Compliance is likely one of the biggest HR-related challenges facing your business. Staying compliant with the Affordable Care Act doesn’t have to be a headache.
The ACA is complicated, and while we can’t cover every detail in one blog post, we’re going to outline important information that you can continually refer to as you navigate the upcoming ACA reporting season. For expert advice, we consulted Regan Debban, J.D., MBA, Principal, of leading compliance consulting firm Benefit Comply.
If you are an Applicable Large Employer (ALE), defined as a company with an average of at least 50 full-time equivalents, you are required to offer affordable health insurance to your full-time employees as a part of the ACA’s Employer Mandate or Employer Shared Responsibility Payments. Minimum essential coverage (MEC) must also be offered to 95% or all but 5 employees (if greater), of full-time employees and their dependents. In addition, the coverage must provide minimum value and must be affordable.
Since the IRS can’t just trust that your business is offering affordable health coverage that meets minimum value, you must prove your compliance to the IRS each year via ACA reporting. If you fail to complete ACA reporting, you may receive a Letter 5699, and if you report but do not appear to be compliant, you will receive a proposed assessment via Letter 226J. After you receive a letter, you will pay your penalty or put forth evidence that you are not in violation and there was a mistake made in the reporting process. Both of these processes can be time-consuming and expensive.
Proving that your business is ACA compliant is a complex, lengthy process. It involves collecting different datasets from several sources, running calculations based on employee demographics, and completing extensive forms. Unfortunately, this opens the door to easy mistakes that could yield penalties and legal complications.
We asked Regan from Benefit Comply to present the ACA violations and the corresponding penalties businesses most often fall victim to:
For each of the violations listed above, the fine per employee and total penalty cost has increased every year. In 2015, the fine for §4980H(a) was $2,080 and by 2018, the penalty grew to $2,320. For example, if a company with a total full-time employee count of 100 did not offer minimum essential coverage to at least 95% of its employees in 2018, the penalty calculation would be: (100-30) X 2,320 = $162,400.
In the past, the IRS did not penalize employers they believed put forth a good faith effort to comply with ACA requirements, but it is unclear whether this will be true for the upcoming reporting year. This makes it more important than ever for employers to accurately complete ACA reporting in order to avoid a large penalty like the example listed above.
Regan often warns employers of two avoidable mistakes that have unnecessarily caused headaches in the past. They include:
The good news is that there are several steps you can take to ensure that your business is ACA compliant. Regan suggests starting by examining your medical plan offerings.
Employers should ensure that their medical plan offerings are set up to comply with §4980H requirements and that the employer has a method of reporting such offers of coverage on a timely basis to the IRS.
When it comes to ACA reporting, Regan named the following three actions as a must for HR administrators and/or business-owners managing ACA reporting:
Regan explained the benefits of keeping up with ACA reporting throughout the year.
To accurately report, the employer must track full-time status and offers of coverage on a monthly basis for an entire calendar year. The whole process is typically easier if the tracking is done throughout the year.
ACA reporting carries a lot of responsibility and risk. The good news is that you do not have to manage ACA reporting on your own. In fact, Regan encourages employers to work with a service or vendor to ensure ACA compliance.
Make sure you have a vendor or system in place that can accurately report the required information to the IRS in a timely fashion.
If you’re new to ACA reporting and/or are looking for a new service or vendor to help, we recommend reaching out to your health insurance broker. Because a lot of the data required to prove your ACA compliance is the same data required for benefits enrollment, your broker will likely be able to help you compile the necessary data. They also may have a software solution or service that you can use to ensure ACA compliance.
No matter the vendor or software solution you use, it’s important that you’re able to perform the actions necessary to prove ACA compliance. This includes:
The first ACA reporting deadline is in less than two months. Proving that your business is ACA compliant isn’t something that can be completed in a few hours. Remember to start early, avoid common mistakes, and take advantage of services and resources that can help. We think it’s the best way to avoid thousands of dollars in fines.
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