Affordable Care Act Pay or Play Penalties—Helpful Look-back Measurement Examples

The Affordable Care Act (ACA) imposes a penalty on applicable large employers (ALEs) that do not offer health insurance coverage to substantially all full-time employees and dependents. Penalties may also be imposed if coverage is offered, but is unaffordable or does not provide minimum value. The ACA’s employer penalty rules are often referred to as “employer shared responsibility” or “pay or play” rules.

On Feb. 12, 2014, the IRS published final regulations on the ACA’s employer shared responsibility rules. The final regulations provide an optional safe harbor method that employers can use for determining full-time status, called the look-back measurement method. The look-back measurement method involves a measurement period for counting hours of service, a stability period when coverage may need to be provided, depending on an employee’s average hours of service during the measurement period, and an administrative period that allows time for enrollment and disenrollment.

This Legislative Brief provides examples of potential measurement, administrative and stability periods for plan years beginning in each month throughout the 2015 and 2016 calendar years. These examples assume that the employer will be using a 12-month standard measurement period, a two-month administrative period and a 12-month stability period.

It also provides examples of optional transition measurement periods in 2015, if allowed for the plan year. The final regulations allow employers to use shorter measurement periods for stability periods starting in 2015 under the look-back measurement method. For 2015, employers can determine full-time status by reference to a transition measurement period in 2014 that:
• Is shorter than 12 consecutive months, but not less than six consecutive months long; and
• Begins no later than July 1, 2014, and ends no earlier than 90 days before the first day of the first plan year beginning on or after Jan. 1, 2015.

If permitted under the employer shared responsibility rules with respect to their plan years, employers can choose to use either the standard measurement period or the transition measurement period for stability periods beginning in 2015.

PLAN YEAR SELECTION
The final rules state that the plan year must be 12 consecutive months, unless a short plan year of less than 12 consecutive months is permitted for a valid business purpose. A plan year may begin on any day of a year and must end on the preceding day in the following year (for example, a plan year that begins on Oct. 15, 2015, must end on Oct. 14, 2016).

Once established, a plan year is effective for the first plan year and for all subsequent plan years unless it is changed, provided that such change will only be recognized if made for a valid business purpose. Note that a change in the plan year is not permitted if the principal purpose of the change in plan year is to avoid the employer shared responsibility requirements.

CALENDAR-YEAR PLANS
A calendar-year plan is a health plan that has a plan year running on the calendar year. Thus, the plan year of a calendar-year plan is a period of 12 consecutive months beginning on Jan. 1 and ending on Dec. 31 of the same calendar year.

Plan Year: Jan. 1 — Dec. 31
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year Nov. 1, 2013 — Oct. 31, 2014 May 1, 2014 — Oct. 31, 2014 Nov. 1, 2014 — Dec. 31, 2014 Jan. 1, 2015 — Dec. 31, 2015
2016 Plan Year Nov. 1, 2014 — Oct. 31, 2015 N/A Nov. 1, 2015 — Dec. 31, 2015 Jan. 1, 2016 — Dec. 31, 2016

 

NON-CALENDAR-YEAR PLANS
A non-calendar-year plan is a health plan that has a plan year that does not run on the calendar year. Thus, the plan year of a non-calendar-year plan is a period of 12 consecutive months beginning in any month after Jan. 1. As a result, the plan year of a non-calendar-year plan will run during parts of two consecutive calendar years.

