As a broker, it often becomes your responsibility to verify that your customers are in compliance with legislation. To that end, we have created the following checklist as a summary of the general tasks associated with ACA compliance. Not all items will apply to every group, but a thorough understanding of these items will help you guide your clients correctly.
Budget Considerations
- Use our Group Size Calculator to determine whether employer had average of 50+ FT plus FTE employees in prior year. If they did, this employer is an Applicable Large Employer (ALE) subject to Employer Mandate the following year.
- Ask clients about commonly-owned companies for accurate employer size determination
- If an ALE, use our Affordability Calculator to determine whether your clients’ coverage meets one of the ACA Affordability Safe Harbors in order to prevent a penalty (Note: Affordability percentage is 9.12% for 2023).
- Ask clients about commonly-owned companies to make an accurate determination of their employer size.
- If any clients just reached the 50+ FT plus FTE threshold for the first time, check eligibility for transition relief from employer penalties in Jan – Mar if MEC with affordable MV offered by April 1. (One time relief)
- Certify whether your clients’ group coverage meets the ACA minimum value requirement in order to prevent a penalty
- For employers on Small Group plan, collect accurate DOBs for dependents under age 21 due to child rating structure.
- Verify your clients are no longer paying directly for/reimbursing employees for individual health plans, unless the employer sponsors a Qualified Small Employer HRA (QSEHRA), or Individual Coverage HRA (ICHRA).
- Discuss impact of any upcoming minimum wage increases on affordability of coverage calculations and overall company budget.
Health Plan Administration
- Verify waiting periods do not exceed the 90-day limitation. If clients have orientation period prior to waiting period verify it is no longer than one month
- If client has orientation period prior to waiting period, verify it is no longer than one month.
- Explain to clients with 50+ FTE employees who have variable-hour employees who may or may not work full-time how to set up their lookback measurement, administrative, and stability periods
- Check Health FSA documents to make sure they reflect the annual calendar year limit, and specify either FSA grace period or carryover provision for 2023 (if applicable).
- For employers in the small group market, verify that all groups are meeting participation and contribution requirements. If not, consider enrollment during annual the 11/15 -12/15Special Open Enrollment Window.
- Verify that all employers are applying the 30-hour full-time definition to determine eligibility for coverage.
- Confirm that employers are not changing employees to 1099 contractors to avoid the ACA’s employer mandate.
- Determine if the use of PEO or staffing agency personnel increases employer size to 50+ FTE due to IRS common law employee rules.
- Explain to ALE clients the IRS employer reporting requirements (Form 1094-C & 1095-C)
Documents for Employees
- Deliver the DOL-Mandated Notice, titled ‘New Health Marketplace Coverage Options and Your Health Coverage,’ within 14 days of hire.
- Deliver Summary of Benefits and Coverage (SBC) and Uniform Glossary at enrollment, renewal, and to new hires.
- Deliver 60-day notices of material modification if plan changes are made outside of renewal.
- If employer is an ALE in 2023, prepare to give copy of IRS Form 1095-C to all employees Full Time for at least one calendar month by 3/1/2024.
If you do not understand a concept on this checklist or need assistance assuring your group has accomplished a particular goal, please contact your Word & Brown Sales Representative who can provide further support.