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Tag Archive for: ACA

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

What Business Owners Should Know About ACA Benefits in 2022

March 27, 2022/in ACA Compliance, News

Applicable Large Employers (ALEs) are businesses that have at least 50 full-time, or full-time equivalent employees in one calendar year. Under federal law, they must provide at least 95% of their employees and their children up to age 26 with Affordable Care Act (ACA) compliant coverage.

Why? Because the ACA was designed to make healthcare services affordable to more people.

Read more
https://www.sbmabenefits.com/wp-content/uploads/2022/03/Untitled-design-1-copy-7.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2022-03-27 10:39:072022-04-07 14:42:19What Business Owners Should Know About ACA Benefits in 2022

Record Number of People Enroll in Health Insurance Coverage

February 13, 2022/in ACA Compliance, Brokers, Employee Engagement, Employee Retention, MEC, News, Open Enrollment

Open enrollment for health insurance in the United States begins annually on November 1st and ends on January 15th. Some states, like California, however, extend the enrollment date for residents to the end of January.

Over the past few years, enrollment rates dipped due to funding cuts from the previous administration for advertisements and navigators aiding sign-ups for coverage.

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https://www.sbmabenefits.com/wp-content/uploads/2022/01/Untitled-design-copy-3-1.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2022-02-13 15:04:292022-04-07 09:38:29Record Number of People Enroll in Health Insurance Coverage

How the Build Back Better Bill Affects ACA Compliance

January 23, 2022/in ACA Compliance, Brokers, Employee Retention, MEC, News, Personal

The Build Back Better framework, created by the current administration, is engineered to “set the United States on course to meet its climate goals, create millions of good-paying jobs, enable more Americans to join and remain in the labor force, and grow our economy from the bottom up and the middle out”. One of the elements of the bill allocates $165 billion to healthcare spending and support. $35 billion is earmarked for adding hearing services to existing Medicare coverage with $130 billion earmarked for Affordable Care Act (ACA) credits, including coverage for previously uncovered states.

Read more
https://www.sbmabenefits.com/wp-content/uploads/2022/01/Untitled-design-copy-5.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2022-01-23 17:06:212021-12-20 17:12:54How the Build Back Better Bill Affects ACA Compliance

The No Surprises Act: Everything You Need to Know

January 9, 2022/in ACA Compliance, Brokers, MEC, News

The No Surprises Act (NSA) The NSA went into effect January 2022. This new law addresses surprise medical billing and requires new disclosures for employers, third party administrators (TPAs), brokers, and all participants in the healthcare industry.

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https://www.sbmabenefits.com/wp-content/uploads/2021/12/Untitled-design-copy-2.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2022-01-09 07:00:392022-05-06 12:38:51The No Surprises Act: Everything You Need to Know

Understanding the ACA’s 1094 and 1095

January 2, 2022/in ACA Compliance, MEC, News

The Affordable Care Act (ACA), enacted in March 2010, was created with the goal to make healthcare more affordable. All applicable large employers (ALEs) with 50 or more full time, or full time equivalent employees must offer ACA compliant benefits to at least 95% of their workforce, and their dependents.

Read more
https://www.sbmabenefits.com/wp-content/uploads/2022/01/Untitled-design.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2022-01-02 10:31:562022-01-06 11:31:06Understanding the ACA’s 1094 and 1095

What OSHA’s COVID Vaccine Mandate Means for ALEs

December 26, 2021/in COVID-19, News, Personal

OSHA stands for the Occupational Safety and Health Administration. It’s an agency of the United States Department of Labor. OSHA’s mission is “to ensure safe and healthful working conditions for workers by setting and enforcing standards and by providing training, outreach, education and assistance.”

Read more
https://www.sbmabenefits.com/wp-content/uploads/2021/12/Untitled-design.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2021-12-26 21:18:002021-11-30 17:26:31What OSHA’s COVID Vaccine Mandate Means for ALEs

Brokers – Build Employer Partnerships During Open Enrollment

December 12, 2021/in ACA Compliance, Brokers, Employee Engagement, MEC, Open Enrollment

Open enrollment, the one period a year where employees can sign up or change health insurance, is still in progress. Open enrollment opens nationally on November 1st and ends January 15th. Some states like California, however, extend their open enrollment period to January 30th.

It’s not too late for brokers to partner with employers to offer benefits plans. Take advantage of this opportunity to encourage employers to offer your insurance as employers can easily change and upgrade their current plans during this time. Click here to find when open enrollment closes per state.

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https://www.sbmabenefits.com/wp-content/uploads/2021/12/open-enrollment-partner-Facebook-Post-copy.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2021-12-12 12:35:002021-12-15 21:16:59Brokers – Build Employer Partnerships During Open Enrollment

HIPAA vs FERPA: What’s the Difference?

November 21, 2021/in ACA Compliance, HIPAA

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.

Read more
https://www.sbmabenefits.com/wp-content/uploads/2021/10/SBMA-Open-Enrollment-Nov-1-copy-2.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2021-11-21 21:39:002021-11-30 17:11:56HIPAA vs FERPA: What’s the Difference?

Reviewing The ACA Times “ACA EMPLOYER PENALTIES ARE REAL AND THE IRS WILL BE ISSUING MORE”

November 14, 2021/in ACA Compliance, News

All Applicable Large Employers (ALEs) are required to offer at least 95% of full-time employees Affordable Care Act (ACA)-compliant Minimum Essential Coverage (MEC) benefits.

ALEs are any business with over 50 full-time employees in a calendar year. Full-time equivalent employees (anyone who works at least 30 hours per week) also count towards the 50 full-time employee tally.

Read more
https://www.sbmabenefits.com/wp-content/uploads/2021/10/SBMA-Open-Enrollment-Nov-1-copy.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2021-11-14 21:09:002022-01-11 10:11:40Reviewing The ACA Times “ACA EMPLOYER PENALTIES ARE REAL AND THE IRS WILL BE ISSUING MORE”
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LATEST NEWS IN ACA COMPLIANCE

  • 1094/1095 PCORI Compliance: What You Need to Know1094/1095 PCORI Compliance: What You Need to KnowJune 5, 2022 - 7:00 am
  • business owners need to stay updated on aca updates in 2022What Business Owners Should Know About ACA Benefits in 2022March 27, 2022 - 10:39 am
  • employees who miss open enrollment may be subject to a year without insurance unless they experience a qualifying eventWhat Happens if Your Employee Misses Open Enrollment?February 20, 2022 - 3:23 pm

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