At the close of 2024, Congress passed two new pieces of legislation: the Paperwork Burden Reduction Act and the Employer Reporting Improvement Act. These laws simplify the Affordable Care Act (ACA) reporting requirements for employers and introduce new limits on the IRS’s authority to enforce “pay-or-play” penalties, among other changes. Under the ACA, applicable large…
For employers subject to the Affordable Care Act (ACA), staying compliant with reporting requirements is non-negotiable. With 2025 due dates just around the corner, now is the time to prepare for distributing Forms 1095-C to employees and filing with the IRS. These forms provide essential information about health coverage offered to employees and are critical…
Most organizations treat employee benefits like a seasonal event. Open enrollment brings a flurry of activity – emails, seminars, and even benefits fairs. However, communication often dwindles after this initial push, leaving employees confused and underutilizing their valuable benefits. This is a missed opportunity. Research shows that employees crave more benefits education, spending hours researching…
The Affordable Care Act (ACA) requires large employers to offer affordable health insurance coverage to their full-time employees or face a penalty known as the “Pay or Play” tax. This tax is based on the employer’s average monthly wage (AMW) and the number of full-time employees. The affordability rate for employer-sponsored health coverage will increase from 8.39% to…
The Department of Health and Human Services (HHS) has issued a final rule that significantly expands the Mental Health Parity and Addiction Act (MHPAEA) requirements under the Affordable Care Act (ACA). This rule aims to ensure that health plans provide equal coverage for mental health and substance use disorder (MH/SUD) benefits as they do for…
The Affordable Care Act (ACA) introduced the Medical Loss Ratio (MLR) to ensure that health insurance companies spend a significant portion of premiums on medical care and quality improvement activities rather than administrative costs and profits. When insurers fail to meet the MLR threshold, they are required to issue rebates to plan sponsors. Understanding MLR…
On September 30, 2021, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (collectively, the Departments), along with the Office of Personnel Management (OPM), released an interim final rule (IFR) under the No Surprises Act (Act) to help protect health care consumers from surprise billing and excessive…
The Affordable Care Act’s employer shared responsibility provision — often called the employer mandate or “play or pay” — requires large employers to offer health coverage to their full-time employees or face a potential penalty. (Employers with fewer than 50 full-time and full-time-equivalent employees are exempt.) Large employers can avoid the risk of any play…
On July 1, 2021, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (collectively, the Departments), along with the Office of Personnel Management (OPM) released an interim final rule with comment period (IFC), entitled “Requirements Related to Surprise Billing; Part I.” This rule related to Title…
