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Tag Archive for: employee healthcare

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

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”

Open Enrollment 2021-2022: What You Need to Know

October 31, 2021/in MEC, Open Enrollment

Open enrollment is the one period of the year where employees can sign up for health insurance or change a health insurance plan provided by the employer. Remember that this period also allows employees to disenroll in health insurance if they no longer wish to have coverage.

The only exception to enrolling, changing a health insurance service, or disenrolling is through a qualifying event. Qualifying events can vary depending on the state the employee resides in.

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.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2021-10-31 13:33:002021-11-30 17:09:29Open Enrollment 2021-2022: What You Need to Know

11 Minutes to a Longer Life

October 24, 2021/in Employee Engagement, Healthy Living

Living a longer, healthier life requires physical activity, eating healthy, and routine visits to the doctor. When these three factors work together, it allows you to stay your healthiest. In turn- your odds of living longer increase.
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/2021/09/Oct-25-SBMA.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2021-10-24 10:47:002021-11-30 17:03:4411 Minutes to a Longer Life

Opt-in vs Opt-out Health Insurance: What You Need to Know

October 17, 2021/in Employee Engagement, Employee Retention

Large employers offering employees health benefits need to choose between opting all employees in automatically, encouraging them to opt-in, or making them opt out of health benefits. When it comes to health insurance, opting in and out plays a key part in enrollment. Using the right strategy can help you as a large employer provides coverage for your employees.

Read more
https://www.sbmabenefits.com/wp-content/uploads/2021/10/opt-in-opt-out.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2021-10-17 22:27:002021-11-30 17:02:25Opt-in vs Opt-out Health Insurance: What You Need to Know

How Do I Get My Employees to Sign Up for Health Insurance?

October 10, 2021/in Brokers, Employee Engagement, Employee Retention

All businesses with over 50 full-time employees are required to offer health insurance or be penalized $3,860 per uninsured employee. Our Affordable Care Act (ACA) compliant MEC benefits calculator breaks down the cost of remaining incompliant vs. annual costs with MEC here. Offering Minimum Essential Coverage benefits saves over $180,000,000 annually.

Read more
https://www.sbmabenefits.com/wp-content/uploads/2021/09/Oct-1121_Encourage-Employee-Health-Insurance_SBMA.png 924 1640 Beatriz Carias https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Beatriz Carias2021-10-10 22:05:002021-11-30 17:02:04How Do I Get My Employees to Sign Up for Health Insurance?

What to do if your employee has COVID

September 14, 2020/in COVID-19

With companies beginning to return to work, there are a few procedures that employers need to put in place to keep their employees and customers safe. One thing employers need to put thought into is how they will handle what happens when an employee displays symptoms of COVID-19. Furthermore, when an employee is suspected or confirmed to have COVID-19, or if employees are exposed to COVID-19 but are not showing symptoms. Here is some guidance on what to do if your employee potentially has COVID-19.

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https://www.sbmabenefits.com/wp-content/uploads/2020/08/pexels-marc-mueller-380768-scaled.jpg 1437 2560 Jackie Berens https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Jackie Berens2020-09-14 07:00:002021-11-30 09:57:37What to do if your employee has COVID

How Have Your Employee Benefits Changed Since the Start of COVID?

September 7, 2020/in COVID-19, Voluntary Benefits

Before Coronavirus swept the world with high unemployment rates, a strain on healthcare resources, and economic strife, employers were thinking creatively about how to not only retain their existing employees but also attract the best employees with benefits. While some states have been more affected by the health concerns surrounding COVID-19, almost all have felt the effects of the economic downturn. How have your employee benefits changed since the start of COVID? Once you identify the changes, how can you begin to prepare your insurance plan for post-pandemic employee benefits to attract and retain the best employees?

Read more
https://www.sbmabenefits.com/wp-content/uploads/2020/08/national-cancer-institute-NFvdKIhxYlU-unsplash-1-scaled.jpg 1707 2560 Jackie Berens https://www.sbmabenefits.com/wp-content/uploads/2021/12/SBMA_Website-Logo_250x150.png Jackie Berens2020-09-07 07:00:002021-11-30 09:54:35How Have Your Employee Benefits Changed Since the Start of COVID?

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.

Read more
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?

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  • 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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