Coverage and Workforce Reporting Under the ACA

The first report is due in 2015. The employer must certify whether the plan offers “minimum essential coverage” to full time employees. Any entity filing a return reporting minimum essential coverage must furnish a written statement to each individual listed on the return showing the information reported to the IRS for that individual. Failure to file this report is subject to a penalty.

This report will identify the employer and their employees/covered dependents. The report must include information necessary to identify who should have been covered and when. It will also have to identify the nature of the coverage and how much it cost.

Additional information will have to be filed if the employer is claiming to provide “minimum essential coverage” including details about any waiting period, when the coverage was available, and plan types and costs will also need to be disclosed.

Not Yet Implemented

Automatic Enrollment

• The Affordable Care Act will require employers with 200 or more full-time employees to automatically enroll new full-time employees in one of their health benefit plans. However, this requirement will not take effect until the Department of Labor issues regulations. Enrollment may be subject to any waiting period authorized by law. Employers will need to provide adequate notice and opportunity for an employee to opt out of any coverage in which they were automatically enrolled at the time of initial enrollment.
• Additional information about Automatic Enrollment under the ACA will be provided after the regulations are issued in the future.

Transparency Disclosures – Quality Reporting

• The Affordable Care Act requires non-grandfathered health care plans to disclose certain information to their associated exchanges and the Department of Health and Human Services. The submitted data will be used to provide insights into the health care landscape. Some of this information will be made available to the public in an attempt to create better informed health care consumers. Information provided to consumers must be in plain language that can be readily used and understood by the target audience.
• This requirement was scheduled to take effect for non-grandfathered health plans outside of exchanges six months after the date of enactment of the ACA. Exchange plans are supposed to provide the same information starting in 2014. No draft rules or guidance on these requirements have been published to date.
• The data disclosure covers basic financial information regarding policies and practices. It will also be necessary to provide data on enrollment and claims. Data on rating practices will have to be submitted as well. Information on cost-sharing and payments with respect to out-of-network coverage will have to be included in the reports as well.

Lifetime Limits