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As ACA regulations become more complicated, CAPS is dedicated to helping our clients stay informed and in compliance with all employer responsibilities and obligations.

Customized Reports

We understand that every client’s employee demographics and employer responsibilities are different. The ACA administrators at CAPS can help you manage those responsibilities by providing customized reports based on your specific data and requirements for staying compliant with current regulations.

CAPS Insurance Exchange

CAPS offers a robust marketplace of coverage options for individual employees. Employees can select personalized benefit plans from a variety of choices covering medical, dental, and vision, as well as home, auto, accident, and long-term care. A useful subsidy calculator allows employees to compute costs in real time.

Need Other Insurance Options?

Cast & Crew Open Health insures the entertainment industry. It provides all-inclusive ACA reporting, tracking, and a full insurance plan for eligible employees. The plan offers a budget-friendly fee structure and employers can use the service regardless of your payroll provider. Contact the CAPS ACA team to learn about how Cast & Crew Open Health can address your ACA challenges.




SECTION 1:

EMPLOYER SHARED RESPONSIBILITY (EMPLOYER MANDATE) PROVISION

  • What 2 sections of the health care reform law will become effective in calendar year 2016?

    1. The employer shared responsibility provision ( also known as the employer mandate ) requires applicable large employers (ALE’s) with 50+ full-time employees (FTE’s) to offer health care coverage to substantially all (at least 95%) of their eligible employees and dependents.
      • In 2015, this provision only applied to employers with 100+ FTE’s and the offer of coverage had to be made to at least 70% of their eligible employees and dependents.
      • The offer of health care coverage must meet Minimum Essential Coverage. See question 5 below for more information on meeting MEC.
    2. Informational returns must be filed with the IRS using either 1094-B & 1095-B or 1094-C and 1095-C and provided to your employees.

    Please use this table to understand whether you will need to make an offer of health care coverage and whether you are required to file the informational returns with the IRS in 2016.

    Employer Size Employer Mandate Responsibility Filing Responsibility
    Small Employer (0-49) Exempt Exempt unless you offered coverage through a self-funded health plan
    Medium Employer (50-99) Required to offer health care coverage to 95% of your full-time employes beginning in 2016 Forms 1094 & 1095
    Large Employer (100+) Required to offer health care coverage to at least 70% of your full-time employes in 2015 95% in 2016 Forms 1094 & 1095
  • How do I know if my company is considered an Applicable Large Employer under the ACA?

    1. If your company has at least 50 full-time and full-time equivalent employees for more than 120 days in the preceding calendar year you are considered an ALE.
    2. CAPS Payroll can provide you with a report tracking your employee’s hours to help you assess whether your employees will meet the full-time employee threshold.
    3. A full-time employee is defined as an employee who works an average of 30 hours a week (also can be calculated as 130 hours a month). For variable hour employees, an employer can determine full-time status by calculating the number of hours they worked during a pre-determined “look-back” measurement period, which can range in length from 3-12 months.
    4. In addition to counting full-time employees, employers must also take into account the hours that their part-time employees worked in order to determine how many “full-time equivalents” or FTE’s they have. Full-time equivalents are calculated by adding the total number of hours their part-time employees worked for the month and dividing by 120 (e.g. 240 part-time hours worked in January/120 = 2 FTE’s). No single employee can have more than 120 hours of service in each calendar month.

    For example, if an employer has 48 full-time employees and determined that they have 4 FTE’s, they are considered an ALE and must offer health care coverage to their eligible employees.

  • To whom must I offer health care coverage?

    1. The ACA requires that you offer a health care plan with at least a 60% “actuarial value” to full-time eligible employees and their child dependents up to age 26. You do not need to offer coverage to spouses.
    2. When determining whether you should offer health care coverage, you should take the intent upon hire into consideration. For example, if an employee was hired in a full-time position or the employer could reasonably predict full-time status, the same “look-back” measurement period procedure for variable hour employees does not apply. For a fulltime employee, you must evaluate their hours within the first 3 months and if you determine that they are eligible, an offer of coverage must be made by the first day of the 4th month.
  • Will I be penalized if I haven't offered health care coverage to my employees?

