Minimum Essential Coverage (MEC)
Individual Plans and a Plan offered in the small group market either in or out of the exchange must offer a Qualified Health Plan that covers at least 60% of all essential benefits at the bronze level. Self-funded plans and plans in the large group market are not required to cover all the essential benefits. An employer can offer minimum essential coverage and avoid the 4980H(a) “no offer” penalty/tax/assessment.
Employee Avoids Tax Penalties
If an employee is covered under the MEC plan he/she avoids the individual “tax penalty”. Your employee can check the box on their 2016 tax return , “yes I have minimum essential coverage”, coupled with the 1095-c, thus avoiding the “shared responsibility” payment.
This individual “shared responsibility payment” is the greater of the two amounts, the “flat dollar amount” and percentage of income amount (referred to as the “excess income amount” under the final IRS regulation) calculated on a monthly basis. The greater of these two amounts is divided by twelve months to determine the penalty due for each month for which the penalty is applicable. In addition, the shared responsibility payment is capped at the national average of the annual cost of a bronze level health insurance plan, for the applicable family size, offered through the “Exchanges”.
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The annual flat dollar amount (phased in over three years) is assessed each individual, spouse, or dependent that is without coverage. The amount is set at $95 for 2014; $325 for 2015; and $695 in 2016. The increase in the fine has been set at 2.5% or COLA (cost of living assessment) for each year after 2016.
Employers penalties will be $2,260 per full-time worker in 2017 (with an exemption for 30 workers), up from $2,160 in 2016, if they fail to offer coverage as required by 4980H(a).
Unlike wages, employer fines are paid as after-tax profits, so the $2,260 fine really equates to $3,711 in taxable wages, or $1.78 an hour for full-time, year-round workers.
An employer offering both MV (minimum value) health plan and the MEC (Minimum Essential Coverage) to all employees avoids both penalties as described in 4980H (a) and (b).
MEC is Self-Funded
The MEC Plan is completely self-funded. All administrative costs are included. There is no insurance coverage required due to benefits: No hospital coverage is included (only negotiated self-pay agreements with individual hospitals), thus the claims cost are very predictable and stable. There are no underwriting requirements for the MEC Plan.
The claims fund is wholly owned by ADIUVARE HEALTHCARE and is used to pay claims and administrative cost for government compliance and over-sight, eliminating the exposure of these costs to the employer or employee.
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