ACA Reporting Services for Non-ALEs Offering Self-Funded Group Health Plan Coverage - Admin America

Home Services ACA Employer Reporting ACA Reporting Services for Non-ALEs Offering Self-Funded Group Health Plan Coverage

Step 1 of 7

ACA Service Year
Select the calendar year for which coverage data is being reported*

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Billing Information
ACA Reporting
Price:
Total
$0.00

Additionally, for each form generated, a $3.50 fee will be invoiced to you.
Billing Contact*
Enter the First and Last Name of the Credit Card Holder as it appears on the Credit Card.
First Last
Billing Contact Email*
The receipt will be sent to the email address entered.
Billing Contact Phone*
Billing Address*
Enter the Address associated with the Credit Card

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
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