Employer’s Obligation to Provide Insurance
Q.
I’m curious how this legislation will affect my business. We buy group coverage for my husband and myself (co-owners) and our two employees. Right now the coverage costs us about $250 a month per employee. We pay $200 and the employees have to cover the rest out of their paychecks. Are there any rules about how much an employer must pay toward the cost of coverage? —
Small-business owner, San Francisco
A.
In general, the new law does not require an employer to provide insurance for any employee (though starting in 2014, large companies will pay a
penalty if a full-time worker gets a public subsidy to buy insurance individually). Nor must an employer who does offer coverage contribute anything toward the premiums. But to take advantage of the
small-business tax credits, a business must shoulder at least half of the employees’ premium cost.
Penalty for Not Providing Insurance
A business with 50 or more full-time employees (excluding seasonal workers, but including part-time employees whose hours have been aggregated into full-time equivalents) must generally pay a penalty if at least one full-time employee requires a public subsidy for insurance. When an employee must find his own coverage because the company offers none, the penalty is $2,000 for each full-time employee in the company, but with a 30-employee deduction. When the business does offer coverage but an employee turns it down because it is unaffordable (defined by the law as costing more than 9.5 percent of the employee’s household income), the penalty is $3,000 for every employee who buys insurance on the exchange with a subsidy. This affordability penalty is capped at the total penalty the company would pay if it did not offer insurance at all. One last complexity: Though these are annual numbers, the penalty is in fact calculated each month.
Q.
Is it correct to assume we’ll determine our full-time equivalent employee count by dividing our total payroll hours by 2,080 [40 hours x 52 weeks] to find out where we fall on the 50-employee threshold? I’ve read one report that suggests I’ll be personally removed from the tally since I have a 10 percent ownership share in the business. What about our younger employees? If adults under 26 can be on a parent’s plan, does that mean they will be removed from the cumulative number as well? —
Independent Restaurant, Kansas
A.
No, no and no. Under the law, for the purposes of the penalty a full-time employee is anyone who works on average over 30 hours a week. However, it is up to the Treasury Department to decide how the rule might apply to salaried workers. Nor does it specify whether an owner may be considered an employee. According to a Democratic Senate aide, that, too, will be up to the administration to determine. Finally, there is no provision that would allow an employer to deduct employees who get coverage elsewhere — including young adults on a parent’s policy — from their head count for the purposes of determining the penalty.
Q.
I employ 55 employees who are all considered part time (less than 37 hours a week — most less than 30 hours a week). Is a part-time work force converted into full-time equivalents, or does having a work force exclusively part time avoid the issue all together? —
JG, Pittsburgh
A.
Oh, good question. It is true that the amendment worked out between the House and Senate requires employers to convert their part-time employees into full-time equivalents for the purpose of figuring out whether they are subject to the penalty. (This is done each month by adding up the part-timers’ hours and dividing the aggregate by 120, which is equivalent to 30 hours a week.) But part-timers do not count for calculating the penalty itself. Practically speaking, then, only employers with at least 31 full-time workers will have to do this exercise, because the first 30 full-time workers are excluded from the penalty. In effect, this lowers the penalty threshold for firms with large part-time staffs from 50 to 31 full-time workers.