HIPAA stands for Health Insurance Portability and Accountability Act of 1996. Under this federal law, patient health information is protected and kept secure unless the patient gives consent to disclose their information. The patient has control of who has access to their records.
Physical activity doesn’t always mean an intense hour-long workout at the gym every day. While this form of exercise has great benefits, it’s not for everyone.
Providing health insurance for employees is a fundamental responsibility for most employers. But as the workplace evolves, so do employee expectations. It’s not just about covering individual employees anymore—many employees seek comprehensive plans that extend to their families. This is where dependent coverage becomes a critical component of employee benefits.
In this blog, we’ll explore what dependent coverage is, why it matters for employers, and how you can effectively provide it to support your workforce in 2025 and beyond.
Dependent coverage refers to health insurance that extends to the family members of your employees. The goal is to help employees manage healthcare costs for their loved ones, reducing financial stress and improving overall well-being.
In most employer-sponsored health plans, dependents include:
The Affordable Care Act (ACA) mandates that health plans must allow employees to cover their children up to age 26. This rule applies regardless of the child’s marital status, financial independence, or student status. For employers, this means ensuring your plans comply with ACA requirements to avoid penalties and maintain employee satisfaction.
Offering dependent coverage is more than just meeting legal requirements; it’s an investment in your workforce. Here’s why:
In a competitive job market, robust benefits can set your organization apart. Employees today value comprehensive health plans that extend to their families, making dependent coverage a key factor in their decision to join or stay with a company.
Employees who know their families are protected tend to be less stressed and more focused at work. When personal concerns like healthcare are taken care of, employees can fully engage in their roles, leading to higher productivity and job satisfaction.
Providing dependent coverage involves costs for both employers and employees. Understanding these costs is crucial for designing plans that balance affordability and quality.
Employers typically share the cost of premiums for dependent coverage. While this can be a significant expense, it’s also a strategic investment in employee well-being and retention.
To manage costs effectively:
Employees also pay a portion of the premium for their family members. Communicating these costs clearly is essential to help employees make informed decisions during open enrollment.
In 2025, coverage is deemed affordable under the ACA if the employee’s share of the premium for the lowest-cost, self-only plan doesn’t exceed 9.02% of their household income. Employers should monitor these thresholds to maintain compliance.
As family dynamics evolve, employers must adapt their benefits to meet the needs of various family types.
Ensuring your health plans accommodate these diverse family structures shows that your organization values inclusivity.
Offering dependent coverage to nontraditional families may require additional administrative effort, but the benefits far outweigh the challenges. Consider consulting with benefits advisors to structure your plans effectively while meeting diverse employee needs.
Healthcare regulations are constantly evolving, and 2025 is no exception. Staying updated is key to providing compliant and competitive benefits.
While dependent health coverage is a cornerstone of employee benefits, supporting employees and their families goes beyond medical insurance. Offering a holistic approach to employee well-being is crucial for fostering a positive work environment and enhancing employee retention.
Even the best benefits plan won’t be effective if employees don’t understand it. Clear communication is essential.
Start educating employees about their options well before open enrollment. Use simple language and avoid jargon to ensure clarity.
Offer materials like FAQs, videos, or infographics that explain:
Ensure employees can easily access assistance year-round, whether it’s through a benefits administrator, online portal, or HR team.
Dependent coverage is more than a legal requirement; it’s a strategic tool for supporting your employees and their families. By offering comprehensive plans, you not only comply with regulations but also position your company as a caring and competitive employer.
As 2025 approaches, now is the time to review your benefits, understand upcoming changes, and ensure your plans meet the needs of all employees and their loved ones.
Any questions? We have answers. Learn more about us and our services, here.
As we move into 2025, the future of the Affordable Care Act (ACA) is uncertain. During his successful 2024 campaign, President Trump made conflicting statements regarding the future of Obamacare. However, his record from his first term suggests that significant changes could be on the horizon, particularly if Republicans retain control of the House. His first year back in office may bring several changes to the ACA.
Let’s explore what the Trump administration’s healthcare priorities could mean for the ACA in the years to come.
Under President Biden, enhanced ACA subsidies were introduced, making healthcare more affordable for millions of Americans, especially in Southern states. These subsidies are set to expire in 2025. If Congress doesn’t act to extend them, premiums could rise by 79% on average, with some states seeing increases over 100%.
