Play or Pay? Look to Payroll System for Guidance
by Marsha Oliver, CPA
Mize Houser & Company P.A.
Despite the recent delay of a key provision of the Affordable Care Act, employers still need to determine whether to "play" or "pay" when the Employer Mandate goes into effect in 2015. While the thought of how the ACA will affect business may be overwhelming, the best place to begin researching employer responsibilities is the payroll system.
Whether payrolls are prepared in house or outsourced to a payroll provider, the details in the payment history files contain insight into how the ACA will affect a business and its employees. The data from the payroll system – which is easy to retrieve and analyze – will enable employers to
- Determine if the company is considered an "Applicable Large Employer" and must comply with the Employer Mandate of the ACA.
- Work effectively with an insurance advisor to reach a decision whether to "pay or play".
- Remain in compliance as the law evolves.
President Obama signed the ACA into law on March 23, 2010. It puts in place comprehensive health insurance reforms that will roll out over a period of four years and beyond. Let's take a look at what has happened so far – and what is anticipated to happen in the future.
2012 – Employers were required to report the total health insurance premiums paid on a company plan on each employee's W-2. Although that information was most likely not something tracked in the payroll system, it had to be added to comply with the 2012 filing requirement.
2013 – On July 2, the Obama administration announced a one-year delay in the implementation of the employer mandate portion of the ACA, which had been set to take effect Jan. 1, 2014. Along with avoiding the fine, businesses also will be able to delay on reporting about the coverage they offer their employees.
2014 – Here's where the information in the payroll system about employees' "hours of service" and total wages will really come in handy. This now is the year all employers must determine if the ACA Employer Mandate applies to them – and if it does, to decide whether to "pay or play."
The employer mandate applies to organizations that are considered "Applicable Large Employers." An Applicable Large Employer had at least 50 full-time equivalents in the preceding calendar year. For planning purposes, use the following calculation for a recent consecutive six- to 12-month period to measure full-time equivalents.
- Start With: The number of known full-time employees (expected to work an average of 30 hours or more per week) for a calendar month
- Add: The number of hours of service of part-time employees in a month, divided by 120
The resulting number is your "Total Full Time Equivalent Employees" for a calendar month. The next step is to add together the number of full time equivalent employees for each calendar month in the preceding calendar year and then divide by 12. The result, if not a whole number, is rounded to the next lowest whole number. If that number is 50 or more, the company must comply with the ACA. Employers then have two options:
- PLAY – Offer affordable and minimum essential health insurance to full-time employees (not full-time equivalents as calculated to determine if you are an Applicable Large Employer) and their dependents. Full-time employees for this purpose are defined as employees who are "employed on average at least 30 hours of service per week."
- PAY – Do not offer insurance or offer insurance that is not affordable or that does not provide minimum value and pay a penalty/tax.
Again, as businesses consider these two very different options, a look at the payroll system can provide the information needed to compare the impact of each. Employers should be able to:
- Look back over several acceptable time frames to determine how many employees would have been eligible for coverage if the plan were in effect today.
- Determine the maximum withholding from employees' income if the plan were in effect today (under the Form W-2 safe harbor, employee's withheld amount for employee only coverage must not exceed 9 1/2 percent of their current year's Box 1, W-2 income). Note that employers are not penalized for failing to subsidize any of the premium for dependent coverage.
The information will provide much of what's needed for employers to "shop" for a health insurance carrier. Once expected premium costs are determined, employers will be in a better position to decide whether to "pay or play". If they decide to "play", most intend to have this analysis completed in time to contract with an insurance company by Oct. 1, 2014. This should allow enough time to offer coverage to eligible employees, get them enrolled and begin coverage Jan. 1, 2015 – when the Employer Mandate officially begins.
2015 and beyond – Based on what we know today, the payroll system should continue to provide the information needed to remain in compliance. This will include tracking:
- If employees already in the plan are eligible to continue
- If additional existing employees become eligible
- When employees added after Dec. 31, 2014, become eligible and should be offered coverage
- Enrollments in the insurance plan
- Full and part-time employees who are working more (or less) than their status assumes – this will enable employers to keep budgeted plan costs as stable as possible.
Of course there are many decisions to make surrounding the ACA and each company's situation is unique. A good payroll system not only should be a means to pay employees – it also should be a resource to make a good business decision about whether to "pay or play" and to remain in compliance with the ACA.