The document summarizes key aspects of the Affordable Care Act (ACA) for employers. It discusses who is affected by the employer mandate based on company size, what requirements employers must meet to be compliant including offering affordable minimum essential coverage and tracking employee data, when forms must be filed by (deadlines in early 2016), and why employers should comply to avoid penalties. It also outlines how the Zenefits platform can help companies document coverage offered, track employee hours and leaves to prove good faith efforts at compliance.

1. Implications of the Affordable Care
Act for Employers
Bob Kocher, M.D.
A P R E S E N T A T I O N B Y

2. Why Am I (Bob) Here?
S E C T I O N 1

3. 3
Healthcare Consulting
Doctor at Harvard
Healthcare Reform
F R O M
Partner at Venrock
T O
T O
T O

4. 4
T H E P R O B L E M
spent on healthcare and
nobody is happy with the
results
$3.1 trillion

5. 5
T H E S O L U T I O N
The Affordable Care Act
Key provisions are intended to extend coverage to
millions of uninsured Americans, to implement measures
that will lower health care costs and improve system
efficiency, and to eliminate industry practices that include
cancellation and denial of coverage due to pre-existing
conditions.

6. Key ACA Takeaways for Employers
S E C T I O N 2

7. Goals of the ACA
R E D U C E C O S T S
E X PA N D C O V E R A G E
I N C R E A S E Q U A L I T Y

8. 8
G O A L 1 : R E D U C E H E A L T H C A R E C O S T S
Commercial healthcare premiums lowest in 50
years
Last 5 years of healthcare costs = slowest growth
ever (in the history of Medicare)
A C C O M P L I S H M E N T S

9. 9
G O A L 2 : E X P A N D I N S U R A N C E C O V E R A G E
America has the lowest rate of uninsured in all
time
Waiting times for patients have NOT changed at
all
A C C O M P L I S H M E N T S

10. 10
G O A L 3 : I N C R E A S E Q U A L I T Y C A R E
700,000 less patients readmitted to hospitals within 30 days
17% drop in hospital-acquired infections since 2010
A C C O M P L I S H M E N T S

11. The ACA and You
T H E W H O , W H AT, W H E N , A N D W H Y ?

12. WHO
T H E

13. 13
T H E W H O
Companies with 100+ full-time employees
Companies with 50-99 full-time
employees
(but you may qualify for transition relief)
The ACA considers you an Applicable Large Employer (ALE) if your company has 50+ full-time employees and full-time
equivalent employees (FT/FTE). Compliance with the ACA employer mandate in 2015 is based on the size of your company in
2014. Affiliated employers may be treated as one employer in determining ALE status.
WHO needs to comply with the ACA?

14. 14
T H E W H O
Calculating your full-time employees
40 Full Time Employees (30 hours/wk)
+
20 Part-Time Employees (15 hours/wk)
50 FTEs
Note: Rules are even more complicated for seasonal workers.
E X A M P L E

15. 15
T H E W H O
 Limited Workforce Size. An employer must employ on average between 50-99 FT
employees (including FTEs) on business days during 2014.
 Maintenance of Workforce and Aggregate Hours of Service. From February 9th, 2014
to December 31st, 2014, an employer may not reduce the size of its workforce or its
employees’ hours of service purely to qualify for the transition relief.
 Maintenance of Previously Offered Health Coverage. An employer must maintain—
and not materially reduce—the health coverage offered as of February 9th, 2014, until
the last day of the 2015 plan year.
Qualifying for Transition Relief

16. T H E
WHAT

17. 17
T H E W H A T
WHAT is Employer Shared Responsibility?
To be compliant, the ACA requires businesses to
offer affordable insurance that provides minimum
value:
Affordable Insurance: < 9.5% of an employee’s annual household
income
Minimum Value: 60% of the total cost of an employee’s medical
expenses
Minimum Essential Coverage: the minimum essential health benefits
that plans are required to coverAnd to track and report employee data

18. 18
T H E W H A T
Using the 3 Safe Harbors
Is your health insurance affordable? Make sure your
lowest cost, self-only employee plan does not exceed
9.5% of:
Employee’s
W2 Wages
S A F E H A R B O R # 1 S A F E H A R B O R # 2
Employee’s Hourly
Pay Rate
S A F E H A R B O R # 3
The Federal Poverty
Level for an
Individual

