Tag: ACA
New Legislation Updates ACA Reporting Rules
At the close of 2024, Congress passed two new pieces of legislation: the Paperwork Burden Reduction Act and the Employer Reporting Improvement Act. These laws simplify the Affordable Care Act (ACA) reporting requirements for employers and introduce new limits on the IRS’s authority to enforce “pay-or-play” penalties, among other changes. Under the ACA, applicable large…
ACA Reporting Deadlines for 2025: What You Need to Know
For employers subject to the Affordable Care Act (ACA), staying compliant with reporting requirements is non-negotiable. With 2025 due dates just around the corner, now is the time to prepare for distributing Forms 1095-C to employees and filing with the IRS. These forms provide essential information about health coverage offered to employees and are critical…
Compliance Recap December 2024
TWO BILLS IMPACTING ACA REPORTING REQUIREMENTS Two recent bills signed into law by President Biden are set to ease the Affordable Care Act (ACA) reporting requirements for employers. The Paperwork Burden Reduction Act and the Employer Reporting Improvement Act introduce significant changes to the way employers handle Forms 1095-B and 1095-C, used to report health…
The Pay or Play Percentage Increase for 2025
The Affordable Care Act (ACA) requires large employers to offer affordable health insurance coverage to their full-time employees or face a penalty known as the “Pay or Play” tax. This tax is based on the employer’s average monthly wage (AMW) and the number of full-time employees. The affordability rate for employer-sponsored health coverage will increase from 8.39% to…
Compliance Recap | Sept. 2024
SUMMARY ANNUAL REPORT DUE The Summary Annual Report (SAR) is a disclosure requirement under ERISA. The SAR acts as a narrative of the Form 5500 for employee benefit plans. It includes financial statements, funding requirements, and participants’ rights. The SAR must be provided to participants and enrolled beneficiaries within nine months after the end of the plan…
Medical Loss Ratio (MLR) Rebates: A Timely Reminder
The Affordable Care Act (ACA) introduced the Medical Loss Ratio (MLR) to ensure that health insurance companies spend a significant portion of premiums on medical care and quality improvement activities rather than administrative costs and profits. When insurers fail to meet the MLR threshold, they are required to issue rebates to plan sponsors. Understanding MLR…
Compliance Recap | June 2024
ACA PREVENTIVE CARE MANDATE REMAINS IN PLACE WITH AN EXCEPTION In a recent decision, the U.S. 5th Circuit Court of Appeals upheld a key provision of the Affordable Care Act (ACA) that mandates private insurance cover preventive services without cost to patients. However, the court also ruled that the plaintiffs are exempt from complying with this mandate,…
Benefits Check-up: 6 Compliance Issues Affecting Your Clients’ Health
A health plan is more than a product or service; it’s a relationship. All productive and healthy relationships—especially in the benefits space—rely on trust. When an employer extends trust in a broker or insurance carrier to purchase something as critical as healthcare—for people as critical as their workers and families—we’re obligated to raise all factors…
Compliance Recap March 2024
AFFORDABLE CARE ACT INFORMATION REPORTING Beginning in 2024, most employers obligated to report under the Affordable Care Act (ACA) must file returns electronically by March 31, 2024. Employers filing fewer than 10 returns a year are allowed to use paper filing. Since March 31 falls on a weekend, the deadline this year is April 1,…
Compliance Recap February 2024
In early February, a federal class action lawsuit was filed against Johnson & Johnson (JNJ) and its plan fiduciaries, alleging overpayment for prescription drugs within its prescription drug plan. The complaint alleges that under the Employee Retirement Income Security Act of 1974 (ERISA), JNJ’s plan fiduciaries are obligated to diligently compare service providers, seek cost-effective options, and…