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Category: Employee Group Benefits
Posted: 8/8/20120 Entries
Health Care Reform
By By HR Pros of the Atlanta Payroll Services HR Support Center

The Patient Protection and Affordable Care Act (PPACA) contains comprehensive health insurance reforms that require compliance by employer-sponsored group health plans. Many of these reforms apply to plan years beginning on or after September 23, 2010. The following general checklist is designed to help employers review their plan's compliance with the major health care reform requirements.

Please note that this list is for general reference purposes only and is not all-inclusive. This list is also subject to change based on new government requirements or directives. If you have any questions regarding your company's obligations with respect to health care reform, please consult with an HR Professional or benefits insurance provider for specific guidance.
 For more information contact Atlanta Payroll Services at 404-920-8668.


  • Determine if the status of the plan is grandfathered (i.e. in effect on March 23, 2010) or non-grandfathered. If a plan loses its grandfathered status, it may no longer be exempt from certain Health Care Reform provisions.
  • Determine whether your company qualifies for the Small Business Health Care Tax Credit. For tax years 2010 through 2013, the maximum credit is 35 percent of the health care premiums paid by small business employers.
  • Ensure that plan documents reflect cost reimbursement restrictions regarding over-the-counter (OTC) drugs for Flexible Spending Accounts (FSAs) and other tax accounts that took effect in 2011. Beginning in 2013, the law limits the amount of contributions to a health FSA to $2,500.
  • Address medical loss ratio (MLR) rebates paid by health insurers. If you as the employer paid premiums on enrollees’ behalf and receive a rebate, then consider redistribution to eligible plan enrollees. (Note: Beginning in 2012, health insurance issuers that do not meet certain MLR standards must provide to a policyholder, like an employer-sponsored group health plan, rebates to be paid by August 1 of each year.)
  • Provide a Summary of Benefits and Coverage (SBC) to inform on plan provisions. The effective date will be determined by the reason for distribution. For example, employers must provide SBCs for participants or beneficiaries: who enroll or re-enroll in the plan during annual enrollment (i.e. as of the first day of the first annual enrollment period that begins on or after September 23, 2012); or who enroll in the plan for reasons other than annual enrollment (i.e. as of the first day of the first plan year that begins on or after September 23, 2012).
  • Pay comparative effectiveness research plan fees if your company sponsors a self-insured plan. Fees start with your first renewal after October 1, 2012.
  • Prepare to report employer-provided health plan coverage on Forms W-2. Beginning with calendar year 2012 Forms W-2 (required to be furnished to employees in January 2013), certain employers that provide a group health plan to their employees are generally required to report annually the cost of coverage to each employee.
Top Five Tips

1. If your company has fewer than 25 full-time equivalent employees earning on average less than $50,000 per year, consider taking advantage of a tax credit that is available for providing health care coverage.

2. Evaluate whether any changes made to the group health plan with respect to benefits, costs, or other changes result in loss of grandfathered status.

3. If benefits are provided under a fully insured plan, discuss with your insurance company whether it may be required to provide a rebate to the plan.

3. If benefits are provided to early retirees (i.e. individuals aged 55 and older who are not yet eligible for Medicare), you may seek reimbursement for claims from the federal government under a temporary program established under health care reform.

4. Stay abreast of any legislative changes that are proposed and enacted and of ongoing litigation regarding health care reform.

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