ACA Reporting Deadlines and Compliance Requirements in 2023

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The Affordable Care Act (ACA) has been in effect for over a decade, but its reporting and compliance requirements continue to evolve. In 2023, businesses and employers will face several ACA reporting deadlines and compliance requirements that they must adhere to in order to avoid penalties and maintain compliance with the law. 

These requirements include providing healthcare coverage to employees, filing information returns with the IRS, and furnishing statements to individuals. It is essential for employers to understand these requirements and stay up to date with any changes or updates to ensure that they are meeting their obligations under the ACA.

What Are the ACA Reporting Deadlines at the Beginning of 2023 to Report on the 2022 Calendar Year?

New regulations have been finalized by the IRS, which stipulate that Applicable Large Employers (ALEs) must provide their employees with the Forms 1095-C on or before March 2, 2023. Additionally, ALEs are required to file Form 1094-C and provide copies of Forms 1095-C to the IRS by March 31, 2023 if they choose to file electronically. 

 

Employers who must file fewer than 250 returns are permitted to file on paper, but must do so no later than February 28, 2023. It is important for ALEs to meet these deadlines to ensure compliance with the Affordable Care Act (ACA) reporting requirements and avoid potential penalties.

ACA Reporting: Overview

The Affordable Care Act (ACA) mandates that Applicable Large Employers (ALEs) report whether they provided full-time employees with affordable, minimum essential coverage (MEC) that meets minimum value requirements. For employers with self-insured plans, regardless of their size, reporting must also include months of coverage for all individuals enrolled. 

 

The reporting requirements for ALEs, regardless of their funding arrangement, are fulfilled through IRS Forms 1094-C and 1095-C. This overview highlights the essential elements of ACA reporting for ALEs.

 

ACA Reporting Deadlines for ALEs

The IRS has recently made changes to the ACA reporting deadlines for Applicable Large Employers (ALEs) by finalizing new regulations that make the automatic 30-day extension permanent. This extension, which was previously available to employers who needed extra time to furnish Form 1095-C to individuals, will now be available for all future years of ACA reporting.

 

The ACA reporting deadlines for ALEs will now be as follows:

 

  • Form 1095-C: Deadline to Furnish to Individuals

Standard Due Date: January 31

Automatically Extended Due Date: March 2

(Leap Year Due Date: March 1)

  • Form 1094-C (+Copies of Form 1095-C):

Deadline to File with IRS by Paper

Standard Due Date: February 28

  • Form 1094-C (+Copies of Form 1095-C):

Deadline to File with IRS Electronically (Required for 250 or More Returns)

Standard Due Date: March 31

 

If the due date falls on a weekend or a legal holiday, the deadline is extended to the next business day.  These deadlines apply to all ALEs regardless of their plan year.

 

The IRS has also proposed regulations that would reduce the required electronic filing threshold to employers filing just 10 or more returns.  That reduced 10-return electronic filing threshold has not been finalized and therefore is not currently being enforced.

ACA Reporting: Fully Insured vs. Self-Insured Plans

The ACA reporting requirements for Applicable Large Employers (ALEs) differ based on whether their medical plan is fully insured or self-insured. Level funded plans are considered self-insured for reporting purposes as they are not fully insured. ALEs with fully insured medical plans are not required to report under §6055 in Part III of Form 1095-C. Their only reporting responsibility is under §6056, which covers Parts I and II of Form 1095-C as well as the full Form 1094-C. 

 

In contrast, enrolled employees and their dependents’ coverage information for a fully insured plan is reported by the insurance carrier on Form 1095-B, and the carrier is solely responsible for furnishing and filing the Form 1095-B coverage information and soliciting any missing dependent SSNs. ALEs with self-insured medical plans are subject to §6055 reporting and must complete Part III, in addition to Parts I and II, of Form 1095-C.

 

The following overview addresses ACA reporting obligations by employer size and funding arrangement:

ALE Sponsoring a Self-Insured Medical Plan (Including Level Funded)

IRC §6055 and §6056 Reporting

 

  • Completed via Forms 1094-C and 1095-C.
  • Employer must complete Part III of the Form 1095-C (“Covered Individuals”) for enrolled individuals.
  • If the employer sponsors both self-insured and fully insured medical plan options, the employer completes Part III only for individuals enrolled in the self-insured medical plan.

 

Important Note: “Level funded” plans are considered self-insured for these purposes.

ALE Sponsoring a Fully Insured Medical Plan

IRC §6056 Reporting Only

  • Completed via Forms 1094-C and 1095-C.
  • Employer does not complete Part III of the Form 1095-C (“Covered Individuals”).
  • Insurance carrier completes coverage information on separate Form 1095-B.

 

Non-ALE Sponsoring a Self-Insured Medical Plan (Including Level Funded)

IRC §6055 Reporting Only

  • Completed via Forms 1094-B and 1095-B.
  • Employer does not complete Forms 1094-C and 1095-C (because not subject to the employer mandate).
  • Employer information listed in Part III (“Issuer or Other Coverage Provider”) of the 1095-B.
  • Employer does not complete Part II (“Information About Certain Employer-Sponsored Coverage”) of the Form 1095-B.

Important Note: “Level funded” plans are considered self-insured for these purposes.

Non-ALE Sponsoring a Fully Insured Medical Plan

No ACA Reporting!

ACA Reporting: Controlled Groups

For an ALE that falls under the ACA employer mandate and has multiple corporate entities in a controlled group, each subsidiary or related entity in the controlled group must file a separate Form 1094-C. Each entity, also known as an Applicable Large Employer Member (ALEM), must file their own report.

Aggregated ALE Groups have additional ACA reporting obligations:

 

Form 1094-C for each ALEM must contain the following:

  • Part II, Line 21: Each ALEM must answer “Yes” to the question “Is ALE Member a member of an Aggregated ALE Group?”
  • Part III, Column (d): The “Aggregated Group Indicator” box will be checked for each month in which the controlled group existed.
  • Part IV: The “Other ALE Members of Aggregated ALE Group” section will be completed listing the names of the other related entities in the controlled group (the other ALEMs) and their EINs.

 

Forms 1095-C from each ALEM must contain the following:

 

  • The full-time employees of each EIN (i.e., each ALEM) must receive a Form 1095-C with that ALEM’s corporate name and EIN.
  • If an employee works for more than one ALEM in the Aggregated ALE Group in any calendar month, the ALEM for whom the employee worked the most hours of service in that calendar month is responsible for the employee’s Form 1095-C ACA reporting for that month.

