Keep your organization ahead of the curve


To make the right decisions, you'll need to consider key questions including:


  • Is my business considered a large or small employer under ACA?
  • What employer requirements do I need to be concerned with?
  • How does ACA affect my decisions regarding health coverage for my employees?


A few questions and answers


What is the best way for me to protect my business from Employer Shared Responsibility penalties? ACA reporting and compliance may seem daunting. It doesn’t need to be this way. Yes, "large employers" need to track, compile, and/or report on employee eligibility and benefit information. Once you understand ACA reporting and compliance, it really is a piece of cake. Work with a trusted advisor to determine your requirements and to help you vet the right solution based on your situation.


Will the GOP's ACA replacement end the employer mandate and required reporting? Don't expect quick changes in employer responsibilities. For now, all the current employer reporting and employee notice provisions will remain in effect under the proposed GOP legislation.


When is 1094-1095 reporting due in 2018?  The Internal Revenue Service is responsible for the administration of these requirements. In order to do so, they must gather information on individuals and employers to confirm everyone is doing what ACA requires. Depending on your plan(s), someone will need to file information on Forms (Form 1094-B, Form 1095-B, Form 1094-C and Form 1095-C) with the IRS in February/March of 2017 which will report data from 2016. 

Forms 1094-B & 1095-B provide the Minimum Essential Coverage (MEC) reporting mandated by IRC Section 6055 (Individual Mandate).
Forms 1094-C & 1095-C provide the Applicable Large Employers’ (ALE) reporting mandated by IRC Section 6056 (Shared Responsibility).



  Health Care Reform


America Still Divided on ACA


Employers have mixed feelings of complete ACA repeal. When asked whether they would like to see the ACA repealed entirely, 44 percent were opposed; 35 percent were in favor; and 20 percent were unsure. A report from the International Foundation of Employee Benefit Plans finds that if ACA is repealed, just over three in four employers (78%) would keep in place at least some of the provisions they have already implemented in their health plans.

Controlling healthcare costs is a very complex issue. We do not know if ACA will be repealed and replaced. What we do know is that employers will continue to do what they’ve always done – adapt.  In addition, recent changes in the individual market will make employer sponsored healthcare a coveted benefit. The key for employers is to explore innovative ways to control healthcare costs, while remaining competitive as an employer.



Healthcare reform 

Preventing Chronic Disease
While certainly not every preexisting condition is preventable, many are. Chronic diseases are the most common and costly of all health problems, but they are also the most preventable. Four common, health-damaging, but modifiable behaviors—tobacco use, insufficient physical activity, poor eating habits, and excessive alcohol use—are responsible for much of the illness, disability, and premature death related to chronic diseases. Improving health is one way to bend the cost curve.

Pre-existing Conditions and the Mandate to Buy Insurance
The reason people were denied coverage and treatments or charged more in the past was very simple, treating sick people is expensive.

The higher the risk a customer is, the less profitable it is for the insurance company to cover them. Taking this into account, insurance companies and legislators came to a compromise. Health insurance companies would agree to cover everyone and give them all the same essential health benefits, but in return, everyone who was able to afford insurance would have to buy insurance. Without the individual mandate, it will be very difficult to keep this provision in Healthcare Reform.

simplify and personalize

health and employee benefits

Key Provisions


Essential Health Benefits

A set of 10 categories of services health insurance plans must cover under the Affordable Care Act.


Much of it is preventive care that must be provided at no cost. Preventive care cuts costs by identifying and treating diseases before they become emergencies.These include well-woman visits, domestic violence screening and chronic disease management. It also covers lab tests to diagnose diseases, including mammograms and colonoscopies. This includes treatment for mental health, addiction and many chronic diseases. According to the CDC, 75 percent of all health care expenditures go toward treating chronic diseases, many of which are preventable. Lastly, plans must offer dental coverage for children. Dental benefits for adults are optional.


Pre-Existing Conditions

ObamaCare eliminated pre-existing conditions starting in 2014. No more pre-existing conditions means you can’t be denied coverage, charged more, or denied treatment based on health status.


Considering 1 in 2 Americans has a health condition that qualifies as a pre-existing condition, the Affordable Care Act (ObamaCare) doing away with pre-existing conditions and making all coverage Guaranteed Issue is a big deal.