Play or Pay Penalty Notices Are Coming

Affordable-Care-Act-Pay-or-Play-RequirementsThe Internal Revenue Service (IRS) has started the process of levying penalties on employers under the Affordable Care Act (ACA) employer shared responsibility provision. Often called the employer mandate or play or pay, the ACA provides for the IRS to assess penalties on employers that do not offer adequate health coverage to their full-time employees. Although the mandate took effect in 2015, the IRS is just now starting to send penalty notices. This article explains the IRS process and the steps you can take if you receive a penalty notice.

Looking Back to 2015
The first round of penalty notices pertains to calendar year 2015. Employers that receive a notice will only have 30 days to respond, so it is advisable for all employers to prepare in advance by reviewing what their situation was in 2015.

Applicable Large Employer (ALE):
For 2015, the play or pay rules applied only to employers that had an average of 50 or more full-time employees, including full-time equivalents, in 2014. Related employers in a controlled group, such as parent-subsidiary groups and entities under common ownership, were counted together to determine whether they were ALEs. Non-ALEs were exempt from the mandate.

Employer Mandate:
Penalties were triggered only if a full-time employee received a government subsidy to buy individual health insurance through a Marketplace. In that case, penalties for 2015 were based on a two-prong test:

  • Penalty A if the ALE failed to offer minimum essential coverage to at least 70% of its full-time employees; or
  • Penalty B if the ALE failed to offer affordable minimum value coverage to its full-time employees.

If triggered, Penalty A is $2,080 times the total number of full-time employees minus the first 80 employees. Penalty B is $3,120 times the number of full-time employees who actually received a Marketplace subsidy due to employer’s failure to offer that employee affordable minimum value coverage. Amounts are pro-rated by month. To calculate the monthly amount, divide $2,080 and $3,120 by 12. Also, if Penalty A applies, then Penalty B is disregarded.

 

ACA Reporting Forms (1094-C/1095-C):
ALEs were required to prepare and distribute Form 1095-C to persons who were full-time employees for any month in 2015 and to file copies with transmittal Form 1094-C to the IRS. The forms reported whether each full-time employee was offered health coverage and, if so, whether the coverage was affordable.

Transition Relief:

Several transition relief provisions were available for 2015.
For example:
  • ALEs that had an average of 50-99 full-time-equivalent employees in 2014, and did not materially reduce their workforce or health coverage through 2015, were exempt from penalties.
  • ALEs with non-calendar year health plans generally were exempt from penalties for the months preceding their 2015 plan year start date.

To take advantage of a transition relief provision, the ALE’s completed 2015 Form 1094-C must indicate the specific provision.

IRS Penalty Process
The IRS is using information from 2015 Forms 1095-C and 1094-C, and information about employees who received a Marketplace subsidy for any month in 2015, to determine which ALEs it believes are liable for penalties. It appears that a Form 1095-C on which line 16 is blank is one of the triggers the IRS is using to identify ALEs for penalty notices. The penalty process consists of the steps below.

 

1. The IRS sends Letter 226J (notice and instructions) along with Form 14765 (list of employees who received a Marketplace subsidy) and Form 14764 (employer response form). ALEs are instructed to review the information and respond within 30 days.

2. The ALE responds by completing and returning Form 14764. The ALE will check a box to indicate whether it agrees with the proposed penalty or disagrees with part or all of the proposed penalty. The form also requires the ALE’s contact information for additional follow-up.

3. If the ALE responds by agreeing with the proposed penalty, the ALE will complete the payment option section of the form.

4. If the ALE responds by disagreeing in whole or part with the proposed penalty, the IRS sends Letter 227 (not yet available). The follow-up letter will instruct the ALE on how to present supporting information for its case. The ALE also will have the option of requesting a pre-assessment conference with the IRS.

5. If the ALE fails to respond to Letter 226J or Letter 227 in a timely manner, the IRS will issue Notice CP 220J as a demand for payment.

