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Tag Archive for: aca standards

1094/1095 PCORI Compliance: What You Need to Know

June 5, 2022/in ACA Compliance, News

Businesses that provide health benefits for their employee workforce must submit the right forms proving that they offered the required benefits. Now that 1094/1095 filing is complete, it’s time to prepare for federally mandated annual PCORI fees. Are you prepared? Let’s discuss 1094, 1095, and PCORI compliance. 

How Can Applicable Large Employers Stay Compliant?

Applicable Large Employers (ALEs), employers with 50 or more full-time employees, must offer Affordable Care Act (ACA) compliant health benefits to at least 95% of their workforce. Failure to do so can result in hefty fines and penalties from the Internal Revenue Service (IRS). 

The IRS can issue ALEs Penalty A or Penalty B fines for ea

ch employee that is not offered correct or compliant benefit plans. Employers can avoid unnecessary fines and penalties by offering ACA Compliant Minimum Essential Coverage (MEC). MEC benefit plans allow employers to provide affordable benefits to their employees without compromising their bottom line. 

In order to verify employers are, in fact, offering ACA compliant benefits, the IRS requires employers to fill out form 1094 and 1095. 

Employers must complete Form 1094, which is used to determine their liability for payment under the employers’ shared responsibility provision. Form 1095, however, is used as a summary of healthcare information the ALE offers employees. 

What Can SBMA Do For You?

One of the many services we provide at SBMA Benefits is 1094 and 1095 Form processing. We simplify the complexity of providing employee benefits while simultaneously ensuring ACA compliance. 

What’s included in our 1094/1095 processing?

  • Electronic filing of 1094 and 1095 forms annually 
  • PDF soft copies of 1095 for employee distribution 
  • 1095 error corrections refiling (if applicable) 
  • Mail distribution

What Happens After I Submit Forms 1094 and 1095?

After submitting Forms 1094 and 1095 by their due date, March 31st, employers must pay fees to the Patient-Centered Research Institute (PCORI) by July 31st. This year, however, the due date has been extended to August 2nd since the previously mentioned due date lands on a Saturday. 

What is PCORI and Why Do I Have to Pay Their Fees?

PCORI was created to improve the quality, quantity, timeliness, and trustworthiness of health information for patients. 

According to the PCORI, its mission is to “help people make informed healthcare decisions, and improve healthcare delivery and outcomes, by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers, and the broader healthcare community.”

Employers are responsible for paying PCORI trust fund fees annually. The amount employers owe depends on the number of people enrolled in their offered benefits program. 

The fee is calculated based on the average number of individuals covered in a benefits plan- including spouses, dependents, retirees, and COBRA participants. Currently, PCORI fees are $2.79 per enrollee. In 2021, PCORI fees cost $2.66 per enrollee. 

The fee was slated to end in 2019, but was extended via Trump’s Further Consolidated Appropriations Act of 2020. For now, PCORI fees are extended through 2029. 

For more information on Forms 1094 and 1095, read our article: What you need to know about 1094/1095 Filing. 

https://www.sbmabenefits.com/wp-content/uploads/2022/06/iStock-1313069986.jpg 1415 2119 maddie https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png maddie2022-06-05 07:00:402022-05-06 13:41:371094/1095 PCORI Compliance: What You Need to Know

Understanding Minimum Essential Coverage Options

January 31, 2021/in ACA Compliance, MEC

Understanding the various minimum essential coverage plans that you can offer your employees is essential to providing coverage that matters. At SBMA, we offer the most competitive limited medical plans in the industry. We ensure every client remains ACA compliant by offering our medical plans.

SBMA benefits serve employers with ACA mandated compliance requirements. It supports those employers by offering employees who need affordable benefits the right solution for them. Our mission is to provide great benefits at a great price. SBMA is nationally recognized as industry experts on ACA compliance, ERISA law, and Healthcare Reform, and we’re here to help!

Read more
https://www.sbmabenefits.com/wp-content/uploads/2021/01/Copy-of-Copy-of-Template-2_-colored-image.png 1080 1080 Jackie Berens https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Jackie Berens2021-01-31 08:33:002021-11-30 15:51:40Understanding Minimum Essential Coverage Options

How much can you save with MEC?

October 5, 2020/in ACA Compliance, MEC

How much can you save with MEC? Minimum Essential Coverage (MEC) is coverage that complies with ACA requirements. The Affordable Care Act (ACA) states that all employers with 50 or more full-time employees- Applicable Large Employers- are required to provide coverage to all eligible employees or they will be subject to fines/ penalties.

Read more
https://www.sbmabenefits.com/wp-content/uploads/2020/10/pexels-andrea-piacquadio-3756679-1-scaled.jpg 1707 2560 Jackie Berens https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Jackie Berens2020-10-05 07:00:002021-11-30 13:54:33How much can you save with MEC?

