely be used), notices from employees to the ACA marketplace if they are receiving subsidies, and accounting for employee reimbursement amounts as compared to the maximum legal annual amounts ($4,950 for employees only and $10,000 annual benefit amount for employee/family coverages.)
  • All QSEHRA benefits are tax-free.  Many employers now are simply paying employees more taxable wages so they can purchase insurance and pay medical expenses “after-tax”.  The tax-free aspect of the QSEHRA benefits saves employers 7.65% in taxes and employees save 25-35% of the benefits in taxes;
  • The QSEHRA program enables employers to “fix” or “define” their costs at whatever monthly reimbursement amounts the employer chooses (but not to exceed the monthly $412.50/$833.33 tax law caps in QSEHRA benefits allowed).  Employers could view this cost certainty as an advantage over the annual pricing of group insurance plans (in essence, the risk of increasing insurance premiums is shifted from the employer to the employee);
  • Although not a group insurance plan, the QSEHRA program is a meaningful medical benefits plan which smaller employers can use for recruitment and employee retention.
Before an employer adopts a QSEHRA program, we recommend that the plan benefits, insurance coverages/networks and costs be compared to group insurance options.  Some benefits brokers have told us that both the networks and pricing available in group insurance plans are better than options for individual insurance policies.  Options available for both personal and group insurance seem to be constantly changing as insurance companies both enter and exit various marketplaces.

Several smaller employers have asked us about the new HRA programs which became law this year.  In many cases, the employers have discovered that the new HRA/insurance reimbursement accounts are far less attractive than their previous, before ACA, reimbursement plans.  It is still too soon to determine how many smaller employers will adopt and use the new QSEHRA programs.

As an employer considers whether to adopt a QSEHRA plan for 2017, they should also carefully review coverage, cost and “network” options available with group insurance plans.

If you would like more information about the brand new QSEHRA plans, we have some very detailed “Q & A” information that can be emailed to you upon request.  If you actually adopt a QSEHRA, please let us know so that we can gather the benefit information needed for 2017 employee W-2 forms.

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ACA 101 For Employers

October 18th, 2016

Employers of all sizes need to review the impact of the Affordable Care Act, also known as Obamacare, on their responsibilities as to notifying employees, providing medical benefits, reporting payroll/benefits information to the IRS, and reviewing both Marketplace and IRS notices for possible ACA penalties.

This PayDay will provide all employers with a basic overview of the Affordable Care Act, to include both required and recommended action steps employers should take regarding the ACA.

Purpose of the ACA

The express purpose of the Affordable Care Act is to provide insurance to all Americans in an affordable manner. A key driver in meeting this objective is a system of penalties/fines which can be imposed on both individuals and employers.

Here are the basics:

Individuals – Virtually everybody is required to obtain health insurance or pay a penalty for not doing so (termed the individual mandate). The amount of the individual penalty has increased dramatically from its inception in 2014 to the thousands of dollars for families without coverage in 2016. Individuals can obtain their coverage through brokers, government exchanges/marketplace, or through their employers. A key component of the ACA is that individuals at lower income levels may be able to obtain cost subsidies or insurance at discounted premiums from government exchanges.

Employers – Employers which average 50 or more “full time equivalent employees” are deemed “large employers” and are required to offer coverage to their employees or potentially pay penalties. The ACA is essentially telling large employers that they are required to offer affordable, minimum essential value insurance coverage, or to instead potentially pay fines/penalties to the IRS. An employer’s payment of penalties in lieu of offering group insurance to employees helps finance the cost subsidies which the government exchanges provide to lower income individuals who procure medical insurance on a government exchange.

Employer Action Step #1 – Are You A Large Employer? 

The ACA’s intent is to mandate large employers to either offer group health insurance or help finance America’s health care costs by paying penalties to the IRS. The ACA relieves smaller employers from the requirement to provide insurance coverage or pay penalties.

A large employer is one which employs 50 or more full time equivalents (so called FTEs) based on monthly averages of FTE’s during a calendar year.