Action Steps

Employers are advised to gather information now so they are prepared to respond quickly if they receive an IRS penalty notice. Again, the first notice will be Letter 226J and the employer will only have 30 days to respond. To prepare:

1. Alert all departments and staff to keep an eye out for any material from the U.S. Treasury or IRS. If part of a controlled group, confirm that subsidiaries or affiliated companies will notify each other if they receive any material.

2. Ensure that copies of all 2015 Forms 1095-C and 1094-C are readily available. Many ALEs used third-party vendors to prepare their forms, so it may be necessary to contact the vendor.

3. Identify staff and establish an audit process for comparing the IRS notice against employee data and benefits records.

4. Upon receipt of Letter 226J, refer to legal counsel for assistance in preparing a timely response. Lastly, note that the majority of employers will not receive an IRS notice, either because the employer was too small to meet the ALE definition or because the employer’s Forms 1095-C and 1094-C did not trigger any IRS action. In any case, an employer will not be on the IRS radar unless at least one of its employees received a Marketplace subsidy.

The IRS provides information about the penalty process in question-and-answer format on its Understanding your Letter 226-J webpage. Employers and their advisors should check the webpage periodically for updated information.

This article was reprinted from ThinkHR

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Hey Kids, Get to Work!

kids-workIf you have come to the conclusion that it is time for your children to start contributing to the revenue (rather than expense) side of your family’s income statement, there are a few things you need to know. Below is a good summary of things to consider before hiring your children to work for you:

Louisiana Employment of Minors

Child Labor

Louisiana’s child labor law is located at La. Rev. Stat. Ann. §§ 23:151 – 23:258. The law generally applies to any employer who employs minors. The law does not apply to minors employed in agriculture or domestic services in private homes.

Prohibited Employment

Minors Under 14

As a general rule, minors under 14 may not be employed at any time in Louisiana. However, minors under 14 may be employed if all of the following conditions are met:

  • The minor is at least 12 years old.
  • The minor’s parent or legal guardian is an owner or partner in the business in which the minor is to be employed.
  • The minor will work only under the direct supervision of the parent or legal guardian who owns or is a partner in the business.
  • All of the protections afforded to minors age 14 and 15 are afforded to minors age 12 and 13.
  • The minor obtains an employment certificate.

Minors Under 16

Minors under 16 may not be employed in the following occupations:

  • In connection with a poolroom or billiard room.
  • In connection with power-driven machinery.
  • In a manufacturing, processing, or mechanical establishment or occupation.
  • Close to any lounge or other location where alcoholic beverages are sold, except as otherwise provided by law.
  • In the distribution or delivery of goods or messages for any person engaged in the business of transmitting or delivering goods or messages.
  • Driving any motor vehicle on a public road.

Minors Under 18

Minors under 18 may not be employed in the following occupations:

  • In oiling, cleaning, or wiping machinery or shafting or applying belts to pulleys.
  • In or about any mine or quarry.
  • In or about places where stone cutting or polishing is done.
  • In or about plants that use, transport, or manufacture explosives or articles containing explosive components.
  • In or about iron or steel manufacturing plants, ore reduction works, smelters, foundries, forging shops, hot rolling mills, or in any other place in which the heat treatment of metals is done.
  • In the operation of machinery used in the cold rolling of heavy metals or in the operation of power-driven machinery for punching, shearing, stamping, bending, or planing metals.
  • In or about sawmills or cooperage stock mills.
  • In the operation of power-driven woodworking machines or off-bearing from circular saws.
  • In logging operations.
  • In the operation of a school bus transporting children to or from school.
  • In the operation of passenger or freight elevators or hoisting machines.
  • In spray painting or in occupations involving exposure to lead or its compounds or to dangerous or poisonous dyes and chemicals.
  • In any place in which the sale of alcoholic beverages constitutes its main business, unless the minor has a written contract to perform and is under the supervision of a parent or legal guardian. An establishment with a retail dealer’s alcoholic beverage permit or license where the sale of alcohol is not the main business may employ a person under 18 if the employment does not involve the sale, mixing, dispensing, or serving of alcoholic beverages for consumption on the premises.
  • In any establishment or occupation that the Executive Director of the Louisiana Workforce Commission determines hazardous or injurious to the life, health, safety, or welfare of the minor.