    1. It is possible that your company may be penalized if you meet certain criteria. Only ALE’s with over 100+ employees may be assessed a penalty for calendar year 2015.
    2. If your company is an ALE and you either did not offer a health care plan to substantially all of your employees, if the plan you offered did not cover at least 60% of the costs, or if it was deemed unaffordable you may be penalized if any of your eligible employees purchases a federally subsidized plan in the public marketplace.
    3. Please review the decision tree on the last page of this FAQ for more information on the penalties.
  • What qualifies a plan as meeting minimum essential coverage?

    1. In order for a health care plan to meet requirements under the ACA, the plan must meet MINIMUM ESSENTIAL COVERAGE and must be deemed AFFORDABLE.
    • 1. Minimum Essential Coverage means that the health care plan must be designed to pay at least 60% of the covered benefit.
    • 2. Affordability means that employee-only coverage cannot be more than 9.5% of the employee’s household income. The IRS has provided employers with three distinct methods to determine whether a plan is affordable. Please visit the IRS webpage by clicking here to learn more about these safe harbors.
  • Do I need to offer a health plan to employees who are covered under a collective bargaining agreement?

    1. You do not need to offer a health plan to an employee if they are a member of a collective bargaining unit (union) that provides an employee benefits program compliant with ACA health plan rules.
  • How do I know if my union employees will be offered an ACA-compliant plan?

    1. Ask the union to confirm that they offer compliant coverage if they are contributing to employee coverage.
  • Can CAPS help me choose a plan if I have to offer health care coverage to my employees?

    1. Absolutely! To find out more about your customized health care solution, please contact ACA@capspayroll.com.

SECTION 2:

Information returns (forms 1094-B & C and 1095-B & C)

  • Will CAPS be filing Forms 1094 and 1095 on our behalf?

    1. As the common law employer, the ultimate responsibility for completing, filing, and furnishing these forms is up to your company. While CAPS will provide you with the data that we have available, we do not have all of the necessary data to complete the forms on your behalf.
  • How will CAPS be providing us with employee data to complete Forms 1095?

    1. In early 2016, CAPS will provide each one of our clients with an employee summary report for 2015. It will contain all of the necessary information on an individual employee basis to assist you in completing the 2016 reporting requirements.
  • What’s the difference between Forms 1094 and 1095?

    1. Forms 1094 are summaries and must be mailed to the IRS by May 31, 2016 or by June 30 if filing electronically. ALE’s with 250+ employees must file electronically.
    2. Forms 1095 are individualized employee statements and must be mailed to the IRS by May 31, 2016 or by June 30 if filing electronically. Forms 1095 must also be mailed to your employees by March 31, 2016.
  • Is there any way for me to get an extension on these due dates?

    1. No. The IRS has already provided extensions to the original due dates so no other extensions will be granted.
  • There are several different forms. Which ones do I have to complete?

    1. CAPS has created the following table to help you understand which forms you need to complete.
    Group Type
    Small = 0-49 FTE's
    Large = 50+ FTE's
    Employer Health Plan Employer Files
    Forms 1094-B /
    1095-B
    Employer Files
    Forms 1094-C / 1095-C
    Small Employer Fully Insured No (Insurer Files) No
    Small Employer Self-Insured Yes (Parts I, III, and IV on Form 1095-B) No
    Small Employer Multiemployer Plan Yes (Parts I, III, and IV on Form 1095-B) No
    Large Employer Fully Insured No (Insurer Files) Yes (Parts I, II on Form 1095-C)
    Large Employer Self Insured No Yes
    Large Employer Multiemployer Plan No (Insurer Files) Yes (Parts I, II on Form 1095-C)
  • How do I fill out Form 1095-C if my employees are members of a union?

    1. The most recent instructions on how to complete Form 1095-C specify that your filing requirements can be fulfilled by completing Part I and Part II of this form. In Part II, you would input Code 1H (no offer of coverage) and Code 2E (multiemployer interim rule relief) on lines 14 and 16, respectively. Part III will be completed by the insurance plan. (At time of publication, the most recent instructions were published on September 16, 2015. You can access these instructions by clicking here.)
  • What penalties are being assessed for non-compliance with these requirements?

    1. As this is the first year that anyone will be filing these forms, the IRS has stressed that it’s most important that you file the forms on time and that you make a good faith effort to complete the forms correctly. The penalty for failing to file the informational returns is $250 per form not to exceed $3 million.
    2. Please see our decision tree below to determine your possible Employer Shared Responsibility Penalties.
    3. *Penalties are annual amounts and are assessed monthly.
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