The bar owner understands the basics of the MEC plan and is willing to assume a new level of risk to avoid the penalty. But, the broker explains, the MEC plan only satisfies one of the two penalties of section 4890(H). Because he wouldn't be offering affordable qualifying coverage, the bar owner will pay a penalty if an employee doesn't enroll in the MEC, but instead goes to an exchange to purchase coverage and receives a subsidy. The bar owner, wringing his hands, says he really wants to avoid all penalties.

The TPA begins to talk about an attorney who has found a minimum value calculator on the CMS website allowing for creation of a minimum value plan that excludes hospitalization. In this scenario, a self-funded plan may be used that provides the bar owner with medical coverage that satisfies the employer mandate and doesn't run the risk of a penalty.

“But what about hospitalization?” the editor pipes in.

Ignoring him, the benefits broker jumps at the opportunity to solve his client's problem and asks the TPA at what level the employer must contribute to the plan. With the understanding the plan must be affordable (employer contributes all but 9.5 percent of premium/funding), the bar owner is ready to absolve himself of penalties, and assume the risk of a self-funded plan.

The broker, bar owner and TPA solidify plans to implement benefits that have no clear precedent. The regulator is not heard from again until February 2015 when final rules are issued. Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2016 states that hospitalization must be covered in order create a minimum value plan.

Fast forward to present day. The bar owner, broker and TPA are meeting to begin discussions on how to modify the plan that's in place. It must be changed at renewal. Will they stick with minimum value? Or drop back to MEC?

The preceding story is fictional. Any similarities to people, events and places are mere coincidence. But this exact situation played out repeatedly in different ways across the United States this past summer and fall. As hourly and part-time employees were thrust into the core benefits conversation, so were voluntary benefits brokers. Consultants, TPAs and others who focused much of their career on traditional benefits suddenly had to create and recommend benefits solutions for large groups of employees who had been benefits afterthoughts for years. This collision of worlds provided many controversial product solutions, moving targets and things that now must be fixed.

So what happens next? What should today's broker be preparing for? Does the employer mandate for the 50-99 employees market create opportunity? What is working for the hourly and part-time workforce? What should be recommended? See you at the Benefits Selling Expo to talk about all of this.