Theatrical Employment

A minor under 16 may not be employed, exhibited, used, or trained for exhibition in the following occupations:

  • As a rope or wirewalker, gymnast, wrestler, contortionist, stunt rider, or acrobat on a bicycle or other similar vehicle or contrivance.
  • In any illegal, indecent, or immoral exhibition or practice.
  • In an exhibition as insane or idiotic or when presenting the appearance of any deformity or unnatural physical formation or development.
  • In any practice, exhibition, or place considered to be dangerous or injurious to the minor.

Permitted Employment

Employment of minors 16 or older who are enrolled in or have completed an accredited nautical science-training program upon a vessel that is documented or registered under the laws of the United States is permitted.

Hours of Employment

Minors 14 and 15 may be employed after school hours and during nonschool days. Additionally, minors under 16 may not be employed under the following criteria:

  • More than eight hours in any one day.
  • More than six consecutive days or 40 hours in one week.
  • More than three hours on any school day.
  • More than 18 hours in any one school week.

The school calendar of the school in which the minor is enrolled or the public school calendar for the district in which the minor resides is used to determine a school day or week.

Minors who have not graduated from high school are bound by the following provisions:

  • Minors under age 16 may not be employed between the hours of 7 p.m. and 7 a.m.; except from June 1st through Labor Day at which time the permissible hours are extended to 9 p.m. Minors who are employed in the dairy industry are exempt from this restriction.
  • Minors 16 years of age may not be employed between the hours of 11 p.m. and 5 a.m. prior to the start of any school day.
  • Minors 17 years of age may not be employed between the hours of 12 a.m. and 5 a.m. prior to the start of any school day.

Additionally, a minor who has taken and passed a General Education Development test (GED) and who has been awarded a high school Equivalency Diploma from the Louisiana Department of Education will be considered to have graduated from high school.

Note: Employment of minors also is subject to the provisions of any local curfew ordinance.

Meal Periods

No minor may be employed for any five-hour period without one interval of at least 30 minutes for meals. If the period of work before the interval exceeds five hours by 10 minutes or less, that difference is considered de minimis and not a violation of the law. The interval may not be included as part of the working hours of the day and the interval must be 30 minutes.

If the length of the meal break is at least 20 minutes, the difference between the actual break time and the required 30-minute break time is considered de minimis, and is not considered a violation of the law. The break must be documented, using the employer’s normal timekeeping system. If a minor fails to clock in or out for a work period or meal break, and a time edit is necessary, the time edit must be documented and acknowledged in writing by the minor and the manager who performs the time edit.

Presumption of Employment

The presence of any minor under 16 in any place of employment prohibited to the minor and observed to be performing work duties on the employer’s behalf constitutes prima facie evidence of the minor’s employment therein.

Employment Certificates

An employer of minors must keep on file an employment certificate for each minor, except for those minors employed in approved federally funded youth training programs and those minors employed in theatrical, modeling, motion picture or television production, musical occupations, or in other performing arts. The certificate must be accessible on the jobsite at all times and available to any officer charged with the enforcement of Louisiana’s child labor law.

Employment certificates will be issued upon the application by the minor desiring employment along with a written permission from the minor’s parent or legal guardian. The issuing officer must approve the following papers before issuing a certificate:

  • A signed statement from the prospective employer stating the nature of the occupation, the number of hours per day and per week, and the wages the minor is to receive.
  • One of the following proofs of age:
    • Birth certificate.
    • Baptismal certificate.
    • Contemporaneous bible record of birth.
    • Passport or certificate of arrival in the United States showing the age, dated at least two years prior to the application date.
    • Life insurance policy covering the minor, dated at least two years prior to the application date.
    • School record or school identification showing the minor’s age.
    • Current valid Louisiana driver’s license or other state-issued identification, including a special identification card, with the minor’s date of birth.
    • An affidavit signed by the minor’s parent or legal guardian showing the minor’s name, date and place of birth, and a statement that no other proofs of age can be produced.

Employment certificates, including those for home study students, may be issued by any of the following:

  • The parish or city public school superintendent or designated agent.
  • The principal of a public or private school or designated representative.