This change could be a key focus for the Trump administration, especially with its ongoing efforts to reduce government spending.
If Republicans keep control of the House, major changes to the ACA are likely. These changes could include:
While a full ACA repeal is unlikely without broader support, Congress could still use budget reconciliation to make significant changes to the law.
President Trump has long advocated for dismantling the ACA. If he returns to office, we could see policies that further limit the reach and effectiveness of the ACA. These changes may include:
One of President Trump’s key healthcare goals has been giving states more control over their healthcare systems. Under his administration, we may see:
Health Savings Accounts (HSAs) are an area where President Trump has shown strong support. He may propose changes to make HSAs more accessible, including:
The Trump administration has opposed Medicaid expansion, a key part of the ACA. Moving forward, we may see:
The Trump administration is also likely to focus on changing ACA regulations, particularly how insurers operate. Potential changes include:
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.
The Affordable Care Act (ACA) has been a game-changer for employee health care benefits since it was introduced. It’s opened up new opportunities but has also brought along some tricky challenges, especially when it comes to federal reporting compliance. With the IRS becoming more aggressive in enforcing these regulations, it’s crucial for HR and benefits leaders to stay on top of their game.
In this article, we’ll cover why accurate data is essential for ACA compliance and share seven strategies to help you keep your data accurate and complete.
To comply with the ACA, you need to report detailed information about your employees and their health care coverage. This includes data such as names, Social Security numbers, hours worked, and the health benefits offered. Accurate and complete data is not just a formality; it’s essential for staying compliant and avoiding costly penalties.
Keeping accurate records of employee demographics and medical coverage information is crucial for avoiding these penalties.
Regular audits help you catch and fix errors or missing information. Verify Social Security numbers, hours worked, and the health benefits offered. Regular checks will help you stay compliant and avoid last-minute stress.
Maintain accurate records of employee status changes—whether full-time, part-time, or seasonal. This includes tracking hiring and termination dates, status changes, and leaves of absence. Keep your system updated in real time to ensure accuracy.
Invest in HR technology such as HRIS (Human Resource Information System), HRMS (Human Resource Management System), or a benefits administration system. These systems can automate data verification, reduce errors, and ensure accuracy. Look for technology partners with ACA validation features to streamline the reporting process.
An advanced HR system can track compliance benchmarks and alert you to important deadlines. This reduces the risk of missing crucial tasks and ensures you stay on top of your compliance requirements.
Educate your employees about the importance of accurate data. This includes initial onboarding and ongoing training about ACA requirements. Keep communication channels open so employees understand how their data impacts compliance.
Work closely with your IT department to ensure data integration systems are running smoothly. While benefits and HR focus on data accuracy, IT ensures that systems integrate and function properly.
Ensure data accuracy across all platforms. Use automated data integration to reduce human error and conduct regular audits to verify the correctness of integrated data. Centralizing data management makes it easier to access, manage, and verify information.
Staying compliant with the ACA can be complex, but it doesn’t have to be overwhelming. Here’s a simplified plan to get started:
By implementing these strategies, you can make ACA compliance more manageable and avoid hefty penalties. Start by seeking advice from ACA and benefits administration experts to refine your data practices and stay compliant with ACA regulations.
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.
As we move into the 2025 tax year, Applicable Large Employers (ALEs)—those with 50 or more full-time equivalent employees—must prepare for important deadlines related to the Affordable Care Act (ACA) compliance. ALEs are required to offer affordable health coverage to full-time employees and submit detailed information about the coverage they provide. These requirements are critical for avoiding penalties and ensuring compliance with federal regulations.
This blog will help you understand the essential deadlines for ALEs in 2025, what they entail, and tips for staying on top of your ACA responsibilities.
One of the most crucial ACA compliance tasks is reporting the health coverage ALEs offer to full-time employees. This is done through Forms 1094-C and 1095-C. These forms must be filed annually to report details about the coverage provided to employees throughout the previous year.
What Are Forms 1094-C and 1095-C?
Deadline for Filing with the IRS:
Why These Deadlines Matter
Filing these forms accurately and on time is essential for avoiding penalties. Inaccurate or late filings may result in penalties under the ACA’s information reporting requirements. Employers with 250 or more forms must file electronically, and it’s crucial to ensure the forms are complete, especially regarding the details about the employee’s health coverage.