Your FTE count is figured as follows (must be calculated every month):

  • Add up all of your employees who work at least 30 hours per week; plus
  • Add the total hours of all remaining part time employees and divide those total part time monthly hours by 120 hours per month

*Special Note – Employers who are affiliated with one another due to common ownership or a management company services group, are generally required to be counted as a single employer for FTE “large employer” purposes. One of our AccuPay ACA experts can help you determine if you have a controlled group of employers (IRC Section 414).

Counting your FTEs every month is required to determine whether you are a large employer for ACA purposes. AccuPay’s staff includes two Certified Healthcare Reform Specialists who can help you count FTEs and determine if you are a large employer.


Less Than 50 FTEs – Small Employer

Small employers are not required to offer health benefits to employees and are not subject to IRS fines/penalties.

Small employers should take the following action steps regarding ACA:     

  • Provide every new employee with a Department of Labor (DOL) notice which explains whether you offer insurance or not, and also informs new employees about government exchanges. AccuPay’s website has copies of “model DOL ACA notices” which you can download and use for your new employees;
  • If you do offer medical insurance/benefits to your employees, the coverages must meet various ACA requirements. Your insurance broker/benefits consultant will make sure your plan meets ACA standards; and
  • Small employers may receive letters/notices from the government marketplace which provides information about employees who have obtained cost subsidies on their marketplace insurance. Small employers may wish to appeal any marketplace notices they feel are incorrect.

Large Employers  

If you count your full time equivalent employees each month and your annual average monthly FTE counts average 50 or more you are deemed to be a “large employer” for the succeeding/next year.

Responsibilities of a “large employer” are all of the following:  

  • Provide DOL notices to your new hires;
  • Maintain detailed records of hours worked for each of your employees so that you can make FTE counts every month and very importantly identify your full time employees every month (for ACA employer reporting to the IRS and to your employees); and
  • Make sure that you carefully evaluate your “pay or play” ACA strategy – the costs and business values of offering group insurance compared to estimated non-tax deductible IRS penalties for not offering insurance;

AccuPay can help you calculate your “pay or play” costs, net of tax benefits, in conjunction with your benefits consultant (who needs to thoroughly understand ACA law);

  • If you decide to “play” and offer group coverage (most employers do), you need to make sure that your coverage meets ACA standards (your benefits consultant will know this);

As a large employer, you are required to report month-to-month annual information for all of your full time employees (generally those who work 30 or more hours per week). Your employee ACA information is reported on IRS 1095-C form and is due January 31st of each year.

  • This information is detailed, complex, and requires information as to hours worked and medical benefit offers made (or not made) to every employee for every month of the calendar year.

AccuPay prepared and mailed thousands of IRS 1095-C forms for year 2015 for our large employer clients. Both of our payroll software platforms (PayChoice by Sage and SaaShr by Kronos) will produce annual employee 1095-C forms.

  • As a large employer you are also required to file an annual Form 1094-C with the IRS by February 29th (March 31st if filing electronically as AccuPay does). The 1094-C form calculates an employer’s number of full time employees each month for the reporting year.

Make sure your payroll company, benefits broker, etc. knows how to accurately prepare your employee 1095-C and IRS 1094-C forms. IRS penalties for errors and omissions are onerous.

In Conclusion

AccuPay assisted about 100 employers with ACA reporting (both employee 1095-C and employer 1094-C) services for the inaugural reporting year of 2015. Accurate ACA reporting requires knowledge of the Affordable Care Act laws, coupled with systems/procedures which integrate payroll and benefits information onto the ACA forms.

Now is the time to make sure you are complying with ACA law as to both benefits offered and employee hours/information tracking.

AccuPay’s team has ACA law and systems consultants who are certified in ACA and can help you comply with ACA requirements in the most cost effective manner. Call us at (317) 885-7600 with your ACA questions and/or to schedule an ACA analysis review meeting.


This blog and our PayDay newsletters are a communication of payroll news, legal updates and tax considerations intended to inform clients and colleagues of AccuPay about current payroll issues and planning techniques.  You should consult with your CPA or tax advisor before implementing any ideas, comments or planning techniques.

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ACA Impact on Employers

December 4th, 2014

The Affordable Care Act imposes various obligations on employers based on their number of “full-time equivalent” employees (FTE’s) for 2014. This PayDay will explain how employers are impacted based on the number of employees who are included in their workforce for 2014.