 

It is important to note that Aggregated ALE Groups must comply with all ACA reporting requirements and that failure to do so could result in penalties.

ACA Reporting: COBRA Guidelines

Employers with fully insured plans only need to address additional COBRA-related ACA reporting requirements in the event of an employee’s qualifying event being a loss of coverage due to a reduction in hours. The appropriate coding in such a case depends on whether the employee has elected COBRA and whether the employee was in employee-only or family coverage.

 

Apart from the above requirements, self-insured plans (including level funded plans) must report coverage information completed in Part III for all months of active or COBRA coverage.

 

Part II of Form 1095-C for COBRA participants who were a full-time employee for at least one month in the year will be completed similarly for both self-insured and fully insured plans. For individuals who were enrolled in COBRA under a self-insured plan for at least one month in the reporting year but whose active coverage terminated in a previous year, the Part II coding will indicate that the individual was not an employee for any month of the year (Code “1G” in Line 14 for all 12 months).

 

Note: additional rules apply when the spouse or dependent elects COBRA separately from the employee.

Still Have Questions?

The best way for employers to remain compliant with healthcare laws is to consult with a team of professionals. Our team at SBMA understands the ACA and can help you stay up-to-date on any changes to the law. 

 

Common Health Insurance Terms to Help You Understand Your Plan

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If you’re considering purchasing health insurance, you may feel overwhelmed by the variety of terminology associated with it. From coinsurance to deductibles, there are numerous health insurance terms you should know before you enroll. But don’t worry; we’ve got you covered. We have translated some of the confusing terminologies around health insurance into plain English to help you better understand your health insurance coverage.

Let’s dive in.

Coinsurance

Coinsurance is a health insurance term that refers to the percentage of the cost of a healthcare service that you are responsible for paying after you have met your health insurance plan’s deductible. 

For example, if your healthcare bill is $1,000 and you have already met your deductible, and your coinsurance is 20%, you will be responsible for paying $200 (20% of $1,000), while your insurance company will pay the remaining $800. Coinsurance is one of the ways in which health insurance companies share the cost of healthcare services with their policyholders.

Copay

Copay refers to a fixed amount of money that you may need to pay out-of-pocket for a covered healthcare service or supply. For example, your health plan may require a $20 copay for an office visit or a $10 copay for a generic prescription. After you pay the copay, your health insurance plan will cover the remaining cost of the healthcare service or supply. 

Copays are a way for health insurance companies to share the cost of healthcare services with their policyholders. Copay amounts may vary depending on the type of healthcare service or supply, and the specifics of your health insurance plan.

Deductible

A deductible is the amount of money that you need to pay out-of-pocket for healthcare services before your insurance plan starts covering those services. For example, if your plan has a $1,000 deductible, you will need to pay the first $1,000 of healthcare services you receive during the year before your plan starts contributing to the cost of covered services. Once you’ve met your deductible, your insurance plan will begin to share the cost of healthcare services with you. The amount of the deductible can vary depending on the specifics of your insurance plan and is an important factor to consider when choosing a plan, as it can significantly impact your out-of-pocket costs for healthcare.

Essential Health Benefits

Let’s talk about Essential Health Benefits – a set of healthcare services that must be covered by plans in the Health Insurance Marketplace, as required by the Affordable Care Act. These benefits include emergency services, hospitalization, maternity and newborn care, mental health, prescription drugs, preventive and wellness services, pediatric services, and more. 

In-Network Providers

Understanding the difference between in-network and out-of-network providers is critical. In-network providers are a group of doctors, hospitals, and other healthcare providers that your health insurance plan has partnered with to provide care to its members. 

Out-of-Network Providers

When you receive healthcare services from a provider that has not partnered with your insurance plan to provide care to its members, this is known as an out-of-network provider. It’s important to note that using an out-of-network provider may result in additional costs for you, so it’s crucial to know which providers are in-network before receiving care.

Another important term to be familiar with is out-of-pocket cost, which refers to the amount you pay for health care services. This may include your deductible, coinsurance, and co-pays.

The out-of-pocket maximum is the most you’ll pay in a policy period, usually one year, before your plan starts to pay 100% of the covered Essential Health Benefits you receive. This limit must include deductibles, coinsurance, and co-payments, but typically does not count premiums toward your out-of-pocket maximum.

Monthly Premiums

Monthly premiums refer to the regular payments that an individual pays to their health insurance company in exchange for coverage. This payment can be made on a monthly, quarterly, or yearly basis depending on the insurance plan. 

The amount of the premium varies based on a number of factors, such as the type of coverage, the individual’s age, location, and the level of benefits they choose. It’s important to understand the cost of the monthly premium when selecting a health insurance plan, as it can impact your budget and overall financial health.

Preventative Care

Preventive care is health care services focused on keeping you healthy before you may become sick. These include routine check-ups, patient counseling, screening tests, and immunizations. Plans must offer these services at no cost to you when the services are provided by in-network doctors. This means they can’t charge a copayment or coinsurance, even if you haven’t met your deductible for the year.

Provider

Lastly, it’s important to understand what a provider is. This refers to a person or place you go to receive health care services. Examples include doctors, hospitals, pharmacies, and more. Check with your health insurance plan to find out if a provider is in-network or out-of-network.

By familiarizing yourself with these health insurance terms, you can better understand your coverage and make an informed decision when choosing a health insurance plan.

Still Have Questions?

We serve employers who want to offer their employees affordable benefits. We simplify the complexity of providing those benefits and ensure compliance with the Affordable Care Act. We provide affordable benefits for the everyday person. We are different because of our personal service, speed of implementation, and innovative approach to providing benefits coverage.

Learn more about us and our services, here.

What is Encompassing Health and Why Does the Government Allow it?

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As healthcare costs continue to rise in the US, reaching a staggering $4.1 Trillion in 2020, it’s no surprise that people are looking for ways to address the issue. But what if there was a way to address healthcare issues before they became serious problems, saving both time and money in the process? Enter preventative healthcare.

In this blog, we will discuss preventative healthcare, why it’s important and how Encompassing Health contributes to the overall well-being of individuals and communities. Let’s dive in.

Let’s Talk Preventative Healthcare: Why Is It Important?

Preventive healthcare is important because it can help to prevent or reduce the likelihood of developing health conditions or diseases in the first place. By proactively addressing potential health issues before they become serious problems, individuals can save time and money on treatment and improve their overall quality of life. 