What is MEC and What Does it Cover?

August 31, 2020/in ACA Compliance, MEC, News, Voluntary Benefits

Understanding Minimum Essential Coverage (MEC) can be complicated when compared to minimum value, essential health benefits, and actuarial value.
Let’s start by answering what is it and what does it cover? Minimum Essential Coverage is a plan that meets the Affordable Care Act (ACA) requirements for health coverage.

Read more
https://www.sbmabenefits.com/wp-content/uploads/2020/07/Asian-doctor-is-using-a-stethoscope-listen-to-the-heartbeat-of-the-elderly-patient.-1126835434_2125x1416.jpeg 1414 2121 Jackie Berens https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Jackie Berens2020-08-31 07:00:002022-01-26 14:42:48What is MEC and What Does it Cover?

Are You Liable for Shared Responsibility Payments?

August 10, 2020/in ACA Compliance

With all the recent changes to employment due to the global pandemic, navigating ACA compliance can be challenging. ACA noncompliance may lead to shared responsibility payments. Businesses with 50 or more full-time employees must offer affordable, minimum essential health coverage.

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https://www.sbmabenefits.com/wp-content/uploads/2020/07/campaign-creators-e6n7uoEnYbA-unsplash-1-1-scaled.jpg 1707 2560 Jackie Berens https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Jackie Berens2020-08-10 07:00:002021-11-30 08:53:28Are You Liable for Shared Responsibility Payments?

What You Need to Know About Penalty A and B Compliance

July 21, 2020/in ACA Compliance, MEC

If you are a business owner and qualify as a “large employer” — any company with 50 or more full-time or full-time equivalent employees (employees who average 30 hours per week) — there a few things you need to know regarding employee coverage. If you don’t comply with the regulations set for you, you will face significant penalties, which can quickly add up.

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https://www.sbmabenefits.com/wp-content/uploads/2020/07/scott-graham-OQMZwNd3ThU-unsplash-2-scaled.jpg 1709 2560 Amanda Rogers https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Amanda Rogers2020-07-21 14:52:372021-11-29 16:20:01What You Need to Know About Penalty A and B Compliance

Penalty A and Penalty B Compliance

July 21, 2020/in ACA Compliance

Employee benefit programs have been mandatory for all applicable large employers (ALE) since the Affordable Care Act, enacted in 2010. This Act requires employers to offer minimum essential coverage to all employees who work in a company with a staff of 50 or more. Failure to comply with this requirement will cause penalties for these companies and will likely lead to an IRS Audit down the road. Here is more information regarding the importance of Penalty A and Penalty B compliance.

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https://www.sbmabenefits.com/wp-content/uploads/2020/07/office-1209640_1920-1.jpg 1281 1920 Amanda Rogers https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Amanda Rogers2020-07-21 14:14:142021-11-29 15:43:16Penalty A and Penalty B Compliance

What Does Minimum Essential Coverage Entail?

July 21, 2020/in ACA Compliance, MEC

Minimum Essential Coverage was created when the Affordable Care Act was enacted. Before the Affordable Care Act began, people who already had medical conditions or had used too much medical care in the past were able to be denied coverage by insurers. Minimum Essential Coverage ensures that all ACA-compliant health care plans offer insurance to all enrollees regardless of health status or which plan they select. What exactly does minimum essential coverage entail?

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https://www.sbmabenefits.com/wp-content/uploads/2020/07/Screen-Shot-2020-07-21-at-1.42.35-PM.png 719 1050 Amanda Rogers https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Amanda Rogers2020-07-21 13:55:272022-01-28 15:24:36What Does Minimum Essential Coverage Entail?

ACA Penalty A and B Breakdown

July 21, 2020/in ACA Compliance

All large employers, with greater than 50 employees, must comply with the Affordable Care Act. The ACA requires employers to offer minimum essential coverage to all employees. If an employer does not comply with this employee coverage requirement could lead to penalties for the employer and potentially and IRS audit later on. Here is a breakdown of the ACA penalty A and B, and how they could affect your company:

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ACA Penalties May Affect Your Business

July 21, 2020/in ACA Compliance

Under the Affordable Care Act (ACA), large employers are required to offer health insurance to their employees. Despite everything going on, the IRS will continue issuing letters to large employers regarding penalties for years prior. Beginning in 2015, employers that do not meet the ACA standards can be assessed by a shared responsibility payment. Here are a few of the details behind the ACA health plan penalties and what that may mean for your business:

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  • 1094/1095 PCORI Compliance: What You Need to Know1094/1095 PCORI Compliance: What You Need to KnowJune 5, 2022 - 7:00 am
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