If the student is a home study program participant, the employment certificate may be issued by any person authorized by the Louisiana Workforce Commission.

The superintendent of the parish, city, or other public school governing authority or a designee, or the private school principal or a designee, must completely fill out and electronically submit the Employment Certificate Interactive Form located on the Louisiana Workforce Commission’s website. The online employment certificate, which includes the information that was entered onto the Department of Labor’s employment certificate database, is to be printed, signed by the minor and the issuing authority, and presented to the minor for delivery to the employer. The employment certificate must be signed by the minor in the presence of the issuing authority and then it must be returned to the minor for delivery to the employer. An employment certificate is valid only for the employer for whom issued, and the employer is required to maintain it on file for a period of 14 days after the minor’s termination of the employment.

Under certain circumstances, such as athletic events, exhibitions, fairs, carnivals, or similar events, the Assistant Secretary of the Office of Regulatory Services may authorize the issuance of a blanket work permit. Blanket permits expire 60 days after issuance.

Recordkeeping Requirements

Every employer of a minor must keep on file an employment certificate or work permit for each minor, except for those employed in approved federally funded youth training programs and those minors employed in theatrical, modeling, motion picture or television production, musical occupations, or in other performing arts. The certificate or permit must be accessible on the jobsite or in the immediate area of the work location at all times and available to any officer charged with the enforcement of Louisiana’s child labor law.

The executive director or authorized representatives may have access to the employment certificates kept on file by the employer as well as all other records that may aid in the enforcement of the child labor law.

Notice Requirements

Every employer must keep conspicuously posted in the establishment a printed abstract of Louisiana’s child labor law and a list of the occupations prohibited to minors. The Executive Director of the Louisiana Workforce Commission may furnish these abstracts.

Enforcement

The executive director or an authorized representative will visit and inspect — at all reasonable times and as often as possible — all places where minors are employed. The secretary or authorized representative may have access to the employment certificates kept on file by the employer as well as all other records that may aid in the enforcement of the child labor law.

Penalties

Any person who violates Louisiana’s child labor law by refusing to allow inspection of the workplace, obstructing enforcement of the law, hiding minors, or helping them escape from a law enforcement officer will be fined between $100 and $500, imprisoned between 30 days and six months, or both. In addition to criminal penalties, anyone who violates the state’s child labor law will be liable for a civil penalty of up to $500. Each day in which a violation continues and each minor employed illegally constitutes a separate offense.

Any talent agent or person who employs, exhibits, uses, or trains for the purpose of exhibition, or who consents or neglects to restrain a minor from engaging in theatrical employment illegally will be guilty of contributing to the delinquency of minors. Upon conviction, such a person will be fined up to $1,000, imprisoned for up to two years, or both and will be liable for a civil penalty of up to $500.

Employers who unlawfully hire minors under 18 to drive school buses will be fined between $25 and $500, imprisoned for up to six months, or both.

Child Performer Trust Act

The Child Performer Trust Act (located at La. Stat. Ann. §§ 51:2131 – 2135) applies to any contract in which a minor is employed or agrees to render artistic or creative services for compensation of $500 or more in Louisiana, which is not otherwise prohibited by law, directly or through a third-party individual or personal services corporation, a loan-out company, or through an agency or service that provides artistic or creative services including, but not limited to, a casting agency or other similar entity.

Artistic or creative services include, but are not limited to, the following services:

  • Actor or actress.
  • Dancer, musician, comedian, or singer.
  • Stunt person or voice-over artist.
  • Any other performer or entertainer in any motion picture, television, radio, theatrical, or sports production or commercial production.

Every contract executed by or on behalf of a minor rendering artistic or creative services for compensation must require that 15 percent of the gross earnings for the minor, under the contract, be placed in a trust fund created for the minor’s benefit. Prior to the execution of any such contract the trust must be established, unless an account was previously established, and the trustee must provide the employer with a written statement that includes the particulars of the trust. Employers may require more information from the trustee prior to executing the minor’s contract.

