Admin America offers streamlined ACA Employer Reporting Service to health insurance professionals & their clients.

We designed our new employer reporting service to be the simplest, most client friendly and most reliable service available.

Over the past year, Admin America has conducted seminars across the country training health insurance professionals and their clients about the ACA’s Section 6055 and Section 6056 annual reporting requirements. It’s clear from that experience that employers are confused, frustrated and even a little afraid of how complex this process seems.

In those training seminars, our goal has been to simplify the reporting requirements for each attendee by focusing on the elements that apply to their specific situation and identifying all of the extraneous rules that are irrelevant for them. We’ve designed our ACA Employer Reporting Service based on the same philosophy.

Rather than relying on a generic one size fits all approach to data collection, we take the time to understand each client’s benefits environment. Based on this, we customize a data collection template for each client to fit their specific reporting obligations. This eliminates unnecessary data gathering for the client while also allowing Admin America to offer our reporting services at extremely competitive simplified pricing.

Simplicity and flexibility are great but we know it must be backed up by reliability. For over 25 years, the Admin America team has been a trusted resource for employers and health insurance professionals regarding federal employee benefits compliance issues. Our track record of reliability normally speaks for itself. However, ACA Employer Reporting was new for everyone in 2016. Employers need to know that their reporting will be done properly. To that end, we believe any ACA Employer Reporting Solution should be willing “to put their money with their mouth is.” That is why every client of our ACA Employer Reporting Solution receives a written performance guarantee against any penalties assessed by the IRS for non-compliance.

We are confident you will find that our experience and expertise have enabled us to develop and execute the best ACA Employer Reporting Service available.

Key features of Admin America’s ACA Employer Reporting Service include:

  • Simplified per 1095 Form pricing with no per-employer minimums or set-up fees
  • Services performed by dedicated account representative assigned to client
  • Written performance guarantee against non-compliance and/or late penalties
  • Client consultations to identify exact reporting obligations including:
    • Applicable Large Employer determinations
    • Look Back and Standard Measurement Period analysis
    • Determining which employees must be reported
    • Proper use of offer codes and affordability safe harbors
  • Customized data collection templates based on each client’s specific plan design
  • Distribution of completed 1095 Forms to employees via U.S. Postal Service
  • Electronic transmittal of 1094 and 1095 Forms to the IRS
  • Post-Filing assistance with TIN rejections
  • Assistance with Marketplace Notice appeals
  • All services supervised by Admin America’s in-house legal counsel

Who must report under the Affordable Care Act (ACA)?

Reporting is required by all Applicable Large Employers (ALE) and plan sponsors of self-funded health plans.

What is an applicable large employer (ALE)?

An applicable large employer is an employer that has an average of 50 or more full-time equivalent employees during the preceding calendar year. The calculation for each month is: full-time employees + (part-time employee hours for the month/120) = full-time equivalent employees. This means that employers may have less than 50 full-time employees but due to the amount of hours worked by the part-time employee population, an employer may have 50 or more full-time equivalent employees for purposes of complying with the ACA.

Who must report under section 6055 (Individual Mandate Minimum Essential Coverage Reporting)?

Anyone who provides minimum essential coverage (MEC) to an individual must report to the IRS and provide a statement to all individuals enrolled in the plan. This includes insurance issuers (insurance carriers) for insured coverage, plan sponsors of self-insured group health plans, and government sponsored programs.

Fully Insured Plans: Your insurance carrier will provide a statement 1095-B to plan participants to comply with this reporting requirement.

Self-Insured Plans: You will provide this information to plan participants on a combined reporting form 1095-C to comply with both the reporting requirements of the individual and employer mandate.

Who is the plan sponsor that must report under Section 6055?

For a self-funded health plan that is maintained by a single employer, the employer is the plan sponsor. For a plan maintained by more than one employer that is not a multi-employer plan (defined by ERISA), the plan sponsor is each participating employer. For a plan that is a multi-employer plan, the plan sponsor is the association, committee, joint board of trustees, or other similar group of representatives of the parties who established or maintain the plan.

Who must report under section 6056 (Employer Mandate Applicable Large Employer Reporting)?

All ALEs subject to the Affordable Care Act’s (ACA) employer mandate are required to report under section 6056 and provide a form 1095-C to all full-time employees. To determine who is a full-time employee that should receive a Form 1095-C under Section 6056, there are two different methods an employer may choose. An employer may use either the “monthly” method or the “look-back” safe harbor method.

Are seasonal employees counted?

If an employer is trying to determine ALE status, seasonal employees working 120 days or fewer per year may be excluded, if the employer is over 50 full-time equivalents (FTEs) for 120 days or fewer per year due to the inclusion of the seasonal employees.  If an employer is trying to determine whether or not seasonal employees must be offered coverage, it depends on the method you are using to determine full-time employee status. If an employer is using the monthly method, seasonal employees working 130 hours or more per month must be offered coverage for that month. Employers using the look-back safe harbor method of full-time status determination may measure a seasonal employee’s work hours for up to a year to determine whether or not they averaged 30 or more hours per week. An employee is only considered seasonal under the look-back safe harbor if individuals are hired into the same position at the same time every year for a period of six months or less.

Which forms go to the IRS and which go to an employee?

Forms 1094 are a transmittal to the IRS and Forms 1095 are a statement to plan participants. Further, the “B” Forms relate to the individual mandate of minimum essential coverage (MEC) and “C” Forms are related to the employer mandate of health coverage offers.