How to Stay on Track with Filing Deadlines:
In addition to submitting Forms 1094-C and 1095-C to the IRS, ALEs must also provide Form 1095-C to their full-time employees. This form serves as a statement to the employee detailing the health insurance coverage offered during the prior year, which they may need when filing their personal tax returns.
Deadline for Providing Forms to Employees:
What You Need to Know About Employee Distribution:
The IRS requires ALEs to provide a copy of Form 1095-C to each full-time employee by the deadline above. Employees will use this form to verify whether they had health insurance coverage and avoid penalties related to the individual mandate, which requires most individuals to have health insurance.
How to Ensure Timely Distribution:
Failure to provide these forms by the deadline may result in penalties, so it’s important to ensure timely delivery to employees. Form 1095-C can also help employees in the event they need proof of health coverage when filing their taxes.
The ACA imposes penalties on employers who fail to provide affordable health insurance that meets the minimum value requirements. These penalties are assessed based on whether an employer offers coverage and whether the coverage meets certain standards.
What Happens if You Don’t Comply?
Deadline for Paying ACA Penalties (If Applicable):
If penalties are owed, employers will need to pay them according to the IRS deadlines. Employers can avoid these penalties by offering affordable, comprehensive health coverage to full-time employees and meeting the reporting requirements.
Meeting ACA deadlines can be overwhelming, especially when dealing with complex reporting requirements and employee coverage standards. However, staying on top of compliance can help you avoid penalties and ensure a smooth process. Here are some tips for staying on track:
Staying compliant with ACA requirements is critical for ALEs to avoid penalties and protect their business. By understanding the deadlines and responsibilities related to health coverage reporting and distribution, you can ensure your business is prepared for the 2025 tax year. Take proactive steps to review coverage, track employee hours, and file the necessary forms on time to keep your company in good standing with the IRS.
With careful planning and attention to detail, you can avoid penalties and stay on track with ACA compliance throughout the year.
Access to physical and mental resources promotes healthy and happy employees. When employees are healthy, both physically and mentally, it ultimately increases overall productivity in the workplace. For more information on how to promote healthy habits in your workforce, read on.
In 2025, Qualified Large Employers (ALEs) are confronting a complex healthcare landscape marked by escalating costs and evolving regulatory requirements. Projections indicate that employer-sponsored health plans will experience cost increases ranging from 5.8% to nearly 8% in 2025, driven by factors such as inflation, high-cost prescription drugs, and increased utilization of healthcare services. Notably, the surge in demand for expensive medications, including GLP-1 receptor agonists for diabetes and obesity, has significantly impacted pharmacy spending, which now constitutes a larger share of healthcare budgets. Additionally, the ongoing shortage of healthcare workers and consolidation within health systems have contributed to rising service prices, further straining employer healthcare expenditures.
Amid these financial pressures, ALEs must also navigate changes in regulatory penalties associated with the Affordable Care Act (ACA). For the first time, the Internal Revenue Service (IRS) has decreased the employer mandate penalties for 2025. The Section 4980H(a) penalty, applicable when an employer fails to offer minimum essential coverage to at least 95% of full-time employees and their dependents, is set at $2,900 annually per full-time employee, a reduction from previous years. Similarly, the Section 4980H(b) penalty, which applies when the offered coverage is either unaffordable or does not provide minimum value, has been adjusted to $4,350 annually per full-time employee receiving a premium tax credit. These adjustments necessitate that employers reassess their healthcare offerings to ensure compliance and to mitigate potential financial liabilities.
As a business owner of a Qualified Large Employer (ALE), managing healthcare costs while providing ACA compliant benefits to your employees can be a daunting task. With rising healthcare costs and the ongoing pandemic, finding effective solutions to mitigate expenses has become even more crucial. This is where SBMA comes in. We offer a low-cost, high-care, and easy-to-administer healthcare option that positions itself as the gold standard in healthcare plans.
SBMA’s self-funded healthcare plans operate on a risk basis, ensuring that clients receive the best possible care at the lowest cost. By choosing a self-funded plan, qualified large employers have more control over their healthcare expenses. If claims volume exceeds the fund, the client assumes the risk. However, SBMA supports its clients by reducing its administrative fee to cover the claims and then gradually recoups the accommodation in subsequent years. This approach provides financial flexibility and helps mitigate the impact of high claims on employers’ budgets.