Preventive healthcare can also reduce the burden on the healthcare system by preventing the need for more costly and complex treatments down the line. In addition, preventive healthcare can help to reduce healthcare costs for both individuals and the healthcare system as a whole by addressing issues before they become more serious and costly to treat. By investing in preventative care, the government can potentially save billions of dollars each year on healthcare costs and improve the overall health of the population.

According to the CDC, chronic diseases that are avoidable through preventive care services account for 75% of the nation’s healthcare spending and lower economic output in the US by $260 billion dollars a year. This means that by introducing a preventative healthcare program, the government could potentially save billions of dollars each year.

Encompassing Health

Encompassing Health is a program that offers elective, limited health insurance benefits under Section 125 of the Internal Revenue Code. This means that the benefits provided through Encompassing Health can be paid for using pre-tax dollars, which can help offset the cost of the benefits through payroll tax savings. Essentially, this means that individuals who enroll in Encompassing Health can use pre-tax dollars to pay for their limited health insurance benefits, which can help reduce their overall tax burden.

Encompassing Health was designed with the intention of providing companies of all sizes with the best, most affordable workplace health services. 

Encompassing Health is just one example of a preventative healthcare program that could help the government save money. By offering tax savings to encourage people to participate in preventative healthcare services, the government can help address healthcare issues before they become serious and costly problems.

So, Why Would the Government Allow a Program like Encompassing Health? 

The answer is simple: to save money and improve the overall health of the population. If you’re interested in learning more about preventative healthcare and how it can benefit you, be sure to check out our Encompassing Health Program.

What is SBMA’s Encompassing Health?

Digital Health Portal

Provides a specialized, fully integrated technology suite, assisting employees to establish a healthy lifestyle while simultaneously improving employee productivity and reducing the need for health services by preventing health issues from arising in the first place.

Personalized Coaching

Provide employees with access to workplace certified health coaches who are personally assigned to them in order to give employees a detailed and effective regiment that will ensure their personal health.

Telemedicine

Telemedicine enables medical consultations to take place through secure, electronic communication including bi-directional video conferencing, telephone and email. This eliminates the need for traveling back and forth to a doctor’s office, and opens up availability for employees who previously may have had trouble getting in to see a doctor for check ups or test results, due to a busy at home schedule.

Behavioral Health

Behavioral clinicians provide assessment, diagnosis, consultation, and brief psychotherapy to address each employees behavioral health needs through live, interactive video conferencing.

Risk Identification

Predict and classify 35 different conditions and identify and rank the health risks of your unique environment.

Genomics Testing

Leveraging this individualistic approach with an emphasis on each employee and offer each participant an opportunity to set goals for his or her physical and mental well-being based on their genetics.

Final Thoughts

In conclusion, the high cost of healthcare in the US is a major concern for many people. However, preventative healthcare services have the potential to address a significant portion of healthcare-related issues, potentially saving the government billions of dollars each year. Encompassing Health is one example of a preventative healthcare program that could help the government save money and improve the overall health of the population. While the tax savings offered by this program may seem small compared to the potential savings, they can still be a valuable incentive for people to participate in preventative healthcare services and help address healthcare issues before they become serious and costly problems.

 

Full-Time vs Part-Time Benefits: Why It Matters

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Employers need to make sure they are compliant with the Affordable Care Act (ACA) and the employer shared responsibility regulations, also known as “the employer mandate” or ALE. This means that employers must consider many factors when deciding between offering full-time vs part-time benefits, including the costs associated with providing health coverage and other employee benefits.

In this blog we’ll explore the differences between full-time (FT) and part-time (PT) benefits and why it matters for business owners.  

What is the ACA’s Employer Mandate?

The Affordable Care Act’s (ACA) Employer Mandate is a federal law requiring businesses with 50 or more full-time employees to provide health insurance coverage to those employees, or face penalties. The ACA requires employers to offer minimum essential coverage that meets certain affordability and value requirements. Employers must also comply with certain reporting requirements so the government can keep track of employer compliance with the law.

The Employer Mandate is one of the most important elements of the ACA, as it helps ensure that more Americans have access to quality health care coverage. The goal of this law is not only to ensure that employers are providing health insurance to their employees, but also to make sure those plans are comprehensive and affordable.

The ACA’s Employer Mandate requires Applicable Large Employers (ALEs) to provide their full-time employees with affordable Minimum Essential Coverage (MEC), meeting Minimum Value (MV) requirements, that covers at least 95% of the workforce.

The Employer Mandate is enforced by the Internal Revenue Service (IRS), and while penalties can be imposed if an employer fails to comply with the law, there are some exemptions that may apply. For example, employers who offer health coverage but do not meet minimum value requirements may qualify for a “hardship exemption.” Additionally, employers with fewer than 50 full-time employees are not subject to the Employer Mandate.

What is ALE (Applicable Large Employer)? 

Applicable Large Employer status is a designation given to certain employers by the Internal Revenue Service (IRS) under the Affordable Care Act (ACA). The ACA requires applicable large employers to offer health insurance coverage to their full-time employees or pay a penalty. 

An applicable large employer is any business that has at least 50 full-time employees, or a combination of full-time and part-time employees that are equivalent to at least 50 full-time employees.

What Qualifies an Employee as Full-Time?

Generally, an employee is considered full-time if they work an average of 30 or more hours per week. Certain government agencies may have specific definitions to define full-time employees, such as those that qualify for unemployment benefits. Depending on the situation, an employee may also be considered full-time if they are classified as a salaried or exempt employee, meaning they would receive a set salary regardless of the number of hours worked. 

Overall, being aware of an employer’s definition of full-time employment can be beneficial for both employers and employees. Knowing what qualifies as full-time can ensure that employees receive the correct benefits and employers are in compliance with any applicable regulations.

What Benefits are Generally Offered to Full-Time Employees?

Full-time employees typically receive benefits such as health insurance, vacation time, 401(k) plans, and other company-sponsored retirement plans. Some employers may also offer tuition reimbursement programs, life and disability insurance, flexible spending accounts (FSAs), and employee discounts. The specific benefits offered to full-time employees vary greatly depending on the employer and the industry. 

Additionally, many organizations are now offering mental health support, remote working options and other perks that may benefit employees in these uncertain times. 

