ACA Compliance

The health care landscape is changing every day. The US Congress is currently working on a replacement for the Affordable Care Act (also known as Obamacare). The new legislation currently called American Health Care Act of 2017 is working its way through Congress. Until new legislature is passed, the ACA (Affordable Care Act/Obamacare) remains in effect.

The following Compliance Guide will help you navigate the current laws and restrictions and ensure that you are following the laws as they exist today.

You my wish to download a copy of the guide from our Resources page. Please contact us if you have any questions or comments. Our programs and consulting services will continue to keep your organization in line with the law and all its nuances.

*This information is as of June 2016 and subject to change

Information intended for the recipient only and subject to change Applies toApplicable FormDue DateWho Completes the Form Information NeededPurpose Forms Go To
Required data for Reporting/Reporting/Compliance Mandates
Monitor average of full and part time employees monthly/Provide report

-All Employers
with 50+ AFTE’s

All employers that are level/self-funded.

-1094 B and 1095 B for level / self funded groups under 50 AFTE

-1094 C and 1095 C for groups over 50 AFTE and self / level funded groups over 50 AFTE

 Feb 28 or March 31
if Electronically
must file Electronically
Employer or Whoever
Prepares W-2’s
 Hours of Full/Part
and Seasonal
Determine FTE’s (Full
Time Eligible)
Employees and
Provide codes to ensure ACA compliant

-All Employers with
50+ AFTE’s

All employers that are level/self-funded.

-1094 B and 1095 B for level / self funded groups under 50 AFTE

-1094 C and 1095 C for groups over 50 AFTE and self / level funded groups over 50 AFTE

 Various Possibly Payroll
 IRS Proper Codes for
all Forms
Meet IRS Compliance
 ACA required aggregate cost of health coverage on W-2’s 250+ EE’s W2 Starting 1/31/13 Payroll VendorBenefits excluded from
gross income
 Reflect Benefits
 Employees and
Notices/Communication distribution
Provide Employees Exchange Notice and Cobra Upon Hire Notice All Employers Exchange NoticeSince Oct 2013
Upon Hire
 Government Exchange Notice To explain the Exchange
Option to Employees
 Distribution of Summary Plan DocumentsEmployers that
offer coverage
 Summary of
 Insurance Carrier Details of
 Provide details of
to Employees
Starting 2016 on or before January 31st, the 1095 may be delivered with W-2 to EmployeesEmployers that
offer coverage
 1095 and W-2On or
before 1/31/16
 Employer Evidence of
 Evidence of
 Post or distribute all notices required by the DOL as of December 2015 ALL EMPLOYERS MISC. NOTICESOn an annual basisEmployer customizesBasic Benefits
Notify employees
of rights
Reporting and Recording for 2015
 Section 6055 Required of all issuers of MEC coverageEmployers that offer
coverage 50+ EE and
All Self Funded
 1094B & 1095B EE 1/31/2016
IRS 2/28/2016
 Fully insured/Insurer
or Employer/CPA/
Payroll Vendor
 Employer info/
Plan info/#
of EE’s/EE info
 Prove coverage and
furnish insured with
statement for proof
of coverage
Employees and
 Section 6056 ALE’e (Applicable Large Employers) All ALE’s 1094C & 1095C EE 1/31/2016
IRS 2/28/2016
Fully insured/Insurer or Employer/CPA/ Payroll Vendor Employer info/Plan info/# of EE’s/EE info Requirement for ALE’s to Affordable/provide statement to EE for proof of coverageEmployees and IRS
 Self Insured Plans All Employers that
offer self insured plans
 Small Employers
1094B&1095B ALE’s
 EE 1/31/2016
IRS 2/28/2016
Payroll Vendor
 Employer info/
Plan  info/#
of EE’s/EE info
 Requirement for ALE’s to
prove MVC and Affordable/
provide statement to EE
for proof of coverage
Employees and
 Employee Classification for Seasonal, Part-time/Full- time, Contract etc. All Employers
50+ on Wage
& Tax
 Payroll Report EE 1/31/2016
IRS 2/28/2016
 Employer or
Payroll Vendor
 Employees Hours Determine FTE’s
Full Time Equivalents
 Variable hour employee tracking and managementAll Employers
50+ on Wage & Tax
Payroll Report EE 1/31/2016
IRS 2/28/2016
 Employer or Payroll Vendor Part time/Temp/Seasonal EE hours monthly Determine FTE’s Full Time EquivalentsIRS
 5500 All Employers
over 100 lives
 5500 July 31st
following plan
 Employer Vendor Info/
Plan Info/Enrolled Info/
Report Employee Count
and Plan Information
for  all coverage’s
 PCORI (Patient Centered Outcomes Research Institute) All Insured
 720 Form for any
Self Funded plan &
HRA’s w/Fully Insured
 July 31st 2017
for  Plan Year
 Fully Insured is Carrier,
Self Funded (includes HRA’s)
is Employer/CPA
  Info Average Number
of Employees Enrolled
For the Plan Year
Pay the $2.26 per
employee Fee for
2016 Enrolled
 Transitional Reinsurance All Insured
 Snap shot or
5500 Information
 January 17th
2017 for 2016
Plan Year
 Total number of
subscribers covered
on medical plan
Pay the $27 per
subscriber per year
for 2016
 Insurer Fee (Pay for the Exchange) All Fully Insured
of Plans
Paid by Carriers cost
to Employers thru
Premium is 2 to
3% Total Premium
 Suspended for
 Fully Insured
 Total premium amount
paid by Employer
for medical coverage
To pay for subsidies
given on the
 Are you providing Affordable and Valuable coverage to avoid penalties Employers
50+ on Wage
& Tax
SBC/Section 6055
& 6056 Requirement/
1094B & 1095B
 EE 1/31/2016
IRS 2/28/2016
 Details of Coverage To determine MVC
and Affordability Required
 Reporting to manage employee eligibility for benefits by alerting you to employees not covered and approaching the threshold requiring coverageAll Employers 50+
on Wage & Tax who
offer coverage
SBC/Section 6055 & 6056
Requirement/ 1094B & 1095B
 EE 1/31/2016
IRS 2/28/2016
 Details of
 Manage Eligibility
and Mandates of Offerings

Enrollment activities

Manage Eligibility
Broker/Vendor Enrollment support services
Are you aware of the compliance requirements for your company?
Deliver Electronic Wrap Documents to Administrator for future Hires

Understanding Your Fiduciary Responsibilities Under A Group Health Plan?

Have you completed the section 125 form for Compliance? Do you have a plan document and complete the annual testing?
Are you aware of the Exchange Notice requirements?
Do you have a designated fiduciary with a file in place that documents all your requirements?
Have all fiduciaries signed a fiduciary agreement?
Are all fiduciaries aware of their duties, responsibilities and the extent of their potential liability?
Are you providing Summary Plan Descriptions for all benefits to your employees?

Click here for ACA Compliance Document 2017

You will also find the Guide along with other items that may be of interest to you on our Resources page