One thing I’ve observed over the years as I’ve helped clients with compliance issues is the tendency for employers to gloss over the details on various rules and regulations. I bet you may want to do that right now after just reading that first sentence! But stick with me – it’s important. Why? Because the details you gloss over now can eventually come back to bite you.
Case in point: we frequently get the question these days that goes something like this: “We have an employee who started working part-time hours this month – can we take them off the health plan?” Prior to the Affordable Care Act and its employer mandate, this was a straightforward question to answer. Now? Different story altogether. The answer now is a series of questions: “How are you identifying full-time employees? Did you use the lookback method? Is this an ongoing employee in an ongoing stability period?” The answer is either silence if we’re on the phone, or an email that essentially says “I don’t know.” That’s okay – the point here is not to cast blame, but to focus on the details. (As a side note, the answer is if the employee is ongoing and in an ongoing stability period, there’s no termination of coverage. So if you terminated that coverage and offered COBRA, you may need to rethink that…)
Historically, the federal government has rarely intervened with group health plans. Yes, there have been audits and yes, those can be painful (or not, if you’ve prepared yourself for them.) But it usually took something serious happening in order to catch the government’s attention. That of course all changed this year with the ACA’s reporting requirement. All those 1095-Cs you completed and submitted to the IRS? Those are the key to your plan – if there’s a disconnect between your reporting and what your employee tells the IRS, or between what you report on the 1095-C and what your carrier reports for the same employee on their 1095-B, you could be drawing attention to yourself that you don’t want. And if the government comes looking, they won’t be interested in generalities. They’ll be interested in the details.
There is good news in the details-laden post – once you really understand the details of your plan, you won’t have to spend a lot of time keeping up with changes, because now that we’re through most of the implementation phase of the ACA, the details shouldn’t keep changing every month (Week? Day? Hour? For a while it felt like that…) In fact, changes that the ACA brought about are going to just become commonplace now. There will be tweaks down the road, but I don’t expect tons of them to happen all at once like they were in 2014 and 2015.
So, make it a project: identify all the normal situations you have to deal with as a plan administrator, review your plan to understand what really needs to happen, close any gaps you find, and then move on to other things. You’ll be glad you took the time to understand the details!
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