Full-time employees must be offered benefits if the employer is subject to ALE, while part-time employees are not eligible for coverage until they meet certain hours thresholds. Employers should carefully consider how their benefits packages will affect the ACA and ALE compliance in order to avoid penalties or fines that could arise from noncompliance.

What Qualifies as Part-Time Employment and Benefits?

Part-time employment typically refers to a worker who is employed for fewer hours per week than a full-time worker. Some employers may offer part-time employees the same benefits as their full-time counterparts, including health insurance, paid time off, and retirement savings plans. However, there can be differences in the amount of benefits offered depending on the employer. For example, some employers may offer reduced health care plans or no retirement savings plan to part-time employees. In addition, some employers may cap the amount of paid time off for part-time workers. It is important for potential and existing part-time employees to know their rights under the applicable labor laws. 

Additionally, employers need to be aware of the different rules for eligibility for full-time and part-time employees. For example, if an employer offers a health plan that is limited to full-time employees but also has part-time employees who work more than 30 hours per week, they may not be eligible to receive coverage under this plan. This means that employers must be very careful when establishing eligibility criteria for their benefits plans and make sure that they are compliant with the ACA and ALE regulations.

How PT vs FT Employee Benefits Impact Retention

Employers should also consider how their employee benefit packages affect their employee retention strategies. Offering attractive benefits to full-time employees can help retain them, while providing minimal or no benefits to part-time employees may lead to high turnover rates. Employers need to assess their workforce needs and determine if it is necessary to offer benefits to part-time employees in order to maintain a healthy and productive workforce.

Things to Consider

Overall, employers must take into account the costs of providing employee benefits, as well as the compliance requirements of the ACA and ALE when deciding between offering full-time vs part-time benefits. Employers should also consider their employee retention strategies and make sure they are providing adequate benefits to ensure long-term loyalty from both full-time and part-time employees.  With proper planning, employers can create an effective benefits package that meets the needs of their workforce while remaining compliant with all applicable regulations.

The Affordable Care Act (ACA) requires employers to calculate the number of employees that qualify as full-time and full-time equivalent for each month in order to determine if they are an Applicable Large Employer (ALE). This calculation involves taking the total number of full-time designated employees, plus all non-full-time designated employees’ hours for the month and dividing by 120. The resulting number is then added to the full-time employee count to determine ALE status. 

To ensure accurate calculations, employers can outsource their ACA compliance process to a service provider who will measure workers’ hours of service and calculate FTEs and ALE status on their behalf. Accurately calculating ALE status is essential for employers to minimize potential penalty exposure from the IRS.

To Sum It Up

The decision to provide full-time or part-time benefits to employees is a complex one that requires careful consideration of various factors such as cost, compliance with ACA and employer shared responsibility regulations. Employers should look into their options and evaluate which option is best for them in order to ensure they are providing their employees with quality benefits. Ultimately, offering the right benefits to employees can help businesses attract and retain talent.

If you’re a business owner that needs help navigating FT/PT employee benefits, reach out to us today!

Received an ACA Penalty from the IRS? Here’s What to Do

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The Affordable Care Act (ACA) has a number of different mandates and regulations, which can carry hefty penalties if you don’t comply. If you receive an ACA penalty, it’s important to understand what to do in order to minimize the impact of this financial burden. In this blog post, we will discuss the types of ACA penalties that you may face, as well as how to navigate the process of dealing with them. We will also provide tips on how to avoid ACA penalties in the future. 

If you are a business owner trying to remain compliant, this blog post will help you take the necessary steps to stay up-to-date with your obligations under the ACA and avoid costly penalties in the future.

What are Some Reasons Why a Business Owner Could Receive an ACA Penalty?

There are a few reasons why a business owner may receive an ACA penalty:

  1. Not Offering Qualified Health Insurance Coverage – The employer mandate requires employers with 50 or more full-time employees provide qualified health insurance coverage to at least 95% of their full-time employees. If a business fails to offer this coverage, they may be subject to an ACA penalty.
  2. Not Providing Affordable Coverage – Employers must also provide affordable coverage to at least 95% of their full-time employees. If the employer fails to meet this requirement, they may be subject to an ACA penalty.
  3. Failing To Offer Dependent Coverage – The ACA requires employers to offer dependent coverage up to the age of 26. If an employer fails to provide this coverage, they may be subject to a penalty.
  4. Not Adequately Reporting ACA Information – Employers are responsible for accurately reporting employee health insurance information on their taxes and other forms. Failure to do so can result in an ACA penalty.
  5. Offering Coverage to Employees Who Are Not Eligible – Employers must also make sure that all of their employees who are eligible for coverage are offered coverage, or else they may be liable for an ACA penalty.
  6. Failing To Comply With State Regulations – Some states have their own requirements when it comes to providing employee health insurance. If a business fails to comply with these regulations, they may be subject to an ACA penalty.

No matter what the reason, it is important for employers to understand their obligations under the ACA so that they can avoid penalties. By understanding the law and taking steps to ensure compliance, employers can avoid costly ACA penalties.

By following the guidelines set forth by the ACA, employers can ensure that they are compliant and avoid having to pay unnecessary penalties. It is important for businesses to stay up-to-date on all of their responsibilities under the law in order to remain compliant and avoid costly fines or penalties. Employers should consult with an experienced attorney or tax specialist to ensure that they are in compliance with the ACA.

The consequences of not complying with the ACA are serious. Business owners should make sure that they understand their responsibilities and take steps to ensure compliance in order to avoid costly penalties or fines. An experienced attorney or tax specialist can help business owners stay up-to-date on all of their obligations under the law.

Additionally. . . 

There are many other reasons why a business owner may receive an ACA penalty, and it is important to understand them in order to avoid them. Consulting with an experienced attorney or tax specialist can help employers understand the law and ensure that they remain compliant. By doing so, businesses can avoid costly penalties while providing quality health care coverage for their employees.

The Affordable Care Act is a complicated law and understanding it can be difficult. However, by taking steps to make sure that they are compliant with all of the provisions, employers can avoid costly penalties and fines. By consulting with an experienced attorney or tax specialist, employers can make sure that they remain compliant while providing quality health care coverage to their employees.

By understanding their obligations under the ACA, businesses can ensure that they remain in compliance and avoid any unnecessary penalties or fines. With the help of an experienced attorney or tax specialist, businesses can make sure that they are up-to-date on all of their responsibilities under the law and remain compliant with the ACA.

