Employer Responsibilities

Under the Affordable Care Act (ACA), employers are not forced to offer health benefits to their employees, but starting in 2014 larger businesses (with 50 or more employees) will have to pay a penalty for a lack of affordable coverage if any of their employees receive financial support from the government to buy health coverage.

With declining reimbursement, neurologists who own their practice will have to consider what to do about employee insurance. Some options include dropping health insurance as a benefit, having employees contribute a greater share toward their premium, or seeking a qualifying high deductible plan that reduces insurance costs over the long-term for the practice.

You might be able to achieve some savings from reduced premiums for employees who experienced health problems, because insurers will not be able to set premiums based on the health status of an individual. Premiums will vary only due to tobacco use, participation in wellness programs participation, age and geographic location.

If you currently offer a comprehensive coverage to your employees, you may grandfather your plan and keep it as it is (plus include the extension of coverage for dependents that are 26 or younger). If you decide to change the plan you currently offer, you will have to make sure that your new plan complies with new standards (e.g. no denials of coverage based on pre-existing condition).

If you decide to purchase new coverage, you may do so through a state-based Small Business Health Options Program (SHOP) Exchange (as long as you have fewer than 100 employees). The SHOP Exchange should make it easier to compare various plans. Also, if you buy coverage via the Exchange, you may qualify for a tax credit to help pay for employees' premiums.

Fewer than 25 full-time employees
You are excused from penalties even if you don't offer coverage.

You are eligible for a tax credit to help pay for your employees' premiums if you:

• Hire no more than 25 employees with average annual wages of less than $50,000;
• Contribute at least 50% to your employees total premium costs; and
• Purchase the coverage via a SHOP Exchange.

The tax credit may pay for up to 50% of your contribution toward your employee's health insurance premium. If you hire less than 10 employees with annual wages of less than $25,000 you will receive a full tax credit. In both instances, you will receive the tax credit for 2 years beginning with the first year in which you offer coverage to your employees via a SHOP Exchange.

Fewer than 50 full-time employees
You are excused from penalties even if you don't offer coverage, however you are not eligible for a tax credit to help pay for employees' premiums.

Over 50 full-time employees
You are not forced to offer coverage but you must pay a penalty if at least one of your full-time employees received a financial support (via a State Insurance Exchange) from the government to purchase coverage:

• If you don't offer coverage to your employees and at least one of your employees receives a premium tax credit or cost-sharing reduction, the penalty is $2,000 per each full time employee (minus 30 employees).
• If you offer coverage, yet still one of your employees receives the premium tax credit or cost-sharing reduction, you will pay a penalty for not offering affordable coverage.  The penalty is the lesser of the following: $3,000 per each employee receiving a premium tax credit; or $2,000 for each full time employee (minus 30 employees).

Some businesses may decide to drop the coverage because it might be less expensive to pay a 'fine'; particularly in the face of continued declines in reimbursement rates and physician salaries. 

Over 200 employees
Businesses that employ more than 200 employees must automatically enroll them into a health benefits plan offered through the employer.