Large Business Questions...help!

2112Greg

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I have a client who owns 4 quick service restaurants and they will fall under the mandate as they have over 100 FTEs.

I haven't been able to find a good answer to this question, so here goes. As it's a restaurant, most of the employees are under 400% of the FPL. So when they sign up for coverage, they should be getting subsidized.

Even though her question is irrespective of the subsidy question, it's related. How much of the premium is paid for by the employer? She is under the impression that there is a cost sharing which says that the amount out of pocket is determined somehow in the process. In other words, she thinks it's like ordinary group coverage that predetermined how much each party pays, 50% or whatever etc...

I am not aware of such a mechanism and that if there is any out of pocket, that is 100% the responsibility of the employer. Who is right here?

What is the final word on this...?

There is so much crazy information out there, I just need a concise explanation of this...

On top of this question, is anyone aware of an actual verification of the SSN that takes place when a new EE signs up for coverage?

I have other questions but those two are a good start...
 
There is so much to explan on your question I don't think anyone knows where to start. Go to save 101.com and listen to some of the training. Call them they will walk you through it.
 
agree with other two posters, this is all over the place.

Assuming the group meets the definition of large, it needs to offer coverage that meets a benefits test and an affordability test. The affordability is 9.5% of the employees w-2 for that employer. This is using the safe harbor test for affordability.

There is much more to it than this, so I agree with the others that you should do some other research.

good luck.
 
Let me break it down. It's really not complicated. Here's just one simple question...

Assuming they meet the benefits and affordability test (we've already done that), as the vast majority of the EEs will qualify for subsidies, who will be responsible for the portion of the non-subsidized premium, the employer of the employee?

Surely this isn't THAT complicated a question...
 
Way to win friends and influence people!

Yes, the question you posed in your last post is not that complicated. But that is not the question you asked in your earlier posts. You never asked who is responsible for the portion of the NON-SUBSIDIZED PREMIUM OF THE INDIVIDUAL PLAN. As I read it, and maybe others, it sounded as if you were asking how much of the GROUP PREMIUM would the employer need to fund.

Your latest question is very easy to answer.
 
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Let me break it down. It's really not complicated. Here's just one simple question...

Assuming they meet the benefits and affordability test (we've already done that), as the vast majority of the EEs will qualify for subsidies, who will be responsible for the portion of the non-subsidized premium, the employer of the employee?

Surely this isn't THAT complicated a question...

It's not complicated, you're just framing it incorrectly (or making an error with how this all works).

Benefits and affordability test applies to GROUP coverage. There will NOT be subsidies for individual employees under a group plan.

Subsidies apply to INDIVIDUAL coverage. Subsidies are NOT available if GROUP coverage that meets benefits (MEC/QHP) and affordability tests is available.

But, to answer your question, the individual employee is responsible for the non-subsidized portion of premium. Businesses may NOT pay this directly, or they face a $100/day/employee fine for violating 5000a of ACA (refer to IRS notice 2013-54 for clarification).
 
Yes, thanks Ray. I was operating under a couple incorrect assumptions. It's all cleared up now.

Sorry I sounded ungrateful in my response above, didn't mean to come across like that.

:)
 
Glad I could help.

It's getting harder and harder to remember all the connections in the web of regulations that has been spun over the past few years. You're not the only one confused by a long shot.
 
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