As deadlines for complying with several major provisions in the Patient Protection and Affordable Care Act loom, employers still lack formal guidance from federal government agencies on several provisions of the landmark health care form law.

“When guidance is issued, it seems to be coming out like layers of an onion,” said Karen Vines, vice president of employee benefits at broker IMA Inc. in Wichita, Kan. “They start with high-level comment, then dive a little deeper, then a little deeper. I don't know where they will land on it.”

“The problem is the lag time,” she said. “We had multiple cases last year where the final regulations changed from what was proposed initially.”

The year 2014 “is going to be here before you know it, and we still don't know about a whole host of notice requirements,” said Alden J. Bianchi, leader of Mintz, Levin, Cohn, Ferris, Glovsky and Popeo P.C.'s employee benefits and executive compensation practice in Boston.

Among the PPACA compliance issues that employers are still trying to get their arms around are:

• Exchange notices

Employers are required to notify employees about the availability of public health insurance exchanges, but are uncertain about how to do so because the Department of Health and Human Services has yet to issue guidance on how those notices must be worded, as well as whether the exchange information must be communicated electronically or in print.

On Jan. 23, federal officials announced that the notification requirement’s effective date is postponed indefinitely until regulations are issued and “become applicable.”

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• Self-funded plan reporting

Self-funded employers remain uncertain about how to comply with a requirement that takes effect in 2015 that they report details of their group health plans to the Internal Revenue Service. Among other things, self-funded employers are required to report to the IRS the identities of all individuals enrolled in their plan, the dates for which those individuals were covered, and any contributions made to the total cost of benefits provided.

In particular, employers need clarity about how to determine individual plan members' coverage effective dates and how to handle the coordination of information with the third-party administrators and insurers that administer their plans. Employers also have raised the issue of potential redundancies with other reporting requirements stipulated by the health care reform law.

• Automatic enrollment

Employers with 200 or more employees still do not know how they will comply with the automatic enrollment provision in the health care reform law.

Under the law, employers are required to notify employees about automatic enrollment and give them an opportunity to opt out of a plan in which they are automatically enrolled. However, regulators have said the automatic enrollment rules will not be published until 2014.

• Excise tax on high-value plans

Employers still have time to comply with rules on the excise tax provision for “Cadillac plans,” because it does not go into effect until 2018. However, some employers already have started projecting the likelihood that their plans will become subject to the 40% tax on premium costs that exceed $10,200 for single coverage and $27,500 for family coverage.

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Under the law, insurers will pay the tax on the plans they insure, while third-party administrators will pay the tax on behalf of self-insured plans. Insurers and third-party administrators are expected to recover the taxes they pay from employer plans.

“That's really way down on their list since it doesn't take effect until 2018,” said J.D. Piro, senior vice president and national practice leader for legal consulting at Aon Hewitt in Norwalk, Conn. “But in terms of the excise tax, there's been no guidance from the IRS.”

• Full-time employee definition

A notice issued by the Internal Revenue Service in December gives employers a bit more flexibility than had been expected in determining which of their employees must be offered coverage under the federal health care reform law, experts say. Under PPACA, if just one full-time employee is not offered coverage and receives a federal premium subsidy to purchase coverage in an exchange, the employer faces a $2,000 penalty for each full-time employee.

Under the notice, which will remain in effect at least through 2014, employers can use a retrospective measurement period lasting between three and 12 months to determine whether an employee's hours meet the definition of “full time.”

Even though the IRS has issued this notice, “a lot of employers are just now waking up to this and need more time to comply,” according to Mr. Piro. “There still needs to be some transition rules,” he said.

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• Transitional reinsurance fee

HHS on Dec. 7, 2012, issued proposed regulations to implement the transitional reinsurance fee program that assesses a fee for three years based on the number of individuals covered under a group health plan or insurance policy. HHS estimates that the fee for 2014 will be $63 per enrollee.

Although the reinsurance fee is temporary, the ERISA Industry Committee is asking HHS to delay implementing another $5 billion fee in PPACA intended to offset the cost of the early retiree reinsurance program to soften the blow on employers.

“ERIC's members are deeply concerned at the potential magnitude of the transition reinsurance fee, particularly when it is combined with the other fees, taxes, assessments, benefit mandates and administrative expenses imposed by the ACA,” wrote the committee's President Scott Macey and Senior Vice President for Health Policy Gretchen Young, in a Dec. 28, 2012, letter to HHS.

There are some questions about whether this fee violates ERISA if it is assessed by the states. The Employee Retirement Income Security Act precludes states from regulating self-funded employee benefits plans.

• Defining minimum essential benefits

Federal regulators have yet to fully define minimum essential coverage, differentiating it from minimum value coverage, sources say.

While some employers and their advisers are interpreting a health benefit plan with a 60% actuarial value as meeting the minimum value requirement, others think it could be something less.

“Congress didn't do us any favors by using terms like 'minimum essential coverage' 'minimum value' and 'essential benefits.' These terms are confusing because they are interchangeable,” said Ed Fensholt, senior vice president and director of compliance services at Lockton Cos. L.L.C. in Kansas City, Mo.

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As a result, “there are a lot of employers looking at the minimum essential coverage standard and wondering what it is. There are a variety of possibilities. It's got to provide coverage for typical medical plan services including inpatient, outpatient services and prescription drugs. Could it be a mini-med plan? That's what we're thinking. A limited medical plan looks like it could satisfy the definition. Another possibility is preventive-only coverage bolted to an indemnity plan that provides catastrophic coverage,” Mr. Fensholt said.

“Employers want to know what this minimum essential coverage is because it is affecting how they design coverage offerings in 2014 and beyond,” he said.

• Application of 105(h) nondiscrimination rules

The IRS also has yet to issue regulations on how employers must apply the 105(h) nondiscrimination rules to fully insured health plans to ensure they do not discriminate against lower-paid employees.

“In some industries, like hospitality, it's creating some challenges,” said IMA's Ms. Vines. “In hospitality, especially the restaurant environment, where most employers have traditionally only offered group coverage to management, you've got a problem right out of the chute.”

Under PPACA, it is not clear what degree of separation will be allowed, if any, she said.