ACA Compliance Collateral

60-Day Notice

The ACA requires Group Health Insurance plans and insurers to provide a minimum 60-day notice of material plan modifications (outside of renewal) to all enrollees prior to the effective date.

Controlled Groups/Common Ownership

An Applicable Large Employer can be a single company or multiple companies combined because of common ownership (such as a parent company and affiliates). Learn about Controlled Group rules.

Essential Health Benefits

All ACA-qualified health plans must include coverage for 10 “essential health benefits,” including ambulatory patient services, emergency services, hospitalization, prescription drugs, and more.

Minimum Essential Coverage (MEC)

The ACA originally included an Individual Mandate for minimum essential health coverage for most Americans. However, the penalty for non-compliance was reduced to zero beginning January 1, 2019.

ACA IRS Reporting

Applicable Large Employers must report their offer (or non-offer) of “affordable” Health Insurance with minimum value to full-time employees and their dependent children – or face penalties.

Minimum Value (MV)

A Minimum Value plan covers at least 60% of the total cost of medical services. The Actuarial Value range for ACA-qualified plans is 60-90%, based on Bronze, Silver, Gold, and Platinum metal tiers.

Employer Notifications Checklist

This checklist contains a general list of notices an employer sponsoring group health coverage must create, distribute, and/or redistribute to employees.

FSA, HSA, & High Deductible Health Plan Limits

Maximum allowable deductibles vary by product type and calendar year. Health Savings Account, Health Reimbursement Account, and Flexible Spending Account contributions also vary annually.

Annual Special Open Enrollment Window

The ACA requires insurers to offer a one-month Special Open Enrollment Window, when eligible Small Groups can enroll in coverage without meeting standard contribution or participation rules.

Summary Of Benefits and Coverage (SBCs)

Health insurers are required by the ACA to provide to employees and dependents an easy-to-understand summary of each health plan’s benefits and coverage at enrollment or renewal.

W-2 Reporting Of Health Care

Informational reporting regarding employer-provided health insurance is required by businesses on employees’ W-2 forms only for those issuing 250 or more W-2s for the prior tax year.

IRS Form 5500

Developed jointly by the IRS, Department of Labor, and Pension Benefit Guaranty Corporation, the Form 5500 series includes forms employers use to meet their annual ERISA reporting requirements.

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