What to Do if You Receive a Penalty

If you’re a business owner and have received an ACA Penalty from the IRS, take the following steps:

  1. Contact your tax advisor. Your tax advisor should be able to provide advice about how to proceed with this penalty and whether it can be appealed or reduced in any way.
  2. Review your employee records. The penalty could be the result of incorrect or incomplete information about your employees, so make sure all records are up to date and accurate.
  3. Determine how you’ll pay the penalty. You may have to pay the penalty in a lump sum or over several payments, depending on how much is owed.
  4. Contact the IRS to discuss payment options. The IRS may be able to assist you in setting up a payment plan for paying the penalty, or they may be willing to work out an alternative arrangement.
  5. Establish a compliance program going forward. Once the penalty is paid and any necessary documents are filed, it’s important to ensure your business is compliant with the ACA going forward. Work with your tax advisor or another specialist to set up a compliance program that will help you avoid penalties in the future.
  6. Appeal if necessary. If you feel the penalty was issued incorrectly or unfairly, you can appeal it by filing an application for reconsideration with the IRS. Your tax advisor can help you determine if appealing is a viable option for your situation. 

By following these steps, you can ensure that your business is compliant with the ACA and any penalties are handled appropriately.

In Summary

The key to avoiding future ACA Penalties is understanding how the law applies to your business and making sure all of your employee records are accurate and up-to-date. Additionally, establishing a compliance program and regularly reviewing your employee records is essential to avoiding future penalties. Finally, be sure to contact the IRS if you receive a penalty and consider appealing it if necessary. With these steps in place, you can help ensure that your business remains compliant with the ACA going forward.

By taking steps to make sure that their business is complying with all of the provisions of the law, employers can avoid costly penalties and fines. The best way for employers to make sure that they remain compliant is to consult with a professional like our team at SBMA, who understands the ACA and can help them stay up-to-date on any changes to the law. 

How SBMA Makes Healthcare Affordable by Focusing on Insurance Needs

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SBMA makes healthcare affordable by focusing on the insurance needs of people and trimming away the things most people don’t actually want. How do we do it? Let’s discuss.

SBMA Provides Affordable Care Act Compliant Benefits

Any ACA-compliant benefit plan must cover these 10 health benefits:

  • “Ambulatory services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care (before and after birth)
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services 
  • Preventative and wellness services and chronic disease management 
  • Pediatric services”

Minimum Essential Coverage (MEC) is a classification of insurance plans that meet the Affordable Care Act requirements for health insurance coverage. Plans that meet MEC requirements include marketplace, job-based plans, Medicare, and Medicaid.

MEC can be a cost-effective way to ensure that families are protected in times of need but employers aren’t overpaying for unnecessary services.

Why Do Employers Need to Offer Coverage?

Employers must offer at least Minimum Essential Coverage (MEC) to any benefit-eligible employee. Non-compliance will generally result in a penalty of $2,750 annually PER eligible employee. 

SBMA provides benefits that will meet these requirements and keep employers from being penalized without making them pay for the services they don’t need. We offer affordable coverage for all clients, with a variety of options, including telehealth, vision, and dental voluntary benefits.

How Affordable Are SBMA’s ACA Compliant Plans?

Many of SBMA’s plans cost less than $100/month and include virtual health, worksite benefits, vision, dental, and ACA-compliant plans that are affordable for both employers and employees.

SBMA plans also offer the bundling of medical and ancillary benefit options, making affordable healthcare options easy for employers. This is a significant contrast to many employers paying thousands of dollars a month for major medical coverage.

Let’s Talk Telehealth Services: Giving People Medical Care at the Right Place and Time

Telehealth services experienced a spike in popularity during the COVID-19 pandemic. Why? Telehealth services allow patients to stay home and keep others safe as well as work around a collection of other challenges, such as:

  • Problems finding childcare
  • Issues driving to or navigating a hospital due to a disability
  • Difficulty getting time off work

SBMA’s virtual health and telemedicine services offer plan participants 24/7 access to their doctor, at no cost to them. They can speak to a licensed physician as and when they need, by phone or video, and find the complete solution to their health care needs.

Learn more about telehealth services.

SBMA Gives Users What They Want: Hassle-free, Basic Care

SBMA knows what the users of its insurance want, need, and expect: they want to go to the doctor when they need a check-up, they want to be able to get their kids registered for school with all their shots, and they want doctor visits and prescriptions to be as efficient and hassle-free as possible. 

Learn more about SBMA and our benefit plans, then read on to learn more about the Chief Executive Officer of SBMA, Frank Crivello. 

Frank Crivello: Meeting Real-World Insurance Needs to Make Healthcare Affordable For All   

Frank Crivello, CEO of SBMA believes that success is not a destination, but a journey. He defines success as the balance of achievement and satisfaction.

“If you don’t like what you’re doing but you have a ton of money, that’s not success. If you do like what you’re doing and don’t have any money, well, that’s not success either,” he says.

Meeting the real-world insurance needs of people

Despite not having gone to Harvard or pursued advanced degrees, Frank achieved success just by learning from everyone around him.

“I’ve absorbed incredible insights and lessons from business owners and co-workers, from janitors and motivational speakers. SBMA is successful because we listen to the needs of our brokers and the companies we serve, and then exceed expectations,” he states.

When Frank first started out in the insurance industry, he noticed that all the third-party administrators were offering all kinds of products that their employer groups didn’t want or need. So when he built SBMA, it was specifically to meet the real-world needs of the people they served. 

SBMA provides ACA-compliant benefits administration for large employers all across the US. The company’s offices and customer care center are located in sunny San Diego, CA.

“Insurance is not a new industry and, to be honest, major medical is not a place where much innovation takes place. At SBMA we saw the opportunity to innovate in the MEC space, and seized the chance to really make a difference,” states Frank.

He notes that SBMA provides affordable coverage for all of its clients, with a variety of options, including telehealth, vision, and dental voluntary benefits. Their revolutionary idea was to offer plan participants real-world benefits they can actually use.

Providing affordable healthcare options for all

SBMA benefit plans provide a complete solution for employers who want to provide affordable benefits to their workers. The firm offers the most competitive limited medical plans in the industry, with seamless benefits that work like major medical, ensuring ACA compliance for the employer at a price they and their employees can afford.

Many of SBMA’s plans cost less than $100/month, and include Virtual Health, Worksite Benefits, Vision, Dental, and ACA-compliant plans that both employers and employees can afford.

SBMA plans also offer the bundling benefits of medical and ancillary options, making affordable healthcare options easy for the employers. Frank points out that not everyone wants to pay out thousands of dollars a month for major medical.