At SBMA, we understand the importance of affordability when it comes to healthcare plans for qualified large employers. We stand by our promise of not increasing administrative rates, ensuring that our clients can rely on stable and predictable costs. Our goal is to offer high-quality care at an affordable price, providing peace of mind to business owners while ensuring their employees receive the benefits they deserve.
In addition to our self-funded plans, SBMA offers captive healthcare plans. These plans leverage a cooperative structure where each company in the #1 position covers their own claims, while the others provide backup coverage. By strategically pooling resources and mitigating losses, captive plans help keep fees low and reduce exposure risk for qualified large employers. This approach enables businesses to share the burden of healthcare costs, leading to more manageable expenses for all participants.
SBMA provides ASO (Administrative Services Only) and Standard group options to cater to diverse employer requirements. With ASO, you have the flexibility of a pay-as-you-go basis, where you absorb exposure for claims, while SBMA creates reserves to cover any deficits. We have recently transitioned to the SBMA captive, which pays the claims and further reduces exposure risk. The ASO and Standard group options ensure that qualified large employers have tailored solutions that align with their specific financial and administrative needs.
Our SBMA captive represents the gold standard in healthcare plans for qualified large employers. Operating on a self-funded basis, it allows clients to handle their claims first, empowering them with greater control over their healthcare expenses. The captive serves as the second position, stepping in to cover deficits if the client goes into the red. With stable administrative rates and a gradual collection of any deficits over the current and subsequent years, the SBMA captive ensures financial sustainability while maintaining the quality of care provided to employees.
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.
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:
Our benefits professionals are fully equipped to support onboarding and offboarding procedures to eliminate the hassle for businesses.
How? Using 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:
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.
Preventive healthcare has become a cornerstone of modern medicine, emphasizing the importance of stopping illnesses before they start. For employers, offering health benefits that support this approach isn’t just a nice-to-have—it’s essential for cultivating a healthy, productive workforce. One effective way to achieve this is through Minimum Essential Coverage (MEC). MEC plans ensure employees have access to preventive healthcare services while aligning with Affordable Care Act (ACA) requirements.
In this blog, we’ll explore how MEC coverage supports preventive care and employee wellness, and why it’s a smart choice for businesses and their teams.
MEC, or Minimum Essential Coverage, refers to health insurance plans that meet ACA requirements by covering a set of basic health benefits. These include preventive care services, such as vaccinations, screenings, and annual check-ups, at no cost to the insured individual.
MEC plans are designed to provide employees with access to essential preventive services without imposing the high premiums associated with traditional health insurance. These plans can be a cost-effective solution for businesses, especially those looking to provide ACA-compliant coverage while maintaining budgetary flexibility.
Preventive care focuses on identifying and addressing health risks early, often before symptoms arise. Common preventive services include:
By encouraging preventive care, employers can help their teams avoid the physical, emotional, and financial strain associated with chronic illnesses or untreated health conditions.
MEC plans prioritize preventive care by offering 100% coverage for a wide range of ACA-mandated services. Here’s how MEC plans specifically support preventive healthcare:
For employees, MEC coverage is more than just an insurance plan; it’s a pathway to better health. Key benefits include:
When employees feel supported in their health journey, they’re likely to bring their best selves to work—a win-win for both the individual and the organization.
Employers also stand to gain significantly from offering MEC coverage. Here’s how:
While offering MEC coverage is a great starting point, businesses can amplify its benefits by integrating it into a broader wellness strategy. Here’s how:
Not all MEC plans are created equal. When selecting a plan for your employees, consider:
Partnering with a knowledgeable benefits advisor can help you navigate these choices and find the best fit for your organization.
MEC coverage is more than a compliance tool; it’s a strategic investment in preventive healthcare and employee wellness. By offering MEC plans, businesses can support their teams’ health, foster a positive workplace culture, and enjoy the long-term benefits of a healthier, more engaged workforce.
In an era where health and wellness are top priorities for employees, MEC coverage is a simple yet effective way for employers to make a meaningful impact. Whether you’re a small business or a large organization, embracing MEC coverage is a step toward a healthier future for everyone involved.
For more information about MEC, check out our comprehensive guide to MEC and what it covers, here.
Prescription drug coverage is a key part of any employer-sponsored health plan, but rising costs and complex systems can make it challenging to manage. This guide will help you take control of your formulary, aligning it with your goals and budget while keeping employees satisfied.