In the event that a trust account was not established on behalf of a minor performer within 30 days of the last day of employment, the employer must forward the 15 percent of the minor’s gross earnings, accompanied by the name of the minor, and, if known, the minor’s address and Social Security number, to the Louisiana Treasurer, who will hold the funds in trust to be transferred to a trust account that is subsequently established on behalf of the minor. However, if no such trust account is established, the minor will receive the trust monies upon reaching age 18. After completing the transfer to the treasurer, the employer has no further duty or obligation with respect to the transferred monies.

Education Requirement

Every contract or employment arrangement agreed to by parties subject to the Child Performer Trust Act must include provisions for the education of the minor being employed to render artistic or creative services. If a minor is absent from school for two or more days within a 30-day period, the employer must do the following:

  • Employ a certified teacher beginning on the second day of employment.
  • Ensure that the teacher provide a minimum of three education instruction hours per day to the minor, pursuant to the lesson plans for the particular minor, as provided by the principal and teachers at the minor’s school.
  • Ensure that there is a teacher-to-student ratio of one teacher for every 10 students.

Note: No minors’ employment regulated under the Child Performer Trust Act may occur without the issuance of a written permit from the Louisiana Workforce Commission.

Contact Information

Louisiana Workforce Commission
www.laworks.net

Affordable Care? 2017 Rates are Out Now!

middle-class-worker-help-obamacare

Here is a personal look at the impact of the impact the Affordable Care Act has had on me and my family.  For reference, in the beginning of 2016, I was 45, my wife 42 and my kids 13, 10 and 5.  Unfortunately, we are all a year older going into 2017.

I am using Blue Cross of Louisiana’s most popular Gold-level plan for my unsubsidized premium comparison.  The plan has a $1,000 deductible ($3,000 for the family) and and out of pocket maximum of $5,000 going down to $4,800 in 2017 ($10,000 going down to $9,600 in 2017 for the family).

  • 2016 Premiums – $1,583.70 per month or $19,004.40 for the year
  • 2017 Premiums – $2,023.05 per month or $24,276.60 for the year

That is an increase of $439.35 per month or $5,272.20 for the year.  It also represents a 27% rate increase.  OUCH!!!

My wife and I both work (pretty hard, I might add).  To be fair, if our combined income was lower, we would qualify for some help with this premium.  You can check your own subsidy availability here.  At $113,000 in combined family income, we would qualify for $303/month in help.  At $114,000 or more, we do not qualify for any help.  I think this is what President Clinton referred to as “the craziest thing in the world.”

Some more broad trends of note:

  • the % increase on some “more affordable” plans (silver and bronze level) is as much as 44%
  • there are more “narrow network” plans this year – both in total number and more drastically in % of total plans available.
  • comparable small group plans are significantly better priced and offer significantly more coverage options.  See – The Small Business Health Insurance Roller Coaster – What is Next? – If you have a business or influence with your small employer, it may be time to run some numbers.

I hope our next President and Congress work together for a better solution for all of our sake. This is not sustainable.

 

New Special Enrollment Confirmation Process

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Due to concerns about whether current federal Health Insurance Marketplace rules and procedures are sufficient to ensure that only those who are eligible enroll through special enrollment periods, the Centers for Medicare & Medicaid Services (CMS) has created a new verification process for individuals to apply.

How Special Enrollment Confirmation Works
Beginning in the next several months, all consumers who enroll or change plans using a special enrollment period for any of the following triggering events will be directed to submit documentation to verify their eligibility:

  • Loss of minimum essential coverage;
  • Permanent move;
  • Birth, adoption, placement for adoption, placement for foster care or child support or other court order; or
  • Marriage.

CMS will provide consumers with lists of qualifying documents, such as a birth or marriage certificate. Consumers will be able to upload documents to their HealthCare.gov accounts or mail them in.

For more information about implementation of the new process, please review the CMS announcement and Fact Sheet.

Indicator Codes for Employee Offer and Coverage (Form 1095-C, Line 14)

In case you don’t recognize the format, this is an excerpt from an IRS favorite: Instructions for Forms 1094-C and 1095-C.