Counting Your Full-Time Equivalent Employees

A full-time employee (FT) is an employee who averages 30 or more hours of work per week (including paid time-off) during a one month period. A part-time employee (PT) is an employee who averages below 30 hours of work per week during a one month period (or in essence is an employee who does not work full-time). An employer’s “full-time equivalent” employees (FTE’s) are calculated every month by adding together the following 2 “counts”:

  1. Add the number of employees who, on average, worked 30 or more hours per week during the month; PLUS
  2. Total all hours worked by part-time employees during the month and divide by 120 hours

Add the two figures above to calculate your “full-time equivalent” employees for each month of the year. An employer’s FTE count for 2014 is calculated by adding all 12 months’ FTE counts and dividing by 12.

Three (3) Employer Sizes for 2014

The impact of the Affordable Care Act in 2015/2016 revolves around an employer’s FTE count for 2014, with 3 possible results:

  • Below 50 FTE’s – You are not a “large” employer.
  • 50 – below 100 FTE’s – You are a “large” employer in 2015, but most ACA requirements are delayed until 2016.
  • 100+ FTE’s – You are a “large” employer with ACA requirements effective January 1, 2015.

ACA Impact – Under 50 FTE

Employers with fewer than 50 FTE’s for 2014 are not required to offer healthcare benefits AND cannot be penalized for not offering benefits. The “employer mandates” of the ACA do not apply to employers whose workforce is below 50 FTE’s.  Employers with less than 50 FTE’s in 2014 should take the following action steps:

  1. Continue to monitor your FTE’s during 2015 for possible “large” employer status in 2016. This is especially important for employers who are close to the 50 FTE’s, and those employers who are increasing their employee counts.
  2. An employer with fewer than 50 FTE’s who provides healthcare benefits must make sure their benefit programs comply with the ACA as to coverages, waiting periods, and related ACA healthcare requirements. You are not required to offer healthcare benefits, but if you do, they must be ACA compliant.
  3. Many smaller employers have adopted programs in which they reimburse employees for their personal health insurance premiums. These employer-premium-reimbursements have been tax-exempt since 1961, but the ACA now requires that employer-reimbursements of employee insurance premiums are taxable compensation. Employers who wish to continue with employer-premium-reimbursement plans should carefully review the IRS Notice 2013-54 and subsequent IRS/DOL guidance to make sure they are not violating the ACA, and exposing themselves to possible massive penalties.

ACA Impact – 50-99 FTE’s

The ACA defines an employer with 50 or more FTE’s as a “large employer” which must provide healthcare benefits which meet “minimum value” and are “affordable” to their employees or pay ACA penalties for failure to provide benefits to employees. However, the “employer mandate” provisions of the ACA were delayed until January of 2016 for those “large” employers with 50-99 FTE’s in 2014.

Considerations if you are an employer with 50-99 FTE’s for 2014 are:

  1. As a “large employer,” you must maintain records of employee hours every month during 2015, identifying your “full-time employees” (30 + hours per week) and your “FTE’s” per month. You must file brand-new IRS forms 1094/1095 for year 2015 early in 2016. These 1094/1095 forms require information as to employee hours worked, by month, in 2015 as well as the cost of employees’ benefits during 2016. NOTE – The smaller “large” employers with 50-99 FTE’s must still track and report monthly employee counts during 2015 even though the requirement to provide healthcare benefits or pay penalties was delayed from 2015 to 2016.
  2. Large employers with 50-99 FTE’s should use 2015 as an opportunity to develop their ACA benefits and workforce management strategies for implementation/rollout in January of 2016. These smaller “large employers” should make sure their ACA employee tracking system is in place, and also review their benefits design and strategy with benefit consultants during 2015.
  3. Employers with 50-99 FTE’s who offer existing employee benefits plans must make sure their existing benefit plans are ACA compliant during 2015.

