Group Benefits
Employer Compliance Basics
Offering a plan brings paperwork with it. Here is the shape of it, in plain English, so you know what to ask your accountant and your attorney about.
The Affordable Care Act
The obligation that gets the most attention is the employer mandate, which applies to applicable large employers — generally those averaging 50 or more full‑time and full‑time‑equivalent employees. Those employers are expected to offer coverage meeting affordability and minimum value standards to full‑time employees, and to report what they offered on Forms 1094‑C and 1095‑C.
Smaller employers are not subject to the mandate. They may qualify for the Small Business Health Care Tax Credit if they meet the requirements, which include buying through the SHOP marketplace and contributing a minimum share of premium.
COBRA and state continuation
COBRA generally applies to employers with 20 or more employees and lets covered people continue group coverage for a limited period after a qualifying event such as termination or a reduction in hours. The notice deadlines are strict, and this is an area where employers most often use a third‑party administrator rather than handling it in house.
Many states have their own continuation rules covering smaller employers, sometimes called mini‑COBRA. What applies to you depends on your state and your headcount.
ERISA and plan documents
Most private employer health and welfare plans fall under ERISA, which brings requirements around plan documents, a summary plan description, and giving participants information about the plan. A carrier’s certificate of coverage is generally not by itself a complete plan document.
Notices that commonly come up
- Summary of Benefits and Coverage, at enrollment and on request
- Summary plan description
- Marketplace exchange notice for new hires
- Medicare Part D creditable coverage notice, before October 15 each year
- Women’s Health and Cancer Rights, CHIP, and other annual notices
- COBRA initial and election notices, where COBRA applies
Where an agent helps
We help you assemble the notices the carriers provide, keep the annual ones on a calendar, and point you toward a COBRA administrator or a payroll provider that handles the reporting. We do not give legal advice, and we will say so rather than guess at your obligations.
Not sure what applies to your company?
Tell us your headcount and your state and we will tell you which questions are worth taking to your accountant.
By calling this number, you will be connected with a licensed insurance agent who can answer questions about the plans we offer. There is no cost or obligation to talk. Or email Bill@imagineins.com.