Why Participation Requirements Are Holding Employers Hostage

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Quick Summary

Most employers assume the hardest part of offering health coverage is the cost. For a meaningful number of businesses, the harder part is simply qualifying for a plan in the first place. Traditional group health insurance carriers require a minimum percentage of eligible employees to actually enroll, typically somewhere between 50 and 75 percent, before they will issue or renew a policy at all. An employer can have the budget, the willingness, and the workforce, and still get turned away because not enough people signed up. This piece breaks down what participation requirements are, why insurers use them, which employers get hit hardest, and how a structured MEC and Restricted Medical strategy sidesteps the problem entirely.

What Participation Requirements Actually Are

A participation requirement is a threshold insurers set for how many eligible employees must enroll in a group health plan before the policy becomes active. Most carriers land somewhere in the 50 to 75 percent range, with many defaulting to 70 percent as an industry standard. The exact number depends on the carrier, the state, and whether the plan is contributory (employees pay part of the premium) or non-contributory (the employer covers the full cost).

Employees who already have coverage elsewhere, through a spouse’s plan, Medicaid, or another qualifying source, are usually excluded from the count. But for many workforces, that exclusion doesn’t move the number nearly enough.

Why Insurers Impose Them

The logic isn’t arbitrary. Insurers use participation minimums to guard against adverse selection, the pattern where only employees who expect to need care actually enroll, while healthy employees opt out and take their risk elsewhere. A plan built entirely around the employees most likely to file claims is a plan that becomes unsustainably expensive to price. Participation requirements force a broader, more representative slice of the workforce into the risk pool, which is what keeps premiums stable for everyone who does enroll.

That protects the insurer’s book of business. It does very little for the employer standing on the other side of the threshold, watching a plan they were ready to fund get rejected because employees who already have coverage through a spouse chose, reasonably, not to enroll twice.

Where Participation Requirements Hurt Employers Most

Participation minimums are not evenly distributing pain across the employer population. A handful of workforce profiles run into this wall far more often than others:

Hourly and lower-wage teams. Employees closer to the margin are more likely to weigh a payroll deduction against take-home pay and decline, even when the coverage itself would benefit them.

High-turnover industries. Restaurants, retail, staffing, and hospitality see enrollment numbers shift constantly as headcount turns over, making a stable 70 percent threshold difficult to hold quarter over quarter.

Seasonal and multi-location businesses. Franchise operators and seasonal employers often have a workforce that expands and contracts throughout the year, which makes hitting a fixed participation number a moving target rather than a one-time hurdle.

Younger or healthier workforces. Employees who feel they don’t need coverage yet are the most likely to opt out entirely, which is exactly the group participation requirements are designed to catch, and exactly the group that tanks the enrollment percentage.

None of these employers are doing anything wrong. They’re running businesses with workforce patterns that don’t match the assumptions baked into a traditional group health model.

What Happens When a Business Falls Short

The consequences aren’t limited to a rejected application. A business that qualifies for a plan initially can lose that qualification at renewal if enrollment slips below the threshold, sometimes with limited warning. Carriers can decline to renew a policy outright, or renew it only after a significant premium increase designed to offset the smaller, less balanced risk pool. For an employer who has already built a benefits program around a specific plan, a participation shortfall can mean starting over entirely at the worst possible time, mid-renewal, with employees expecting continuity of coverage.

How SBMA Removes the Barrier

This is precisely the gap SBMA’s MEC and Restricted Medical structure was built to close. Because these plans are not underwritten the same way traditional major medical group policies are, they carry low or no participation minimums, which means an employer’s ability to offer coverage doesn’t hinge on how many employees happen to enroll in any given year.

That structure works particularly well for the employer profiles most exposed to traditional participation rules:

  • Franchise and multi-location operators managing enrollment across dozens of sites with different headcounts
  • Hospitality and seasonal employers whose workforce expands and contracts throughout the year
  • High-turnover industries where a stable enrollment percentage is difficult to sustain
  • Any employer who has been declined or non-renewed by a traditional carrier specifically over a participation shortfall

Employers can offer coverage confidently, and employees who want it can enroll, without either side worrying about whether the whole plan collapses if participation dips below an arbitrary line.

