Compliance Materials

Employers have two separate reporting and employee statement requirements as outlined in IRC Section 6055 and Section 6056. Section 6055 reporting applies to employers of any size that sponsor a self-insured (including level-funded) group health plan, government agencies that administer government-sponsored health insurance coverage, and any other entity that provides minimum essential coverage (MEC) to individuals. The purpose of Section 6055 reporting is to report the months in which an indi

These FAQs provide information about ACA reporting requirements under IRC Sections 6055 and 6056. Specifically, the FAQs provide guidance to applicable large employers (ALEs) on how to complete Part II (Lines 14, 15, and 16) and Part III of Form 1095- C. The ACA defines ALEs as those with 50 or more full-time employees (FTEs), including full-time-equivalent employees, in the preceding calendar year. For purposes of the following FAQs, it is assumed that all employers are ALEs unless otherwise n

Under the ACA employer mandate, employers with at least 50 full-time employees (FTEs) (including full-time equivalents) – known as “applicable large employers” (ALEs) – must offer affordable minimum value coverage to substantially all FTEs (those working 30 or more hours per week) and their dependents, or risk owing penalties through an employer shared responsibility payment (ESRP). Importantly, the IRS notifies employers of a proposed ESRP through Letter 226-J. The following FAQs address how A

The ACA requires health insurance issuers ("Insurers") to pay annual Medical Loss Ratio (MLR) rebates to policyholders by each September 30 if the insurer previously spent less than a specified minimum percentage of the premium on medical claims and certain healthcare quality improvement initiatives in the prior calendar year. The MLR provision is intended to limit the amount of money that insurers can allocate to administrative expenses and profits. Employers that receive MLR rebates have comp

Employers that sponsor group health plans typically require enrolled employees to pay a portion of the monthly premium according to a cost-share model (also referred to as a contribution model). While employers have broad discretion to structure cost-share models for dental, vision, life, and disability benefits as they see fit (provided they do not charge employees more than the gross premium), there are several compliance considerations regarding cost-share models for medical plans. This publ