ACA Compliance

What Is ACA Compliance?

Businesses subject to Affordable Care Act (ACA) compliance must offer essential health coverage at affordable rates for eligible employees or pay employer shared responsibility to the IRS. At Mark E. Snapp & Associates, we provide ACA compliance services from our offices in Charleston, West Virginia and Palm Beach, Florida, including the areas around Huntington, Beckley, Parkersburg, and Morgantown, WV, as well as the greater Palm Beaches in Florida.

To comply with the ACA, eligible employers must offer 95% of full-time employees and their dependents minimum essential coverage and minimum value. They must also provide employees with the appropriate forms, including Form 1095-C, Notice of Coverage and Available Benefits, and Summary of Benefits and Coverage. Additionally, employers must submit Forms 1094-C/1095-C to the IRS annually.

Rx Compliance

Employers of different sizes, whether an ALE or a small business, may need to report the share of prescription drug costs they covered on an employee’s W-2 in Box 12, Code DD. We can help you follow the IRS’s W-2 reporting rules for required reporting, what not to report, and what is optional to report.

DOL and ACA Compliance Support Through Arlo Health

Arlo Health provides employers with support for several important Department of Labor and Affordable Care Act compliance requirements. Some items are handled directly by Arlo and its partners, while others remain the responsibility of the employer or plan sponsor.

ACA Reporting: Forms 1094 and 1095

For Applicable Large Employers with 50 or more full-time employees, Arlo makes Forms 1094 and 1095 available for download through the employer portal. The employer is responsible for distributing Form 1095 to employees and filing the required forms with the IRS.

PCORI Fees

For level-funded and self-funded plans, Arlo sends the employer a PCORI fee notification and provides a payment link through the portal. The employer is responsible for submitting the annual payment using IRS Form 720 by the applicable July 31 deadline.

Form 5500

Form 5500 is generally required for ERISA plans with 100 or more participants. The employer or plan sponsor is responsible for completing and filing this form. It is generally due seven months after the end of the plan year, with an extension available when properly requested.

RxDC Reporting

Arlo handles RxDC reporting on the employer’s behalf in partnership with SmithRx. No additional filing is required from the employer group.

Section 125 Cafeteria Plan

Arlo provides Section 125 cafeteria plan setup for the employer at no additional cost.

COBRA Administration

Arlo provides COBRA administration for eligible groups with 20 or more employees and sends the required COBRA information directly to terminated members. The employer retains the underlying compliance responsibility, while Arlo handles the administrative process.

Medicare Part D and HIPAA Notices

Standard Medicare Part D and HIPAA notices are included with the plan and provided as part of the annual compliance process.

Gag Clause Prohibition Compliance Attestation

The employer or health plan is responsible for submitting the annual Gag Clause Prohibition Compliance Attestation to the Departments of Labor, Health and Human Services, and Treasury through HIOS by December 31.

Yuzu, Arlo’s third-party administrator, can provide a signed letter confirming that its administrative contracts do not contain prohibited gag clauses. This letter may be used as supporting documentation, but it does not replace the employer group’s required attestation filing.

Census Reporting

Insurers will request that employees submit their name, date of birth, number of dependents, and zip code when they apply for coverage. This information helps estimate the costs that the group could incur. You can request your insurer’s census reporting information to help you estimate taxes and fees for your CPA reporting obligations.

For ACA compliance assistance, contact us at Mark E. Snapp & Associates at our offices in Charleston, West Virginia or Palm Beach, Florida.

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