“Our benefits provide coverage for those who value acute care, prescription coverage, and regular DR visits, but don’t want to pay for comprehensive major medical. We created healthcare that costs between $40 to $125/month, by carving out the big ticket items to build plans that give people benefits they actually use. Practical, useable, affordable, and ACA-compliant benefits for everyday people! That’s our revolution!” he declares.

Frank points out that, prior to the pandemic, the majority of patients preferred in-person doctor visits over telehealth options. However, when a contagious airborne virus appeared, telehealth options expanded dramatically. Almost all health insurance providers now have new, simple-to-use options.

With a Virtual Health medical professional on the line at any time of day or night, nationwide telehealth services help avoid unnecessary doctor visits and provide numerous financial benefits to both healthcare providers and patients.

Telehealth services can help reduce transportation costs and save money for both patients and providers. Virtual visits aid in increasing patient retention, streamlining time on task, improving appointment compliance, lowering overhead costs, and reducing in-person liability.

SBMA’s virtual health and telemedicine services offer plan participants 24/7 access to their doctor, at no cost to them. They can speak to a licensed physician as and when they need, by phone or video, and find the complete solution to their health care needs.

Flipping the MEC model on its head

Minimum essential coverage (MEC) is an insurance plan that meets the Affordable Care Act requirements for health insurance coverage. Plans under MEC include marketplace, job-based plans, Medicare, and Medicaid.

Prior to the Affordable Care Act, insurers would refuse to insure people with preexisting medical conditions. Those who had used too much of their medical coverage in the past were also at risk of losing it.

MEC ensures that all enrollees have access to insurance, regardless of their health status or the plan they choose. It can be a cost-effective way to ensure that families are protected in times of need. Frank points out that the MEC space has traditionally been filled by those providing minimum essential coverage paired with minimum service.

“We flipped the model on its head by providing gold standard service to accompany the government mandated MEC coverage that employers must offer to be ACA compliant,” he states.

SBMA knows what the users of its insurance want, need, and expect. They want to go to the doctor when they need a check-up, they want to be able to get their kids registered for school with all their shots, and they want doctor visits and prescriptions to be as hassle-free as possible. 

SBMA also knows what its employer groups want: Fast enrollment and off-boarding, no hassle ID cards, no hassle claims, and coordinated technology that streamlines their experience. And finally, the firm makes brokers’ lives better by taking all the hand-holding off their plates. 

Brokers are able to provide employer groups not only with great rates and easy compliance with the ACA requirements, but they can also hand those employer groups off to SBMA, knowing that there will be a gold standard support team handling every phase of their relationship, from the moment the group enrolls.

A respected leader who commands trust and faith

Frank defines his leadership style as casual, collaborative, and authoritative. “Don’t mistake that for authoritarian. I know what needs to be done, and am clear with everyone around me. I move fast, make decisions with certainty, and I pivot easily,” he points out.

As CEO, Frank ensures that SBMA is on track to be the best in the industry. His relationships with the leading brokers keep his finger on the pulse of the industry, allowing SBMA to be more agile, more responsive, and a better partner for its brokers, and employer groups, with the freedom to be the best ACA-compliant MEC coverage provider in the industry.

Some of the people on Frank’s leadership team have been with him since the early days, which he feels is a testament to the strength of their trust and faith in him as a leader.

“Nobody gave me anything starting out,” Frank observes. “I had to earn everything from the ground up. That might make some people resentful, but not me. I’m grateful for all the hard work I put in to get here. The view from the top is amazing, especially if you took the stairs.”

Today, SBMA is the industry leader in providing MEC coverage. Over the past five years, the firm has grown to become the gold standard in customer service by building the technology to streamline all of its operations. “I see blue skies and market domination in our future. And, I’m just getting started!” states Frank.

As a father, Frank dotes on his two beautiful daughters who keep him grounded and balanced. “They’re everything to me. Watching them grow up, and creating a life for them where they see that hard work pays off, and that grit and determination is enough to succeed, gives me great satisfaction,” he says.

Frank’s parting advice to aspiring business leaders is to: LISTEN. Don’t let ego get in the way of learning. It’s easy to think you already know, or even to worry that someone will think you’re stupid if you don’t know the answer. Lose that perspective as fast as possible. If you can absorb everyone else’s knowledge and experience around you, you will accelerate your own trajectory to success.

Healthcare Insurance Brokers: How to Increase Your Margins

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Healthcare insurance brokers are constantly looking for ways to provide the best for their clients while increasing their margins. If this is the case for you, look no further!

SBMA provides the most competitive rates for minimum essential coverage (MEC) plans. Our mission as a benefits administrator is to help you—as a healthcare insurance provider—deliver the best for your clients (and a little extra commission wouldn’t hurt).

Below are a few tips on how to increase margins as a healthcare insurance broker (Hint: we saved the best tip for last!)

How to Increase Your Margins as a Healthcare Insurance Broker

As a healthcare insurance broker, you are always looking for ways to provide the best possible coverage for your clients while also increasing your own margins. 

There are a few key ways that you can do this:

Get Higher Commissions

One way to increase your margins is to simply get higher commissions from the insurance carriers you work with. This can be done by negotiating better terms with the carriers, or by simply switching to carriers that offer higher commissions. (But more on this later!)

Get Better Insurance Rates

Another way to increase your margins is to get better insurance rates for your clients. This can be done by:

  • Hopping around for the best rates
  • Using discounts, or
  • Simply being aware of the different rates that are available

Increase Your Efficiency

Finally, you can also increase your margins by increasing your efficiency as a healthcare insurance broker. This means finding ways to work faster and more efficiently, saving you time and money long-term.

How Brokers Can Earn Higher Commissions with SBMA

We told you we saved the best tip for last! Working with SBMA is the easiest way you can increase your margins as a healthcare insurance broker.

Employers renew their ACA-compliant affordable benefits at $50, $60, and $70 per enrollee. 

At SBMA, our ACA-compliant policies start at a $45 base with a $10 commission built-in. Additionally, we work with our brokers to ensure you feel comfortable with the commission you’re earning – no one knows how much your time is worth except for you and we want you to be satisfied with your rate.

Brokers that work with SBMA can upcharge their insurance to the insureds they’re working with. In other words, while the MEC base sits at $45, as a broker working with SBMA, you decide what you charge for the insurance you provide.

Increase Your Margins by Working with SBMA!

