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In addition to the very well-known ACA employer mandate, there are myriad of other lesser-known ACA requirements that could pack a punch for organizations that are noncompliant when it comes to penalty fees on 2015 tax returns. Knowing the breadth and depth of these mandates and determining if you are in compliance (or how to achieve compliance if possible) will save on surprises come 2016.
Below is a list of some of more obscure ACA mandates that are in effect for 2015. Noncompliance could result in ERISA penalties and fines of up to $100/day for each affected employee:
- Prohibition on employer payment plans for individual healthcare plans
- Access for dependent coverage up to age 26
- No annual or lifetime limits for essential health benefits
- Inclusion of preexisting conditions in all plans and coverage
- Use of 90-day (or less) waiting periods
- Nondiscrimination for wellness plans
- Coverage for routine healthcare during approved clinical trials.
- Preventative service coverage with no cost-sharing
- Patient protections, allowing them to chose PCPs, secure OB-GYN care without authorization, and to plan for emergency care
- Employee rights to appeal claims decisions by internal review or via an independent third party
- Coverage of 10 essential health benefits for all individual and small group health plans
- Implementation of 2015 cost-sharing limits
- Health FSAs must be offered through a “cafeteria” plan (IRS section 125) and used as excepted benefits
- Health reimbursement arrangements cannot be used to fund individual policy premiums
- Summary of Benefits and Coverage (SBC) must be submitted to employees during enrollment and upon request
- Any changes to the SBC must be documented and distributed to plan participants no later than 60 days before the date any modifications take effect
While good faith does apply to many of the above, these mandates will still apply in 2016 meaning that understanding how to obtain and maintain compliance now will be crucial for a smooth year ahead.
To learn more about these and other ACA mandates, penalties, and exclusions
– as well as key terms and deadlines related to the ACA in 2016- download
The Nonstop Guide to ACA Penalties for the 2015 Tax Year
