Changes to some ACA requirements take effect in 2021 for employers sponsoring group health plans. To prepare for 2021, employers should review these upcoming requirements and develop a compliance strategy.

This ACA Overview provides an ACA compliance checklist for 2021.

PLAN DESIGN CHANGES

The following plan design requirements have changed for 2021:

  • Limits on cost-sharing for essential health benefits
  • Coverage affordability percentages under the employer shared responsibility rules
  • Health flexible spending account (FSA) salary contribution limits

COST-SHARING LIMITS

Under the ACA, a health plan’s out of pocket maximum for Essential Health Benefits for non-HSA plans may not exceed $8,550 for self-only coverage and $17,100 for family coverage, effective for plan years beginning on or after January 1, 2021.

The self-only annual limit on cost sharing applies to each individual, regardless
of whether the individual is enrolled in self-only coverage or family coverage. This embeds an individual out-of-pocket maximum in family coverage so that an
individual’s cost sharing for essential health benefits cannot exceed the ACA’s out of pocket maximum for self-only coverage.

For taxable years beginning in 2021, the IRS announced that the health Flexible Spending Account (FSA) limit will remain at $2,750.

SUMMARY OF BENEFITS AND COVERAGE (SBC)

Employers and health insurance issuers must provide an SBC to applicants and
enrollees to help them understand their coverage and make coverage decisions. Plans and issuers must provide the SBC to participants and benefciaries who enroll or re-enroll during an open enrollment period, as well as to participants and beneficiaries who enroll other than through an open
enrollment period, including individuals who are newly eligible for coverage and
special enrollees.

AFFORDABILITY OF COVERAGE

Under the ACA, health coverage is considered affordable if the employee’s
required contribution to the plan does not exceed 9.83% of the employee’s income for the 2021 taxable year.

An employer can measure affordability based on the employee’s Form W-2 wages, the employee’s rate of pay or the federal poverty level for a single individual, however most employers use the rate of pay of
employees.

REPORTING OF COVERAGE

The ACA requires all employers with 50 or more employees to report information to the IRS and to their full-time employees regarding the employer-sponsored health coverage they offer. The IRS will use the information that they report to verify employer-sponsored coverage and administer the employer shared responsibility provisions.

For the 2020 calendar year, returns must be fled by March 1, 2021 (since February 28 is a Sunday), or March 31, 2021, if fled electronically.

For the 2020 calendar year, the deadline to furnish the Form 1095-B and Form
1095-C is March 2, 2021.

HEALTH INSURANCE EXCHANGE & ANNUAL NOTICES

Barry Cohn, CEO of JorgensenHREmployers are required to provide all new hires and employees with a written
notice about the ACA’s health insurance Exchanges. This notice must be provided at the time of hiring and at Open Enrollment each year. The notice may be provided by first class mail, or may be provided electronically. All employees whether part time, full-time, temporary or seasonal are included in the requirement. There is one form if employees are eligible for benefits and a different form if they are not eligible.

In addition, annually, employers must provide all employees the following notices.

  • Annual Notices include:
  • Notice of Patient Protections
  • Notice of Special Enrollment Rights
  • Notice of Privacy Practices
  • Medicare Part D Credible Coverage

If you think you are not in compliance with any of the above requirements JorgensenHR may be able to help.