Employers with less than 50 employees

Though companies with fewer than 50 full-time equivalent employees aren’t required to offer them, if they offer major medical coverage, it must:

  • Cover at least 60 percent actuarial value.
  • Include essential health benefits.
  • Provide certain preventive services at no cost to employees.
  • Set limits on cost-sharing.
Benefits requirements

When it comes to benefits requirements, keep the following in mind:

  • Required Communication – Employers are required to provide notice about health insurance marketplaces to all new employees within 14 days of hire
  • Benefits waiting periods – Keep enrollment waiting periods to 90 days or less.
  • Summary of benefits and coverage – If your company offers major medical insurance benefits to its workforce, a summary of benefits and coverage must be provided to all major medical insurance applicants and enrollees before benefits enrollment or re-enrollment. The SBC must provide an accurate description of the benefits and coverage under the applicable plan or coverage.
  • Keep track – Employers are responsible for keeping detailed records of employment status and hours worked by their employees. Tracking involves important details for full- and part-time employees issued by the federal government, including measurement periods and reassessment.
  • COBRA notifications – If your company offers a group health plan, exiting employees must receive a COBRA notification that includes information about health insurance marketplaces

The shared-responsibility penalty is for large employers that do not offer health insurance to their full-time employees and their dependents under the age of 26. Under the Affordable Care Act, companies with fewer than 50 full-time equivalent employees aren’t penalized for not providing employee benefits coverage.

Required reporting

Your company won’t need to submit IRS reporting for employer-sponsored health care coverage. But if you offer benefits through a self-funded health plan, you’ll need to submit minimum-essential coverage reporting annually.

The Cadillac tax

The Cadillac tax, scheduled to take effect in 2020, is equivalent to 40 percent of the cost of health coverage beyond a certain threshold, depending on the type of plan. It’s important to wait for further guidance as 2022 draws near – including the tax threshold amounts and other implementation details.