By following these tips as a healthcare insurance broker, you can easily increase your margins. This will allow you to provide even better coverage for your clients while also making more money yourself. So don’t wait, start increasing your margins today!

Get in touch with SBMA today to learn more or read on to learn how brokers can get their employer groups engaged!

Why SBMA is the Gold Standard of Customer Service

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At SBMA, we serve employers who want to offer their employees affordable benefits. We simplify the complexity of providing those benefits and ensure compliance with the Affordable Care Act. 

We’re in the business of providing health care to everyday people, ensuring peace of mind through trust and transparency. 

We pride ourselves on our personal service, speed of  implementation, and innovative approach to providing benefits coverage.


Today, we’d like to chat a bit more about the exceptional service we provide and why SBMA is, therefore, the gold standard of customer service for minimum essential coverage (MEC) insurance providers.

(Hint: Our one-stop-shop benefits portal plays a large role in our successful customer service efforts!)

Let’s dive in.

What Problem Do We Solve?

With us, you get peace of mind, security, and the insurance your employees want at a price everyone can afford. Providing affordable benefits to your employees not only ensures you employees remain motivated and excited about work, but they also ensure you remain in compliance with the ACA.

What Makes SBMA Benefits Different?

Our customer service is what sets us apart. We work when you work. Our carrier partners have given us exclusive offerings to complement our medical plans, giving you the best possible price. Our quick execution and advanced approach to benefit coverage is second to none.

How SBMA Supports the Onboarding and Offboarding Processes

At SBMA, we support businesses beyond providing affordable minimum essential coverage (MEC). We are proud to support the employee onboarding process so your human resources (HR) teams have more time to focus on the daily tasks that keep your business running.

This is why we offer a complete insurance solution that covers:

 

  • Implementation
  • Enrollment
  • Administration, and
  • Reporting

Our benefits professionals are fully equipped to support onboarding and offboarding procedures to eliminate the hassle for businesses.

How? Using our benefits portal.

Our Benefits Portal

Employee benefits administration can be a pain for any HR department. At SBMA, we aim to simplify the process by giving you access to everything you need in one place.

Our one-stop-shop portal is proprietary and unlike any other. Our portal grants you access to all of the tools necessary to support a new hire (from beginning to end).

We eliminate the headache of unnecessary paperwork with benefits management portal access. You can:

  • Make plan changes
  • Order ID cards
  • Check a claim status online
  • Track onboarding and offboarding
  • And more

Resources are only a click away.

Besides creating a seamless onboarding process with our all-in-one portal, we also provide video tutorials for our partners. These resources provide instructions that assist navigation through the portal.

Read on to view our enrollment portal walkthrough.

Safeguard Your Family’s Wellness This Back-to-School Season

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School is back in session!

As a parent, we’re sure you’re excited that the summer chaos, coordinating camps and activities, and simply having your children around 24/7 have ended!

As you know, going back to school typically means your child gets sick more frequently. So, how can you safeguard your child and the rest of your family’s wellness this back-to-school season?

Below are a few tips.

Stay Up-to-Date on Immunizations and Vaccines

Vaccination requirements typically vary on a state-by-state basis or even in a school-specific district. To find out precisely what immunizations your child needs, contact your local school board.

The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians recommend a few specific vaccines based on your child’s age. These are as follows:

By Age Two

A vaccination series of the following vaccines should be completed in all children by age two:

  • Hepatitis B
  • DTaP (diphtheria, tetanus, and pertussis)
  • Hib (Haemophilus influenzae)
  • Polio
  • Pneumococcus
  • MMR (measles, mumps, rubella)
  • Varicella (protects against chicken pox)

In addition, annual flu vaccines are recommended for infants from six to 24 months, as this age group is at high risk of complications from contracting the flu.

Hepatitis A vaccines may also be recommended starting at age 2 for those in high-risk groups or areas.

Age Four to Six

Typically, boosters are recommended between ages four to six for DTaP, Polio, and MMR. Those who are younger than nine and have not received the flu vaccine, need two doses of the vaccine given more than one month apart. After age nine, annual vaccination is recommended.

Children with asthma or lung diseases, sickle cell anemia, HIV, diabetes, and heart or kidney disease should receive the influenza vaccination annually.

Age 11 to 12

At around age 11 to 12, a pediatrician visit is recommended to review vaccinations and ensure all necessary immunizations have been provided. At this age, a hepatitis B, MMR, or varicella vaccine may be given if missed or incomplete at earlier ages.

Your child may also receive a combination of boosters for tetanus and diphtheria (if five years have passed since the last Td vaccine). Children with a high risk of complications from the flu should receive an annual vaccine. 

Attend Annual Checkups

Annual doctor’s office visits and check-ups can help prevent greater health issues later on down the line. These check-ups can help identify hearing and vision issues, malnutrition, and other lifestyle imbalances.

Hearing and Vision Issues

Vision and hearing losses are often overlooked in children at a younger age. These issues are difficult to identify if your child is not getting tested in their annual check-up for vision and hearing ability.

Identifying these issues early on can make a huge impact on your child’s ability to learn and engage both in school and at home.

Malnutrition

A child’s development depends on proper nutrition, both physically and cognitively. Malnutrition is an issue that impacts children globally, including in the U.S.

Annual checks and doctor’s visits can help give you greater insight into how your child is developing compared to other children of the same age. A slight change in nutrition can have a huge impact on your child’s ability to learn.

Infographic for "Safeguard Your Family's Wellness This Back-to-School Season"

MEC Covered Services for Children

To make sure your child can receive the care they need to remain healthy during the school year, you need proper insurance coverage.

Minimum essential coverage (MEC) offers an affordable coverage option to keep you and your family healthy at all times.

Some of the services covered for children include:

  • Alcohol and drug use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children at 0 to 11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years
  • Bilirubin concentration screening for newborns
  • Blood Pressure screening for children at 0-11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years
  • Blood screening for newborns
  • Cervical dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under age three
  • Dyslipidemia screening for children at higher risk of lipid disorders at one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Fluoride varnish for all infants and children as soon as teeth are present
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screen for all newborns; and for children once between 11 and 14 years, 15 and 17 years, and 18 and 21 years
  • Height, weight, and body mass index measurements for children at 0 to 11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years of age
  • Hematocrit or hemoglobin screening for all children
  • Hemoglobinopathies or sickle cell screening for newborns
  • Hepatitis B screening for adolescents ages 11 to 17 years at high risk.
  • HIV screening for adolescents at higher risk
  • Hypothyroidism screening for newborns

These services in combination with preventative measures taken at home can help keep your family and your children safe during the back-to-school influx of sickness.

