What Employers
Need to Know About
the Affordable Care
Act
Crystal Clear Rx
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Avenue, Suite G-103
Parker, CO 80138
(303) 955-7827
The Affordable Care Act (ACA) continues to attract intrigue despite its passing all the way
back in 2010.Although passed in that year, it was only in 2014 that a mandate came that
it be used by all American workers — something that has brought confusion among
employers.
Employee Coverage of ACA
The ACA’s provisions affect American company policies in employee coverage. Initially, it
served as a secondary and emerging health care option for American workers since ESI
or employer sponsored insurance.
Beginning 2014, employers were
required to inform employees that
the new health care insurance
marketplace has opened. In 2015,
employers with 50 employees or
more must offer employees health
coverage.
Failure to comply–despite no
mandate given – meant punishment
by way of fines. But this only applies
on one condition: if employees look
into the possibility of health
insurance despite earning so low that
they qualify for federal subsidies.
The coverage does not affect
workers working not more than 30
hours a week.
Employers Have a Choice
The ACA is not pinning any responsibilities on companies with less than 50 workers.
However, if they voluntarily elect to give ACA coverage for their employees, the insurance
markets may point them where to shop. Employers with fewer than 25 staff members are
eligible for federal tax credits, so long as average wages fall below $50,000.
Stating thus, employers with fewer than 50 full-time employees are excused from the
employer shared responsibility and the employer reporting requirements.
Effect of ACA in PBM
In terms of prescription drug coverage, all private health insurance plans provided to
workers through their employer or purchased from a market must cover at least one
medication in 50 drug categories as demarcated by the U.S. Pharmacopeia.
A pharmacy benefit rule provision cites that each covered drug in the category must be a
biologically or chemically distinguished product. Qualified health plans must, too, make
provisions for enrollees to receive prescribed medication that are not on the standard
formulary.
The ACA has changed the health care provisions for employees. The challenge to employers
is to weigh how they can best manage their health care provisions without sacrificing the
business.
Resources:
http://crystalclearrx.com/content/pbm-services-consultants
http://www.insidecounsel.com/2014/07/01/affordable-care-act-what-employers-
need-to-know
https://www.federalregister.gov/articles/2014/03/10/2014-05051/information-
reporting-of-minimum-essential-coverage