Plan year: Feb. 1 — Jan. 31
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year Dec. 1, 2013 — Nov. 30, 2014 June 1, 2014 — Nov. 30, 2014 Dec. 1, 2014 — Jan. 31, 2015 Feb. 1, 2015 — Jan. 31, 2016
2016 Plan Year Dec. 1, 2014 — Nov. 30, 2015 N/A Dec. 1, 2015 — Jan. 31, 2016 Feb. 1, 2016 — Jan. 31, 2017
Plan year: March 1 — Feb. 28 (or Feb. 29, during a leap year)
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year Jan. 1, 2014 — Dec. 31, 2014 July 1, 2014 — Dec. 31, 2014 Jan. 1, 2015 — Feb. 28, 2015 March 1, 2015 — Feb. 29, 2016
2016 Plan Year Jan. 1, 2015 — Dec. 31, 2015 N/A Jan. 1, 2016 — Feb. 29, 2016 March 1, 2016 — Feb. 28, 2017
Plan year: April 1 — March 31
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year Feb. 1, 2014 — Jan. 31, 2015 July 1, 2014 — Jan. 31, 2015 Feb. 1, 2015 — March 31, 2015 April 1, 2015 — March 31, 2016
2016 Plan Year Feb. 1, 2015 — Jan. 31, 2016 N/A Feb. 1, 2016 — March 31, 2016 April 1, 2016 — March 31, 2017
Plan year: May 1 — April 30
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year March 1, 2014 — Feb. 28, 2015 July 1, 2014 — Feb. 28, 2015 March 1, 2015 — April 30, 2015 May 1, 2015 — April 30, 2016
2016 Plan Year March 1, 2015 — Feb. 29, 2016 N/A March 1, 2016 — April 30, 2016 May 1, 2016 — April 30, 2017
Plan year: June 1 — May 31
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year April 1, 2014 — March 31, 2015 July 1, 2014 — March 31, 2015 April 1, 2015 — May 31, 2015 June 1, 2015 — May 31, 2016
2016 Plan Year April 1, 2015 — March 31, 2016 N/A April 1, 2016 — May 31, 2016 June 1, 2016 — May 31, 2017
Plan year: July 1 — June 30
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year May 1, 2014 — April 30, 2015 July 1, 2014 — April 30, 2015 May 1, 2015 — June 30, 2015 July 1, 2015 — June 30, 2016
2016 Plan Year May 1, 2015 — April 30, 2016 N/A May 1, 2016 — June 30, 2016 July 1, 2016 — June 30, 2017
Plan year: Aug. 1 — July 31
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year June 1, 2014 — May 31, 2015 July 1, 2014 — May 31, 2015 June 1, 2015 — July 31, 2015 Aug. 1, 2015 — July 31, 2016
2016 Plan Year June 1, 2015 — May 31, 2016 N/A June 1, 2016 — July 31, 2016 Aug. 1, 2016 — July 31, 2017
Plan year: Sept. 1 — Aug. 31
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year July 1, 2014 — June 30, 2015 N/A July 1, 2015 — Aug. 31, 2015 Sept. 1, 2015 — Aug. 31, 2016
2016 Plan Year July 1, 2015 — June 30, 2016 N/A July 1, 2016 — Aug. 31, 2016 Sept. 1, 2016 — Aug. 31, 2017
Plan year: Oct. 1 — Sept. 30
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year Aug. 1, 2014 — July 31, 2015 N/A Aug. 1, 2015 — Sept. 30, 2015 Oct. 1, 2015 — Sept. 30, 2016
2016 Plan Year Aug. 1, 2015 — July 31, 2016 N/A Aug. 1, 2016 — Sept. 30, 2016 Oct. 1, 2016 — Sept. 30, 2017
Plan year: Nov. 1 — Oct. 31
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year Sept. 1, 2014 — Aug. 31, 2015 N/A Sept. 1, 2015 — Oct. 31, 2015 Nov. 1, 2015 — Oct. 31, 2016
2016 Plan Year Sept. 1, 2015 — Aug. 31, 2016 N/A Sept. 1, 2016 — Oct. 31, 2016 Nov. 1, 2016 — Oct. 31, 2017
Plan year: Dec. 1 — Nov. 30
  Standard Measurement Period (optional for 2015) Transition Measurement Period (optional for 2015) Administrative Period Stability Period
2015 Plan Year Oct. 1, 2014 — Sept. 30, 2015 N/A Oct. 1, 2015 — Nov. 30, 2015 Dec. 1, 2015 — Nov. 30, 2016
2016 Plan Year Oct. 1, 2015 — Sept. 30, 2016 N/A Oct. 1, 2016 — Nov. 30, 2016 Dec. 1, 2016 — Nov. 30, 2017

MORE INFORMATION
Please contact CIBC of Illinois, Inc. for more information on the employer shared responsibility rules.

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About CIBCsolutions

CIBC is a leader in the development and implementation of innovative employee benefits plans. Headquartered an hour south of Chicago in Kankakee, CIBC has branch offices throughout Illinois serving private sector clients, non-profit organizations, governmental agencies and Taft-Hartley health and welfare funds across the Midwest. Over the past two decades, we have creatively addressed the employee benefits needs of hundreds of organizations — some with as few as two employees and others with as many as 25,000 employees around the globe. A relationship with CIBC gives you access to a team of employee benefits experts who are among the most knowledgeable consultants, analysts and account managers in the industry. With more than 75 years of experience, our team commands the respect of insurers and health care providers nationwide.

Posted on August 22, 2014, in Health Care Reform, Human resources, Uncategorized and tagged , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink. Leave a comment.

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