Looking to start a family or grow your current family? Take a look at one of our recent articles to learn about pregnancy and minimum essential coverage.

Which Industries are Most Susceptible to ACA Penalties from the IRS?

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While all organizations are susceptible to receiving IRS penalties, some industries are particularly vulnerable. These industries include home healthcare, staffing, restaurant, and construction industries. 

Why are these industries under fire from the IRS? Let’s take a look.

These Industries Typically Have a High Number of Hourly Workers

Home healthcare, staffing, restaurant, and construction industries have a high percentage of hourly workers with varying schedules. This can make it difficult for employers to determine which employees are ACA full-time and require an offer of health coverage.

HR is often a non-centralized function, making it challenging to gather the data necessary for compliance.

High Staff Turnover Rates

These industries are often associated with a high employee turnover rate. This can make it difficult for employers to track employees and their benefits. If an employer is unable to track the benefits in an efficient manner, that could be putting their company in a position to receive hefty fines.

SBMA identified this paint point among our clientele and decided to create a one-stop shop portal for all of your benefits needs; from onboarding to offboarding, we have you covered.

Workforces that Disproportionately Decline Health Coverage

Home healthcare, staffing, restaurant, and construction industries generally employ workforces that are more likely to decline offers of health coverage benefits. Employers may struggle to track declinations and face ACA penalties from the IRS. 

One way to encourage your employees to enroll in health coverage is to remind them of the importance of maintaining your health and how a simple annual doctor’s office visit can make a positive impact on their well-being. 

How Can Organizations Ensure They Are Complying with ACA Requirements?

Employers can ensure they are ACA compliant by determining the accurate full-time and part-time status of employees under ACA. Employers may experience significant ramifications for misclassifying employees. 

Additionally, employers should familiarize themselves with their requirements under the ACA’s Employer Mandate. For example, employers with 50 or more full-time employees, or ALEs, must:

  • “Offer Minimum Essential Coverage (MEC) to at least 95% of their full-time employees (and their dependents) whereby such coverage meets Minimum Value (MV); and 
  • Ensure that the coverage for the full-time employee is affordable based on one of the IRS-approved methods for calculating affordability.”

For more information, read on for the full article from the ACA Times.

Infographic for "Article Review Which Industries are Most Susceptible to ACA Penalties from the IRS?"

These Industries are Most at Risk for ACA Penalties From the IRS

The home healthcare, staffing, restaurant, and construction industries are under fire from the IRS for failing to comply with the ACA. Organizations within these industries have been shocked to receive ACA penalty notices from the IRS that are in the millions of dollars.

Of course, all types of organizations – hospitality, manufacturing municipal governments, non-profits, and other industries – are receiving IRS penalty notices too. However, the four industries mentioned above seem to be getting more than their fair share.

Here’s why these industries are so susceptible to receiving ACA penalties:

  • HR is often a non-centralized function, making it challenging to gather the data necessary for compliance
  • They have a high percentage of hourly workers with varying schedules, making it difficult to determine who is ACA full-time and requires an offer of health coverage
  • They employ workforces that disproportionately decline offers of health coverage benefits, creating a heavier employer burden in tracking declinations
  • Employees come and go during the year with high staff turnover rates, increasing the employer’s burden to track all such employees
  • Per diem piece work and multiple rates of pay complicate the determination of pay rates and affordability
  • Reliance on payroll systems (or other software programs) that collate data and submit Forms 1094-C and 1095-C often result in a failure to let you know when the data used is inaccurate, which will trigger ACA penalties

Determining the accurate full-time and part-time status of employees under the ACA is arguably the first, and most important, step for ACA compliance. There are real ramifications for inaccurately classifying employees. 

Under the ACA’s Employer Mandate, ALEs, or employers with 50 or more full-time employees and full-time equivalent employees to:

  • Offer Minimum Essential Coverage (MEC) to at least 95% of their full-time employees (and their dependents) whereby such coverage meets Minimum Value (MV); and 
  • Ensure that the coverage for the full-time employee is affordable based on one of the IRS-approved methods for calculating affordability

ALEs that fail to comply with these requirements can be subject to Internal Revenue Code (IRC) Section 4980H penalties.

For example, let’s look at an employer that improperly classifies an employee as not full-time and does not make an offer of insurance. That employee goes to a government marketplace exchange to purchase health insurance and receives a Premium Tax Credit (PTC) that helps subsidize the cost of the health insurance purchased on the exchange. This can trigger the issuance of an IRS Letter 226J penalty notice under IRC 4980H. 

The penalty assessment will be applied to every full-time employee working for that employer during the course of the tax year, not just the employee obtaining the PTC. For the 2022 tax year, that penalty could be as high as $275,000 for every 100 employees.

The first step in the full-time status evaluation is determining which measurement method is best for your organization.

For organizations made up primarily of variable-hour employees, you will want to implement the Look-Back Measurement Method. If your workforce has mostly full-time employees and non-varying schedules, the Monthly Measurement Method will be best.

The most expedient step for employers is to get your ACA Vitals score. This will help determine your risk of receiving IRS penalties by analyzing your unique workforce composition.

Such a review can reap dividends by helping employers avoid significant ACA penalties from the IRS, particularly if those organizations have not been filing ACA-required information annually with the IRS. These organizations should file this information as soon as possible to avoid receiving an IRS penalty notice and to minimize potential penalties. 

The IRS is currently issuing warning notices to employers identified as having failed to file and furnish Forms 1094-C and 1095-C for the 2019 tax year via Letter 5699. If you have received one, contact us to have the penalty reduced or eliminated. We’ve helped our clients prevent over $1 billion in ACA penalty assessments.

If you are part of the home healthcare, personnel staffing, restaurant and construction industries, or any industry that relies on a significant mix of full-time and part-time employees, you are at serious risk of being penalized for not complying with the ACA.

We see daily how the IRS is enhancing its methods for identifying employers that are not complying with the ACA and sending them penalty notices. 

We regularly see the surprise and shock expressed by organizations that receive these penalty notices, many of them containing significant penalty assessments. 

We also see how these organizations could have avoided these penalty assessments by receiving help from experts that understand ACA and IRS regulatory requirements and know how to successfully meet those regulatory requirements.

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