What Employers Need to Know About the Affordable Care Act

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  • What Employers

    Need to Know About

    the Affordable Care


    Crystal Clear Rx

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    Avenue, Suite G-103

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    (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


    Employee Coverage of ACA

    The ACAs 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


    Failure to complydespite 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


    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


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