ACA Employer Mandate & Workplace Benefits Flashcards

Under the ACA, which section addresses wellness programs offered through employer-sponsored group health plans?

Answer: Section 2705

ACA Section 2705 governs nondiscrimination and wellness programs in group health plans, including incentive limits and reasonable alternative standards.

What is the maximum reward percentage of the total cost of employee-only coverage that an employer can offer under a health-contingent wellness program under ACA rules?

Answer: 30%

Under ACA and HIPAA wellness regulations, the maximum incentive for health-contingent wellness programs is 30% of the total cost of employee-only coverage (50% for tobacco-related programs).

Which employer size is exempt from the ACA's employer shared responsibility provisions (employer mandate)?

Answer: Employers with fewer than 50 full-time equivalent employees

Employers with fewer than 50 full-time equivalent employees are not subject to the ACA employer shared responsibility provisions and face no penalties.

Under the ACA, what does the term 'minimum essential coverage' (MEC) include for employer-sponsored plans?

Answer: Any eligible employer-sponsored plan that covers basic medical care

Minimum essential coverage for employers includes any eligible employer-sponsored plan that provides at least basic medical benefits, regardless of cost-sharing amounts.

An ALE's 4980H(b) penalty is assessed per month per full-time employee who does what?

Answer: Receives a premium tax credit through the Marketplace

The 4980H(b) 'B' penalty is triggered for each full-time employee who receives a premium tax credit through the Marketplace because the employer's coverage was unaffordable or failed minimum value.

Which IRS code section governs the employer shared responsibility (pay-or-play) provisions under the ACA?

Answer: IRC Section 4980H

IRC Section 4980H contains the ACA's employer shared responsibility provisions, establishing the 'A' and 'B' penalty frameworks for ALEs.