Which Employers Should Pay Attention to This

If your business has ever been quoted a participation minimum you weren’t confident you could hit, or if you’ve lost a plan at renewal because enrollment slipped, this is worth a closer look regardless of company size. It’s especially relevant for Applicable Large Employers balancing ACA mandate compliance with a workforce that doesn’t behave like a stable, full-time office population, and for brokers who need an answer ready the next time a client gets non-renewed over a number that had nothing to do with their budget or their intent to offer coverage.

Where This Goes From Here

Participation requirements were built for a workforce model that a growing share of employers no longer have. As hourly, seasonal, and multi-location work becomes the norm rather than the exception, the businesses that get boxed out by a 70 percent threshold aren’t the exception either. Structuring benefits around a model that doesn’t impose that constraint in the first place means the coverage decision stays where it belongs, with the employer and the employee, not with an enrollment percentage neither of them can fully control.

Frequently Asked Questions About Participation Requirements

What counts as an “eligible” employee for participation purposes? Eligible employees are generally those who meet the plan’s hours and waiting period requirements, typically full-time staff working 30 or more hours per week. Employees who already have coverage through a spouse’s plan, Medicaid, or another qualifying source are usually excluded from the count, since they aren’t expected to enroll regardless of how good the plan is.

What percentage of employees actually need to enroll? It depends on the carrier and the state, but most traditional group health plans set the threshold somewhere between 50 and 75 percent of eligible employees, with 70 percent being common. A contributory plan, where employees pay part of the premium, often carries a different requirement than a non-contributory plan the employer funds in full.

Does every employee who declines coverage count against the participation rate? Not every decline counts the same way. Employees with coverage elsewhere are usually excluded from the eligible pool entirely. But an employee who simply chooses not to enroll, for cost or any other reason, does count against the threshold, which is what makes the number so hard to control for employers with a young, healthy, or price-sensitive workforce.

Can a business lose a plan it already qualified for? Yes. Participation is typically reassessed at renewal, not just at initial enrollment. A business that met the threshold when the plan started can fall short a year later if enrollment slips, and carriers can respond with a significant premium increase or a decision not to renew at all.

Do participation requirements apply to ACA compliance strategies like MEC? Traditional major medical group plans are underwritten with participation minimums built in. SBMA’s MEC and Restricted Medical plans are structured differently and carry low or no participation minimums, which is why they work for ACA compliance strategies where enrollment percentage can’t be guaranteed.

Does low participation mean employees don’t want coverage? Not necessarily. Low participation is often a reflection of workforce economics, cost sensitivity, or existing coverage elsewhere rather than a lack of interest in the benefit itself. Conflating the two can lead an employer to drop a coverage strategy that would otherwise serve the workforce well.

How quickly can SBMA implement a plan without participation minimums? Most SBMA plans are configured and deployed within 30 days, including enrollment setup, digital ID cards, billing integration, and employee communication, the same timeline as SBMA’s other MEC and Restricted Medical offerings.

Are participation requirements the same in every state? No. Participation thresholds are set at the carrier and state level, so the exact percentage and how it’s calculated can shift depending on where a business operates. Employers with locations in multiple states may be working against different thresholds for the same plan design.

Mastering ACA Jargon: Key Terms Every Applicable Large Employer Should Know

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By SBMA Benefits Team

Quick Overview

The Affordable Care Act’s employer mandate comes with its own vocabulary. Terms like Applicable Large Employer, Minimum Value, look-back measurement period, and affordability safe harbor each carry a specific legal meaning, and those meanings determine which employers must offer coverage, what that coverage must include, and how compliance is reported to the IRS.

The definitions below are grouped by topic: ALE status, full-time employees, coverage standards, affordability, penalties, and reporting. