The Center for Medicare & Medicaid Services (CMS) has released a review of the rules regarding when a family becomes ineligible for the Covered California subsidy after being offered employer-sponsored health insurance. While the presentation is geared toward health insurance agents, there is good information relevant to everyone in the file. As CMS notes, gaining employer-sponsored health insurance while enrolled in Covered California is a Common Complex Situation.
Covered California will begin contacting employers of Covered California individuals and families notifying them that their employee is receiving Obamacare premium assistance. Only employers for whom enrolled Covered California members have provided employer contact information will be sent the notification. The letters will alert the employer that they may be subject to the employer shared responsibility payment if they have 50 or more employees.
Employers with 50 or more full-time employees, including full-time equivalent employees, in the previous year use Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, to report the information required about offers of health coverage and enrollment in health coverage for their employees. Form 1095-C is used to report information about each employee.
Whether an you are an applicable large employer, and are therefore subject to the employer shared responsibility provisions, depends on the size of the your workforce. The vast majority of employers fall below the workforce size threshold and, therefore, are not subject to the employer shared responsibility provisions.
The Affordable Care Act (ACA or health care reform law) requires employers with at least 50 full-time workers (called Applicable Large Employers or ALEs) to offer their employees health care coverage (minimum essential coverage or MEC). Those who don’t comply may face penalties.
Under the Employer Shared Responsibility provisions, if an applicable large employer does not offer affordable health coverage that provides a minimum level of coverage to their full-time employees and their dependents, the employer may be subject to an Employer Shared Responsibility payment.