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Admin America, Inc.

Alpharetta, GA 30005

770-992-5959        800-366-2961

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ACA Reporting Services for Applicable Large Employers (ALEs)

Home Services ACA Employer Reporting ACA Reporting Services for Applicable Large Employers (ALEs)

1ACA Service Year
2Employer Details
3Contact Details
4Employer Status Detail
5Employer ACA Data Information
6Employer ACA Data Information for 1/1 Renewal
7Employer ACA Data Information Before Renewal
8Employer ACA Data Information After Renewal
9Submission Summary
10Authorized Representative Information
11Billing Information

  • ACA Service Year


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  • Submission of this Enrollment Application reserves Employer access to Admin America's {For which year are you requesting ACA services?:98} ACA Reporting Service.

  • Employer Details




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  • Contact Details









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  • Employer Status Details


  • All questions below pertain to year {For which year are you requesting ACA services?:98}



  • An ACA Service Enrollment Application is required for each entity for which you want {For which year are you requesting ACA services?:98} ACA services.

    A link to submit an additional form will be available after submission of the form you are currently completing.

  • Click the + add rows and the - to remove rows as needed



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  • Employer ACA Data Information


  • The question below pertains to year {For which year are you requesting ACA services?:98}


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  • Employer ACA Data Information for 1/1 Renewal


  • All questions below pertain to your Medical Plan(s) for renewal date {What is the Renewal Date of your Medical Plan?:28}/{For which year are you requesting ACA services?:98}



  • Admin America, Inc. will help you make this determination



  • Admin America, Inc. will help you make this determination

  • Enter currency format 9,999.99 without the dollar sign







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  • Employer ACA Data Information Before Renewal


  • All questions below pertain to your Medical Plan(s) prior to {What is the Renewal Date of your Medical Plan?:28}/{For which year are you requesting ACA services?:98}


  • Admin America, Inc. will help you make this determination


  • Admin America, Inc. will help you make this determination

  • Enter currency format 9,999.99 without the dollar sign







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  • Employer ACA Data Information After Renewal


  • All questions below pertain to your Medical Plan(s) after {What is the Renewal Date of your Medical Plan?:28}/{For which year are you requesting ACA services?:98}


  • Admin America, Inc. will help you make this determination


  • Admin America, Inc. will help you make this determination

  • Enter currency format 9,999.99 without the dollar sign







Save and Continue Later

  • Submission Summary

  • {all_fields}
Save and Continue Later

  • The details of your submission will be sent to the email address provided below.


  • The details of your submission will be sent to the email address(es) provided below.

    To send to multiple email addresses, separate the email addresses with a comma.

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  • Billing Information


  • please wait

  • $0.00

    Additionally, for each form generated, a $3.50 fee will be invoiced to you.

  • Enter the First and Last Name of the Credit Card Holder as it appears on the Credit Card.
  • The receipt will be sent to the email address entered.
  • Enter the Address associated with the Credit Card

  • American Express
    Discover
    MasterCard
    Visa
    Supported Credit Cards: American Express, Discover, MasterCard, Visa
      


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We provide expert welfare benefit plan advice to both brokers and businesses. With 30 years of experience we’ll ensure that you’re always getting the best guidance from the most professional company offering both administration and compliance.

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