If an applicable large employer offers health coverage that is affordable and that provides minimum value to its full-time employees and offers health coverage to the dependents of those employees, will it be subject to a penalty if some of its employees don’t enroll in the coverage and purchase health insurance through the Exchange or if some of its employees enroll in Medicare or Medicaid?

As long as an applicable large employer offers affordable and minimum value coverage to substantially all of its full-time employees and their dependents, the employer will not be subject to a penalty. Moreover, an applicable large employer will not be subject to a penalty solely because one, some, or all of its employees purchase health insurance coverage through the Exchange or enroll in Medicare or Medicaid. An employer will only be liable for a penalty if at least one full-time employee receives a premium tax credit on the Exchange. In general, an employee will not be eligible for a premium tax credit if the employer has offered that employee health coverage that is affordable and provides minimum value, even if that employee rejects the offer of coverage and instead enrolls in coverage through the Exchange or enrolls in Medicare or Medicaid. If no full-time employee receives a premium tax credit, the employer will not be subject to a penalty.

Are union EEs counted in the FTE count when determining ER size for purposes of the large employer shared responsibility?

Yes.

Please describe the penalties that companies will pay when employees go to the Exchange in 2014, because the company did not provide coverage.

• Penalty if large employer fails to offer minimum essential coverage: ($2,000 x the number of full-time employees minus the first 30 full-time employees) ÷ 12
• Penalty if large employer fails to offer affordable or minimum value coverage: The lesser of ($3,000 x the number of employees who receive a premium tax credit or cost-sharing reduction) ÷ 12; or ($2,000 x the number of full-time employees minus the first 30 full-time employees) ÷ 12
• Please note, for 2015 plus any calendar months of 2016 that fall within the employer’s 2015 plan year[1], if an applicable large employer with 100 or more full-time employees (including FTEs) is subject to a penalty, the penalty will be calculated reducing the applicable large employer’s number of full-time employees by 80 rather than 30.

In 2014, if an employee wants to go to the Exchange to purchase a cheaper plan and get the premium tax credit and cost-sharing reductions, will the company be fined?

The Affordable Care Act does not require small employers to offer health care coverage. Employers with 1-50 eligible employees will not be subject to penalties for not providing health coverage.

Large employers, which are employers with an average of at least 50 full-time employees (including full-time equivalents) on business days during the preceding calendar year, must offer its full-time employees (and dependents) the opportunity to enroll in minimum essential coverage under an employer-sponsored plan that is affordable and provides minimum value or face a penalty if a full-time employee is certified to the employer to receive an applicable premium tax credit or cost-sharing reduction through the Marketplace.

For employer with 100+ employees (including FTEs) no penalty will apply during 2014 or any calendar month during the portion of the 2014 plan year that falls in 2015. For employers with 50-99 full-time employees (including FTEs), no penalty will apply during 2015 or any calendar month during the portion of the 2015 plan year that falls in 2016.

Does the employer mandate require employers to cover part-time employees?

An applicable large employer must offer its full-time employees (and dependents) the opportunity to enroll in minimum essential coverage under an employer-sponsored plan that is affordable and provides minimum value.

Are small employers who do not meet the 9.5% affordability requirement penalized/taxed?

The Affordable Care Act only requires employers that employed an average of at least 50 full-time (FT) and full-time equivalent (FTE) employees in the prior calendar year to offer Minimum Essential Coverage, that is Minimum Value and affordable, to substantially all of its FT employees and their dependents (does not include spouses).  Employers with less than 50 FT plus FTE employees will not be assessed a penalty for not meeting the affordability requirement.

Does an employer have to pay a fine if an employee opts-out of the employer’s plan (that is affordable and meets minimum value) and goes to the Exchange?

No.