The Affordable Care Act (ACA) requires certain employers to report information about the health coverage they offer to full-time employees. Accurate reporting is essential to demonstrate compliance and avoid IRS penalties.

Who Must Report?

Applicable Large Employers (ALEs)—generally those with 50 or more full-time or full-time equivalent employees—must file annual ACA reports with the IRS.

Forms You Need to File:

• Form 1094-C: Transmittal form summarizing all coverage offered by your organization.

• Form 1095-C: Individual statements provided to each full-time employee, showing coverage offered, months of availability, and whether it meets minimum value and affordability standards.

Filing Deadlines:

• Form 1095-C to employees: Typically January 31 each year

• Forms 1094-C and 1095-C to the IRS: Typically February 28 (paper) or March 31 (electronic)

Deadlines can shift annually; confirm current IRS guidance.

Why Accurate Reporting Matters:
Accurate ACA reporting helps you avoid:

• IRS penalties per form, per employee

• Inaccurate employee documentation

• Audits and administrative burdens

Correct reporting also ensures employees can verify their coverage for tax purposes.

How We Help:
We provide complete ACA reporting support:

• Tracking eligibility and full-time employee status

• Preparing and reviewing Forms 1094-C and 1095-C

• Filing electronically or by mail with the IRS

• Ensuring accuracy to reduce risk of penalties

The Employee Retirement Income Security Act (ERISA) sets standards for employee benefit plans, including health, retirement, and other welfare benefits. Compliance ensures your plans are administered fairly and meet federal legal requirements.

Who Must Comply?
ERISA applies to most private-sector employers who sponsor employee benefit plans, including:

• Health and welfare plans (medical, dental, vision, disability, life insurance)

• Retirement plans (401(k), pension, profit-sharing plans)

Key ERISA Requirements:

• Plan Documentation: All benefit plans must have written plan documents detailing eligibility, benefits, and administration procedures.

• Fiduciary Responsibility: Plan sponsors must act in the best interests of plan participants and beneficiaries.

• Reporting and Disclosure: Employers must provide required notices, including:

  • Summary Plan Descriptions (SPDs)

  • Summary of Benefits and Coverage (SBCs)

  • Annual reports (Form 5500 for certain plans)

• Claims and Appeals: Plans must have a fair and timely process for participants to file claims and appeal denied benefits.

Why ERISA Compliance Matters:
Noncompliance can result in:

• Significant financial penalties

• Legal disputes with employees

• Reputational risk for your business

How We Help:
We support employers with full ERISA compliance services, including:

• Drafting and reviewing plan documents

• Preparing and distributing SPDs, SBCs, and required notices

• Filing Form 5500 and other regulatory reports

• Implementing claims and appeals procedures

• Ongoing monitoring to ensure your plans remain compliant with changing regulations

The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows employees and their dependents to continue health coverage after a qualifying event that would otherwise end their benefits. Compliance is critical to avoid penalties and ensure employees maintain access to healthcare.

Who Must Comply?

• Employers with 20 or more employees generally fall under COBRA requirements.

• Applies to group health plans, including medical, dental, and vision coverage.

  Qualifying Events

  COBRA coverage may be elected following events such as:

  • Voluntary or involuntary termination (other than gross misconduct)

  • Reduction in work hours that affects eligibility

  • Divorce or legal separation from a covered employee

  • Death of the covered employee

  • Loss of dependent status (e.g., aging out of a parent’s plan

  Employer Responsibilities

  • Notice Requirements: Notify eligible employees and their dependents of COBRA rights within 14 days of a qualifying event.

  • Coverage Continuation: Offer continuation of coverage for up to 18 or 36 months, depending on the type of qualifying event.

  • Premium Collection: Employees are responsible for paying the full premium, including the portion previously paid by the employer plus an administrative fee (up to 102% of the total cost).

  • Administration: Track eligible participants, manage elections, and maintain documentation for compliance audits.

• Why COBRA Compliance Matters

  Failure to comply can result in:

  • IRS or DOL penalties

  • Legal disputes or employee claims

  • Employee dissatisfaction and reputational risk.

The Health Insurance Portability and Accountability Act (HIPAA) protects employees’ personal health information (PHI) and sets standards for privacy, security, and electronic transactions. Employers who sponsor group health plans must ensure compliance to safeguard sensitive data and avoid penalties.

Who Must Comply?

• Employers who sponsor group health plans (medical, dental, vision, or other health coverage)

• Plan administrators or third-party vendors who handle PHI on behalf of the plan

Key HIPAA Requirements

1. Privacy Rule

   • Protects PHI from unauthorized use or disclosure

   • Requires employers and administrators to provide a Notice of Privacy Practices to plan participants

2. Security Rule

   • Requires administrative, physical, and technical safeguards to protect electronic PHI (ePHI)

   • Examples include secure access controls, data encryption, and regular risk assessments

3. Transaction & Code Sets Rule

   • Standardizes electronic claims, payment, and health information exchanges

4. Breach Notification Rule

   • Employers must notify affected individuals, the Department of Health and Human Services (HHS), and sometimes the media if a breach of unsecured PHI occurs

Employer Responsibilities

• Ensure third-party vendors (TPAs, brokers, administrators) are HIPAA-compliant

• Implement internal policies and training to protect PHI

• Maintain documentation of compliance efforts and risk assessment

Why HIPAA Compliance Matters

Noncompliance can result in:

• Civil and criminal penalties ranging from $100 to $50,000 per violation

• Breach notification obligations

• Loss of trust with employees and potential legal exposure

Employers offering group benefits must ensure their plans are fair and equitable. Federal law prohibits discrimination in benefit eligibility or coverage based on factors like age, gender, health status, or compensation. Compliance is essential to avoid penalties and promote workplace fairness.

ey Non-Discrimination Rules

1. ACA Non-Discrimination Rules

   • Applicable to employers with 50+ full-time employees (ALEs)

   • Health plans cannot favor highly compensated employees when offering benefits

   • Ensures access to preventive services for all employees without discrimination

2. HIPAA Non-Discrimination Rules

   • Health coverage cannot discriminate against employees or dependents based on health status, medical condition, or genetic information

3. Internal Revenue Code (IRC) Rules

   • Section 105(h) & Section 125: Non-discrimination rules for self-insured health plans and cafeteria plans

   • Plans cannot favor highly compensated or key employees in terms of eligibility or benefits

4. ERISA Considerations

   • ERISA requires fair administration of employee benefit plans

   • Must avoid disparate treatment or discriminatory practices that disadvantage certain groups of employees

mployer Responsibilities

• Design benefits to comply with all applicable non-discrimination rules

• Regularly test plans to ensure highly compensated employees are not receiving disproportionate benefits

• Maintain documentation to demonstrate compliance in case of audit

Why Non-Discrimination Compliance Matters

Noncompliance can result in:

• IRS penalties for discriminatory plans

• Legal challenges or employee claims

• Reputational damage and loss of employee trust