January 11, 2019

5 Affordable Care Act (ACA) matters employers need to understand in 2019

With the New Year upon us, where are we and where are we going when it comes to the Affordable Care (Act)?

The following is an overview of the most critical issues employers need to understand, intended to help you stay on top of the ever-evolving ACA in 2019. You can also download our 2019 Regulatory & Legislative Update to learn more.

  1. Employer shared responsibility mandate – a quick review
  • Applicable to employers employing 50 or more full-time plus full-time equivalent employees
  • Risk of excise tax if adequate and affordable coverage not offered to individuals working 30-plus hours per week. You can view the potential excise tax penalties on page 6 of our handbook.
  • Determine Applicable Large Employer (ALE) status – Average number of employees and their hours of service in preceding year determines ALE status for the current year. Determination of ALE status for 2019 is made as of Dec. 31, 2018.
  • Count all “common-law employees.”
  • Affordability standard for purposes of employer’s risk of excise tax is percentage amount tied to inflation – 9.86% (indexed for 2019; was 9.56% in 2018).


  1. Tax information reporting & disclosure penalties
  • For 2019 tax year, potential IRS penalties assessed for failure to file information returns or provide payee statements (Forms W-2, 1099, 1094, 1095, etc.):
    • Penalty for failure to file a correct information return – $270 each return for which the failure occurs; total penalty cap of $3,275,500 for a calendar year
    • Penalty for failure to provide a correct payee statement – $270 each statement for which the failure occurs; total penalty cap of $3,275,500 for a calendar year
    • Special rules apply that increase the per-statement and total penalties if there is intentional disregard of the requirement to file the returns and furnish the required statements.

See what other reporting and disclosure penalties employers should be aware of here.


  1. Patient-Centered Outcomes Research Institute (PCORI) Fee
  • Applies to insurers of all-sized fully insured plans and all-sized employer-sponsored self-funded plans
  • For policy and plan years ending between Oct. 1, 2018 and Sept. 30, 2019, PCORI fee is $2.45 multiplied by number of covered lives under policy or plan (up from $2.39 for policy and plan years ending between Oct. 1, 2017 and Sept. 30, 2018).
  • PCORI fees paid annually via IRS Form 720 (generally due July 31)
  • Under current law, PCORI fee will no longer be assessed for policy/plan years ending on or after Oct. 1, 2019.


  1. ACA Fee Moratoriums
  • Short-term government funding bill enacted on Jan. 22, 2018 suspends several ACA-related fees:
    • Cadillac tax remains suspended until 2022.
    • Health insurance provider fee returned in 2018 but suspended for 2019.
    • Two-year moratorium (2018 and 2019) for the 2.3% excise tax on medical devices.


  1. Women’s Preventive Care Services
  • Final Regulations – Religious and Moral Exemptions and Accommodations
    • Religious and moral exemption to contraceptive services mandate available to all non-government entities.
    • Exemptions for moral convictions available to all entities except government and publicly traded entities.
    • Accommodation process made optional.
    • Effective date: Jan. 14, 2019



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