Affordable Care Act (ACA)
The Affordable Care Act (ACA) sets guidelines for employers regarding health care coverage based on their company size and structure.
Companies with 50 or more full-time equivalent (FTE) employees must provide benefits to at least 95% of their full-time employees and their dependents, and file Forms 1094-C and 1095-C under the “employer mandate” (also known as "employer responsibility).
Smaller businesses (less than 50 FTE) that offer benefits to their employees must comply with various ACA rules, but they are not required to file or report anything.
Niural assists clients in maintaining compliance in the following ways:
- Handle pre-tax payroll deductions and provide the necessary Section 125 document for authorization.
- Prepare and file Forms 1094-C and 1095-C for companies with 50 or more FTE in the previous calendar year, distributing Form 1095-C to employees.
- Provide newly hired employees with the ACA Marketplace Notice.
- Electronically distribute the Summary of Benefits and Coverage (SBC) to your employees during health benefits enrollment.
- Ensure alignment with your existing policies and insurance carrier requirements.
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal program that offers temporary continuation of health insurance coverage to employees when their job ends or hours are reduced.
Employers with 20 or more employees in the previous year must provide COBRA as part of their group health plan. In some states, employers with fewer than 20 employees may also be obligated to offer continuation coverage based on state-specific regulations.
Department of Labor (DOL) and Center for Medicare Services (CMS)
Employers are required to adhere to DOL regulations related to employment and anti-discrimination laws, among others. Additionally, they must provide participants with information that could affect their Medicare eligibility or costs.
Employee Retirement Income Security Act of 1974 (ERISA)
ERISA safeguards plan participants and beneficiaries, obligating plan administrators to furnish them with plan information.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
HIPAA mandates proper handling of protected health information (PHI) by workers, with potential penalties or criminal charges for non-compliance. It also imposes limitations on employer access to and use of such information.
Internal Revenue Service (IRS)
Employers providing pre-tax benefits must comply with IRS regulations, ensuring adherence to Section 125 requirements. This involves having appropriate plan documents and correctly managing plans in accordance with group benefit participation rules.