A formulary is a list of prescription drugs covered by a health plan. It typically includes generic drugs, brand-name drugs, and specialty medications, categorized into tiers that determine how much employees pay out-of-pocket.
Understanding your formulary is the first step toward effective management. Formularies are typically structured as:
Each tier comes with different costs for the employer and employee, impacting the overall affordability of your plan.
Poorly managed prescription drug plans can result in:
Effective management ensures cost control, enhances employee satisfaction, and reduces administrative headaches.
Start by analyzing your current prescription drug coverage. Look at utilization trends, costs, and employee feedback.
An annual review with your benefits consultant or pharmacy benefits manager (PBM) can uncover gaps and inefficiencies.
Pharmacy Benefit Managers (PBMs) play a critical role in formulary management. They negotiate drug prices with manufacturers, decide which drugs are included in your formulary, and determine employee cost-sharing.
A good PBM can help you strike a balance between affordability and access.
Generic drugs and biosimilars are often just as effective as their brand-name counterparts but at a fraction of the cost. Work with your PBM to encourage employees to choose cost-effective options.
Specialty drugs treat complex conditions but often come with exorbitant price tags. According to industry reports, these medications account for a small percentage of prescriptions but a significant portion of drug spending.
Clear communication is essential for effective formulary management. Employees need to understand their options and the rationale behind the plan’s structure.
Use newsletters, webinars, and one-on-one meetings to keep employees informed and engaged.
Digital tools can simplify formulary management and improve the employee experience.
Prescription drug prices are rising faster than inflation. To combat this, consider:
Employees may express frustration if a drug they need isn’t covered or is too expensive. Be prepared to address these concerns.
Regulations like the Affordable Care Act and the Consolidated Appropriations Act require transparency and fairness in drug coverage. Partner with legal experts or consultants to ensure compliance.
Managing your formulary doesn’t have to be overwhelming. By partnering with a trusted PBM, prioritizing cost-effective options, educating employees, and leveraging technology, you can create a prescription drug plan that balances cost, compliance, and care.
Remember, a well-managed formulary benefits everyone—employers control costs, employees access the medications they need, and your organization builds a reputation as a supportive and forward-thinking workplace.
For more insights on health benefits management, reach out to your benefits consultant or explore resources from your PBM. A proactive approach today can lead to a healthier, more cost-effective tomorrow.
Any questions? We have answers. Learn more about us and our services, here.
Navigating the intricacies of the Affordable Care Act (ACA) can often feel like deciphering a complex code. One of the key aspects that businesses need to understand is the concept of “Applicable Large Employers” (ALEs) and the associated terms.
In this guide, we’ll break down these ALE terms to help you make sense of your ACA compliance responsibilities and avoid costly penalties.
At the heart of ACA compliance lies the distinction between small and large employers. An ALE, or Applicable Large Employer, is an employer that meets specific criteria regarding the size of its workforce. Under the ACA, an ALE is defined as an employer that employed, on average, at least 50 full-time employees (including full-time equivalent employees) during the preceding calendar year.
MEC (Minimum Essential Coverage) is a term you’ll encounter frequently in ACA discussions. It refers to health coverage that meets the minimum requirements set by the ACA. Put simply, if your plan qualifies as MEC, it satisfies the basic ACA coverage criteria.
Minimal Value Coverage, on the other hand, means that your employer-sponsored health plan covers at least 60 percent of the total allowed cost of benefits under the plan. In practical terms, it ensures that your plan offers substantial coverage to your employees.
Essential Health Benefits: MEC plans must cover essential health benefits, which include services like preventive care, emergency services, maternity and newborn care, prescription drugs, and more. Understanding what constitutes essential health benefits in your plan is essential.
Minimum Value Standard: This is the benchmark used to determine if an employer-sponsored plan offers sufficient coverage. A plan must cover at least 60% of the total allowed cost of benefits to meet the minimum value standard.
Safe Harbor Methods: These are simplified approaches that employers can use to determine whether their health coverage meets the affordability requirement. The three common safe harbor methods are the Form W-2, Rate of Pay, and Federal Poverty Line (FPL) safe harbors.
Full-Time Equivalent (FTE) Calculation: Employers use this calculation to determine how many full-time equivalent employees they have when factoring in part-time and variable-hour employees. It’s essential for determining ALE status.
