the affordable care act

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The Affordable Care Act

Can Employers Afford It?


• Jason Altmire, Senior Vice President, Florida BlueJason is a former three term US Congressman who was a key participant in the debate on healthcare reform. He is currently responsible for public policy, government and community affairs at Florida Blue.

• Randy Jouben, Director Risk Management,FIVE GUYS Enterprises, LLCRandy is responsible for leading the mission of protecting the tangible and intangible assets of Five Guys in the areas of risk management, safety, security, business continuity and compliance.

• Chris Williams, 2nd Vice President, TravelersChris is responsible for fiduciary underwriting strategy, marketing, training, and consultation on complex fiduciary accounts. In this capacity, Chris has a deep understanding of the ACA and its exposures to ensure that he is properly training underwriters on the ACA and its related risks.


What to Expect

• Develop an understanding of legislative accommodations made to ensure enactment of ACA, and the impact thereof.

• Illustrate the Potential Benefits to Employers of the ACA.

• Recognize ACA litigation exposures, penalty exposures, and mitigation techniques.


Do Employers Understand Their Risks?

What Percentage of Employers are not at all or not very familiar with the overall requirements of the ACA?

a. 10%b. 23%c. 36%d. 42%


Employers Obligation Under the ACA

• For 2015, employers with more than 100 employees who do not to provide health insurance coverage to 70% of their full time employees (those working more than 30 hours per week) may be subjected to the following penalty:o (Number of Full Time Employees – 80) x $2000.

• For 2016:o The employee threshold is reduced to 50 from 100o The percentage increases to 95% from 70%o The penalty is calculated using the following formula:

– (Number of Full Time Employees – 30) x $2000.


Potential ACA Fiduciary Litigation Exposures

• Section 510 of ERISA prohibits discrimination or discharge of a participant solely for the purpose of interfering with the attainment of a benefit right under a plan.o Reduction in Hourso Misclassification of Employees as Independent

Contractorso Wrongful Termination


Do Employers Understand Their Risks?

Of those employers that are familiar with the ACA’s mandate, what percentage are concerned about employee lawsuits?a. 5%b. 17%c. 31%d. 45%


ACA Penalty Exposures Are Real-Section 1104 of the PPACA requires health plans to file a statement with the Secretary

of Health and Human Services certifying data and information systems are in compliance with applicable standards. A $1 per covered life penalty may be imposed until certification is complete.

-Section 1511 requires employers with more than 200 employees to automatically enroll their employees in health insurance. The penalty amount has not yet been determined.

-Section 1514 of the ACA requires large employers (50 or more) to report to the Secretary of Health and Human Services whether full time employees are offered minimum essential coverage. A $100 per person penalty is imposed for the failure to file information regarding health insurance coverage.


Getting Prepared: Mitigation Techniques

• Develop Understanding of Requirements under ACA.

• Consult outside counsel prior to changes in employment structure.

• Talk to an independent agent to consider risk transfer mechanisms and options.


Questions, Final Comments and Contact Information

Thank You for Joining us Today!

the affordable care act

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