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
| ACA COMPLIANCE GUIDE | |||||||
| Information intended for the recipient only and subject to change | Applies to | Applicable Form | Due Date | Who Completes the Form | Information Needed | Purpose | Forms Go To |
| Required data for Reporting/Reporting/Compliance Mandates | |||||||
| Monitor average of full and part time employees monthly/Provide report | -All Employers –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 250+ must file Electronically | Employer or Whoever Prepares W-2’s | Hours of Full/Part Time and Seasonal Employees | Determine FTE’s (Full Time Eligible) | Employees and IRS |
| Provide codes to ensure ACA compliant | -All Employers with –All employers that are level/self-funded. | -1094 B and 1095 B for level / self funded groups under 50 AFTE
| Various | Possibly Payroll Vendor | IRS Proper Codes for all Forms | Meet IRS Compliance Mandates | IRS |
| ACA required aggregate cost of health coverage on W-2’s | 250+ EE’s | W2 | Starting 1/31/13 | Payroll Vendor | Benefits excluded from gross income | Reflect Benefits Costs | Employees and IRS |
| Notices/Communication distribution | |||||||
| Provide Employees Exchange Notice and Cobra Upon Hire Notice | All Employers | Exchange Notice | Since Oct 2013 Upon Hire | Government | Exchange Notice | To explain the Exchange Option to Employees | Employees |
| Distribution of Summary Plan Documents | Employers that offer coverage | Summary of Benefits | Upon Implementation | Insurance Carrier | Details of Coverage | Provide details of coverage to Employees | Employees |
| Starting 2016 on or before January 31st, the 1095 may be delivered with W-2 to Employees | Employers that offer coverage | 1095 and W-2 | On or before 1/31/16 | Employer | Evidence of Insurance | Evidence of Insurance | Employees |
| Post or distribute all notices required by the DOL as of December 2015 | ALL EMPLOYERS | MISC. NOTICES | On an annual basis | Employer customizes | Basic Benefits Information | Notify employees of rights | Employees |
| Reporting and Recording for 2015 | |||||||
| Section 6055 Required of all issuers of MEC coverage | Employers that offer coverage 50+ EE and All Self Funded Groups | 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 IRS |
| 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 coverage | Employees and IRS |
| Self Insured Plans | All Employers that offer self insured plans | Small Employers 1094B&1095B ALE’s 1094C&1095C | EE 1/31/2016 IRS 2/28/2016 | Employer/CPA/ 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 IRS |
| 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 | IRS |
| Variable hour employee tracking and management | All 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 Equivalents | IRS |
| 5500 | All Employers over 100 lives | 5500 | July 31st following plan year | Employer | Vendor Info/ Plan Info/Enrolled Info/ Compensation | Report Employee Count and Plan Information for all coverage’s | IRS |
| PCORI (Patient Centered Outcomes Research Institute) | All Insured Plans | 720 Form for any Self Funded plan & HRA’s w/Fully Insured | July 31st 2017 for Plan Year 2016 | 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 | IRS |
| Transitional Reinsurance | All Insured Plans | Snap shot or 5500 Information | January 17th 2017 for 2016 Plan Year | Employer/Payroll Vendor/TPA | Total number of subscribers covered on medical plan | Pay the $27 per subscriber per year for 2016 | IRS |
| 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 2017 | Fully Insured Carriers | Total premium amount paid by Employer for medical coverage | To pay for subsidies given on the Exchange | IRS |
| 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 | Employer/Payroll Vendor/TPA | Details of Coverage | To determine MVC and Affordability Required | IRS |
| Reporting to manage employee eligibility for benefits by alerting you to employees not covered and approaching the threshold requiring coverage | All Employers 50+ on Wage & Tax who offer coverage | SBC/Section 6055 & 6056 Requirement/ 1094B & 1095B | EE 1/31/2016 IRS 2/28/2016 | Employer/Payroll Vendor/TPA | Details of Coverage | Manage Eligibility and Mandates of Offerings | IRS |
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?