Employer Mandate

post-img8The Patient Protection and Affordable Care Act (PPACA) requires that by Jan. 1, 2015, applicable large employers must decide whether to “pay or play” in the realm of employer-sponsored group health plans.

An employer may be required to “pay” a penalty for failing to offer an employer-sponsored group health plan, providing unaffordable coverage or providing coverage that provides less than the minimum value requirement. The penalty would be triggered if one of the employer’s full-time employees obtained coverage through a health insurance exchange and qualified for a premium tax subsidy.

Alternatively, an employer will not pay a penalty if it decides to “play” by offering affordable, minimum value employer-sponsored group health coverage for its full-time employees (and their dependents). PPACA refers to the “pay or play” requirement as “employer shared responsibility” or the “employer mandate”, and employers need to understand the possible impact on plan designs, contribution strategies and workforce planning.


Other Health Care Reform Changes

  1. Employer Mandate
  2. Grandfathered Plans
  3. Automatic Enrollment
  4. Dependent Coverage
  5. Preventive Care Mandate
  6. Pre-existing Conditions Prohibition