What the Affordable Care Act Means for Your Business

A guest column by Mark Stulmaker, one of Lipsitz Green Scime Cambria’s employee benefits attorneys, appears in the November 2 issue of the Buffalo Law Journal. In “New ACA requirements for small business”, Mr. Stulmaker discusses the Affordable Care Act changes that will go into effect on January 1, 2016 for small businesses. He explains how the definition of a small business will change and the various regulations that these businesses will now have to follow, including what benefits must be provided to employees and how employers are expected to comply.

Read the full article on the Buffalo Law Journal website.

Redefinition of small business

Currently, the ACA views a small business as having 50 or fewer full-time, or full-time equivalent, employees. On January 1, that number will increase to 100 employees. New health insurance plans provided by small businesses must be priced using community rating, which means that everyone pays the same rate within a geographic area, regardless of individual health risks, occupations, or medical histories. New York requires strict community
rating, without any variation in premiums for age or sex.

Essential health benefits

Small-group health plans are required to provide the Essential Health Benefits described by the ACA. These benefits include:
  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services
  • Laboratory services and testing
  • Preventive and wellness services
  • Pediatric services

SHOP Exchange

When the ACA changes take effect in 2016, small businesses with 100 or fewer full-time-equivalent employees can choose to purchase their insurance through the Small Business Health Options Program (SHOP) in order to satisfy health insurance requirements. For plan years that start on or after January 1, small businesses are eligible for SHOP if:

  • The business has a physical address in New York State
  • At least one common-law employee is enrolled in coverage
  • The business has 100 or fewer full-time equivalent workers
  • Coverage is offered through SHOP to all eligible employees who work at least 30 hours per week

While SHOP is not a requirement, small businesses who choose to participate can get lower costs on group plans and claim tax credits.

Who can help

Navigating employee benefits can be confusing, especially in the wake of changing regulations. The employee benefits attorneys at Lipsitz Green Scime Cambria have the experience and knowledge to guide employers through the issues associated with the ACA, HIPPA, COBRA, and other related matters. Lipsitz Green has been named to U.S. News & World Report/Best Lawyers’ “Best Law Firms” for Employee Benefits (ERISA) Law. Call our attorneys today for guidance regarding
your employee benefits needs.

This article does not purport to give legal advice and is for informational purposes only.