Code Series 1— Offer of Coverage.   The Code Series 1 indicator codes specify the type of coverage, if any, offered to an employee, the employee’s spouse, and the employee’s dependents. The term “dependent” has the specific meaning set forth in the Definitions section of these instructions. In addition, for this purpose an offer of coverage is treated as made to an employee’s dependents only if the offer of coverage is made to an unlimited number of dependents regardless of the actual number of dependents, if any, an employee has during any particular calendar month.  An offer of COBRA continuation coverage that is made to a former employee upon termination of employment should not be reported as an offer of coverage on line 14. For a terminated employee, code 1H (No offer of coverage) should be entered for any month for which the offer of COBRA continuation coverage applies.  An offer of COBRA continuation coverage that is made to an active employee (for instance, an offer of COBRA continuation coverage that is made due to a reduction in the employee’s hours that resulted in the employee no longer being eligible for coverage under a plan) is reported in the same manner and using the same code as an offer of that type of coverage to any other active employee.  If the type of coverage, if any, offered to an employee was the same for all 12 months in the calendar year, enter the Code Series 1 indicator code corresponding to the type of coverage offered in the “All 12 Months” box or in each of the 12 boxes for the calendar months.

  • 1A. Qualifying Offer: Minimum essential coverage providing minimum value offered to full-time employee with employee contribution for self-only coverage equal to or less than 9.5% mainland single federal poverty line and at least minimum essential coverage offered to spouse and dependent(s).

    This code may be used to report for specific months for which a Qualifying Offer was made, even if the employee did not receive a Qualifying Offer for all 12 months of the calendar year. However, an employer may not use the Alternative Furnishing Method for an employee who did not receive a Qualifying Offer for all 12 calendar months (except in cases in which the employer is eligible for and reports using the Alternative Furnishing Method for 2015 Qualifying Offer Method Transition Relief as described in these instructions).

  • 1B. Minimum essential coverage providing minimum value offered to employee only.
  • 1C. Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) (not spouse).
  • 1D. Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to spouse (not dependent(s)).
  • 1E. Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) and spouse.
  • 1F. Minimum essential coverage NOT providing minimum value offered to employee; employee and spouse or dependent(s); or employee, spouse and dependents.
  • 1G. Offer of coverage to employee who was not a full-time employee for any month of the calendar year (which may include one or more months in which the individual was not an employee) and who enrolled in self-insured coverage for one or more months of the calendar year.
  • 1H. No offer of coverage (employee not offered any health coverage or employee offered coverage that is not minimum essential coverage, which may include one or more months in which the individual was not an employee).
  • 1I. Qualifying Offer Transition Relief 2015: Employee (and spouse or dependents) received no offer of coverage; received an offer that is not a qualifying offer; or received a qualifying offer for less than 12 months.

2015 ACA Reporting is Delayed

Specifically, the Notice extends:

  • the due date for furnishing to individuals the 2015 Form 1095-B and Form 1095-C from February 1, 2016, to March 31, 2016, and

  • the due date for filing with the IRS the 2015 Form 1094-B, Form 1094-C and Form 1095-C from February 29, 2016, to May 31, 2016, if not filing electronically, and from March 31, 2016, to June 30, 2016 if filing electronically.

For detailed information about these Forms, please see our earlier article.

In the Notice, the IRS also grants special relief to certain employees and related individuals who receive their Form 1095-C or Form 1095-B, as applicable, after they have filed their returns:

  • For 2015 only, individuals who rely upon other information received from employers about their offers of coverage for purposes of determining eligibility for the premium tax credit when filing their income tax returns will NOT be required to amend their returns once they receive their Forms 1095-C or any corrected Forms 1095-C.

  • For 2015 only, individuals who rely upon other information received from their coverage providers about their coverage for purposes of filing their returns will NOT be required to amend their returns once they receive the Form 1095-B or Form 1095-C or any corrections.

Thus, generally, employers should not be concerned that furnishing these Forms on a delayed basis in accordance with the Notice will force employees to file amended 2015 income tax returns.

Finally, the extensions do not require the submission of any request or other documentation to the IRS and have no effect on information reporting provisions for other years.

From the great folks at Jackson Lewis P.C. © 2015

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