19. 19
T H E W H A T
Tracking Employee Data
HR Payroll Benefits Time & Attendance
Date of birth Hours work and paid
Proof of offering health
insurance
Leave of Absence dates
Date of hire/termination Hourly rate of pay
Minimum value
documentation
State-mandated leaves

20. 20
T H E W H A T
Form 1094-C
Employer Transmittal
Accounts for each of the following,
per 2015 calendar month:
Full-time employees
Total headcount
Whether Minimum Essential
Coverage was offered
Whether an applicable 4980H
“Safe Harbor” was used

21. 21
T H E W H A T
Form 1095-C
Employee Statement
Accounts for each of the following,
per 2015 calendar month:
Proof of offer of coverage (with code)
Employee’s share of the lowest cost
monthly premium
Whether an applicable 4980H “Safe
Harbor” was used

22. 22
T H E W H A T
Written Statement to Each Covered Employee
The employer’s name, address, and contact information
The information for the employee on the return being
filed

23. T H E
WHEN

24. 24
T H E W H E N
WHEN do you need to file the forms?
February 29, 2016
P A P E R D E A D L I N E
March 31, 2016
D I G I T A L D E A D L I N E
Form 1094-C & Form 1095-C

25. 25
T H E W H E N
WHEN do you need to file the statement?
A written statement for each covered employee
January 31, 2016
D E A D L I N E

26. T H E
WHY

27. 27
T H E W H Y
The penalties are already in effect for the 2015 plan
year for companies with 100+ FT/FTE. For companies
with 50-99 employees, penalties are effective for the
plan year beginning on January 1st, 2016.
WHY comply with the ACA?

28. 28
T H E W H Y
Avoid Penalties
Do This… …or Pay This Penalty
Offer your employees health coverage
$2,000 for every FT employee at your company
(less the first 30)
Offer affordable health coverage (an employee’s contribution doesn’t
exceed 9.5% of their household income) that provides minimum value
(the plan covers, on average, 60% of an employee’s medical expenses)
$3,000 for every FT employee at your company
(less the first 30)
File forms 1094-C and 1095-C $200 for each delinquent or incorrect return
Provide written information statements to each of your employees $200 for each missing statement

29. The Future of HR
S E C T I O N 3

30. 30
T H E F U T U R E O F H E A L T H C A R E
All other sectors have benefited from information technology
and data liberation. There will be MORE changes in the next
decade.
It’s healthcare’s turn.
M O R E
Reliable
M O R E
Affordable
M O R E
Technology
M O R E
Rewarding

31. 31
T H E F U T U R E O F H R
The new human resources is connected and integrated. No more separate, siloed
systems.
BenefitsPayrollHR Time & Attendance
Your all-in-one ACA coverage and compliance solution

32. Q&A

33. 33
T H E H O W
Companies who show “good faith efforts to comply with the ACA
reporting requirements” are eligible for short-term relief from penalties.
HOW to show good faith
Document your offers of health coverage
Track your employees’ time and
attendance
Keep accurate payroll and pay rate records

34. 34
T H E H O W
HOW Zenefits can help
you prove good faith

35. 35
T H E H O W
We cover your employees with choices of
carriers and affordable plans.
We provide each employee with
documented proof of coverage offered.
Document health coverage
Z E N E F I T S H E L P S

36. 36
T H E H O W
We automatically offer employees health
coverage when they surpass the ACA
threshold.
We automatically un-enroll employees
(and administer COBRA) when they drop
below the threshold.
We alert you to compliance risks before
they become penalties.
Track time & attendance
Z E N E F I T S H E L P S

37. 37
T H E H O W
We track your employees’ paid and
unpaid hours and leaves of absences.
We generate your 1094-C and 1095-C
forms and eliminate manual errors.
Keep accurate payroll & pay rate records
Z E N E F I T S H E L P S

38. Cheers!
P L E A S E J O I N U S O N T H E T E R R A C E F O R D R I N K S +
S N A C K S