ACA Impact – 100+ FTE’s

Employers who have correctly counted their FTE’s for 2014 as 100 or more FTE’s, have the following obligations effective January 1, 2015:

  1. “Large” employers must have a system in place which tracks employee’s hours every month during 2015, identifying each month’s full-time employees, part-time employees, and those whose status as full or part-time is not known when they are hired. (These “can’t tell whether full-time or part-time” employees are called “variable hour employees.”)
  2. “Large” employers are required to complete and submit IRS forms 1094/1095 early 2016 to the IRS/DOL. Large employers should make sure they have systems in place to track employee hours and benefit costs so they can accurately complete these new ACA reports for 2015.
  3. Large employers with 100 or more FTE’s in 2014 must offer healthcare insurance/benefits to their “full-time employees” during 2015 or pay ACA penalties! The ACA imposes a “two-tiered” system of fines as follows:
    • The “A” penalty is imposed on employers who do not “offer” benefits. The penalty amount is $2,000 for every “full-time employee,” but the “first 30″ full-time employees are exempt from the “A” penalty. NOTE – for year 2015 only, the “first 80″ full-time employees are penalty-free.
    • The “B” penalty is imposed on employers who offer healthcare benefits but the benefits do not provide “minimum value” or are not “affordable” for some of the full-time employees. This “B” penalty is $3,000 per full-time employee but only applies to the employees who received premium tax credits or cost subsidies on the government exchanges.
  4. Large employers with 100 or more FTE’s should have an “ACA strategy” in place for January of 2015 which includes the following components:
    • What is our exposure in dollars, to either the “A” or “B” penalties in 2015? What is the cost of benefits to us which will avoid the ACA penalties?
    • Most large employers will wish to avoid the potentially very large “A” penalties for a “non-offer,” but may wish to review a benefits program which exposes itself to the “B” penalty only. (The “B” penalty only applies to offered benefits which do not provide “minimum value” or “affordability” to a select group of “full-time employees” not the entire full-time employee group to which the “A” penalty applies. KEY NOTE: Large employers are only required to offer healthcare benefits to their “full-time employees” – those employees who on average work 30 or more hours per week. Employees who work less than 30 hours per week are not required to be offered healthcare benefits by “large” employers. Employers should be able to track their employee hours in “real time” with consideration given to scheduling hours below 30 per week (determined monthly) to avoid payment of benefits or penalties.
    • Large employers should classify their “new hires” as full-time, part-time, or “I don’t know for sure” (variable hour) employees. A “variable hour employee” is not required to be offered benefits (nor do penalties apply) during their “initial measurement period” (in essence, a “let’s test how many hours they work on average to determine their statuses as full or part-time”) Most employers who hire several part-timers (restaurants and retail) need to establish their “measurement periods” for classification of “variable hour employees.” As a general rule, a 12-month, 52-week measurement period will be adopted by an employer since it does generally reduce the number of variable hour employees who will later be classified as “full-time” after the initial measurement period.

What About Controlled Groups?

The Affordable Care Act treats employers who are under “common control” (similar ownership) as a simple employer for employee counting and employer obligations.  A “controlled group” for ACA purposes is defined in the same manner as a “controlled group” for retirement plan purposes (IRS Section 414). You must be very careful in reviewing common ownership of separate legal entities to determine if the separate entities will be treated as a single employer for ACA purposes.

How AccuPay Can Help

AccuPay combines software technology with ACA expertise to help our employer-clients determine how the Affordable Care Act pertains to them, and how to implement systems to meet objectives for compliance with the ACA. AccuPay has also partnered with local benefits consulting firms who specialize in designing benefit plans which are intended to be ACA-compliant at minimum benefit cost. AccuPay’s owner, Larry Shaub, CPA, is a “Certified Healthcare Reform Specialist,” who has studied curriculum and passed an exam to become certified in the ACA. Larry has already conducted dozens of “ACA Reviews” for employer-clients of AccuPay, and our benefits consultants have also been discussing benefit plans with many of our clients. We also have licensed software resources which track employee hours, and calculate FTE’s and full-time employees on a monthly basis. If you are currently an AccuPay client, we can provide you with monthly “FTE” reports for year 2014.  Additionally, AccuPay has recently licensed software from Kronos which helps large employers manage employees’ hours and which alerts employers to those employees (including variable  hour employees) who are nearing “full-time employee” status.

Larry can be reached at 317-885-7600 or You can also ask your processor to have Larry contact you.

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