Affordable Care Act (ACA) Reporting: This term encompasses the process of reporting compliance with the ACA to the IRS and providing employees with relevant information about their coverage through forms 1094-C and 1095-C.
Dependent Coverage: The ACA requires ALEs to offer affordable coverage to full-time employees’ dependents. Employers should understand who qualifies as a dependent under the ACA.
Minimum Essential Coverage (MEC) Offer: ALEs must offer MEC to at least 95% of their full-time employees to meet the ACA requirements. Understanding what constitutes MEC is crucial.
Affordability Safe Harbors: These are specific methods that employers can use to determine if the coverage they offer is affordable for their employees. They include the Form W-2, Rate of Pay, and Federal Poverty Line (FPL) safe harbors.
Full-Time Employee Look-Back Measurement Periods: Employers can use these periods to determine the full-time status of employees for ACA compliance. The standard measurement period, stability period, and administrative period are essential components of this calculation.
Premium Tax Credits: These are subsidies provided to eligible individuals and families to help them afford health coverage purchased through the Health Insurance Marketplace. Employers should be aware of how their employees’ access to these credits can affect ACA compliance.
Minimum Value Calculator: This is a tool employers can use to determine if their health plans meet the minimum value requirement. It helps ensure that the plan covers at least 60% of allowed costs.
Reporting Entity: Employers may need to determine which entity within their organization is responsible for ACA reporting. This can vary depending on the structure of the company.
Grandfathered Plans: Some plans that existed before the ACA was enacted may be considered grandfathered, exempt from certain ACA requirements. Understanding the criteria for grandfathered plans is important.
What is the ACA, and how does it impact employers?
The Affordable Care Act (ACA) is a federal law designed to make healthcare more accessible and affordable for Americans. For employers, it introduces regulations related to employee health insurance coverage. It defines Applicable Large Employers (ALEs) and mandates they provide affordable health coverage to their full-time employees.
How is an Applicable Large Employer (ALE) determined?
An ALE is an employer that, on average, employed at least 50 full-time employees (including full-time equivalent employees) during the preceding calendar year. Full-time employees work, on average, at least 30 hours per week or 130 hours per month.
What is Minimum Essential Coverage (MEC), and why is it important?
MEC refers to health coverage that meets the minimum requirements set by the ACA. It’s crucial because ALEs must offer MEC to at least 95% of their full-time employees to meet ACA requirements. MEC ensures employees have basic healthcare coverage.
How can I determine if my health plan meets the Minimum Value Standard?
The Minimum Value Standard requires an employer-sponsored plan to cover at least 60% of the total allowed cost of benefits. You can use the Minimum Value Calculator or consult with a benefits professional to assess your plan’s compliance.
What are Safe Harbor Methods, and how can they help with affordability calculations?
Safe Harbor Methods are simplified approaches employers can use to determine whether their health coverage meets affordability requirements. Common safe harbor methods include the Form W-2, Rate of Pay, and Federal Poverty Line (FPL) safe harbors, which provide alternative ways to assess affordability.
What penalties could my business face for non-compliance with ACA regulations?
Non-compliance with ACA regulations can result in significant penalties. Penalties may apply if you fail to offer MEC, the coverage is not affordable, or if at least one full-time employee receives premium tax credits through the Health Insurance Marketplace.
Are there any exemptions or special provisions for small businesses?
Small businesses with fewer than 50 full-time employees are generally exempt from the ACA’s employer mandate requirements. However, they may still choose to offer healthcare benefits voluntarily.
How can I ensure I’m accurately reporting ACA compliance to the IRS and employees?
To report compliance, employers must use forms 1094-C and 1095-C. It’s crucial to maintain accurate records and ensure that the information submitted is timely and error-free. Consider consulting with a tax professional or ACA compliance specialist for assistance.
What should I know about Premium Tax Credits and their impact on ACA compliance?
Premium Tax Credits are subsidies provided to eligible individuals and families to help them afford health coverage through the Health Insurance Marketplace. Employers should be aware that employees’ access to these credits can affect ACA compliance, particularly if your coverage is not affordable.
How often do ACA regulations change, and how can I stay updated?
ACA regulations can evolve, so it’s essential to stay informed. Regularly check official IRS resources and consider working with ACA compliance experts who stay up-to-date with changes and can provide guidance on compliance adjustments.
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.
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