ACA compliance and reporting. The employer mandate, done right.

If your company has 50 or more full-time employees, including full-time equivalents, the ACA requires you to offer affordable, minimum value coverage and report it to the IRS each year. Ethos Benefits tests affordability, maintains your SBCs, supports the PCORI fee for self-funded plans and, as an added service, prepares Forms 1094-C and 1095-C.

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What you get.

ACA penalties are assessed long after the year they apply to, from data that was reported the year before. Most problems start with an eligibility or affordability mistake no one caught at the time.

Employer mandate reviewWhether your company is an applicable large employer, and whether the coverage offered meets the mandate for every full-time employee.
Affordability testingEach plan option tested against the IRS affordability percentage using the safe harbor that fits your workforce.
Summaries of Benefits and CoverageSBCs prepared or reviewed for every plan option and provided when required.
PCORI feeThe fee calculated and the Form 720 package prepared for self-funded plans.
Forms 1094-C and 1095-CAs an added service, the annual ACA reporting prepared and filed.
Other ACA rulesWaiting periods, preventive care, out-of-pocket limits and dependent coverage to age 26 checked against plan design.

The employer mandate.

An applicable large employer must offer coverage to at least 95% of its full-time employees and their dependents, and that coverage must be affordable and provide minimum value. If it doesn’t, and a full-time employee gets subsidized coverage on the exchange, the IRS can assess a penalty under Internal Revenue Code § 4980H.

Affordability, every year.

The affordability percentage changes each year. Ethos re-tests every plan option at each renewal using the safe harbor that fits your workforce, before contributions are set, not after.

Reporting.

Forms 1094-C and 1095-C report what coverage was offered to whom, month by month. As an added service, Ethos prepares and files them from your payroll and enrollment data. Either way, the data that drives the forms is checked during the year so the filing reflects what actually happened.

Part of your Fiduciary Framework™.

Every Ethos service reports to your benefits committee. The work is reviewed at your quarterly committee meeting, each decision is recorded with the reasoning behind it, and the record lives in your Ethos Fiduciary OS. That is what lets your committee show the plan was run prudently.

See the Fiduciary Framework™ · How fiduciary governance works

Sources

Employer shared responsibility provisions, Internal Revenue Service
Patient Centered Outcomes Research Trust Fund fee, questions and answers, Internal Revenue Service

Questions employers ask about this.

Who is an applicable large employer?

An employer with an average of 50 or more full-time employees, including full-time equivalents, during the prior calendar year. Related companies under common control are counted together.

What does affordable mean under the ACA?

Coverage is affordable if the employee’s required contribution for the lowest-cost self-only option stays under a percentage of income that the IRS sets each year. Because employers don’t know household income, they test it using an IRS safe harbor such as rate of pay or W-2 wages.

Is ACA reporting included?

Preparing and filing Forms 1094-C and 1095-C is available as an added service. Affordability testing and the other ACA requirements are part of Ethos compliance support.

See what your plan is really costing you.

A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.

Request a Strategic Analysis Call (407) 803-4710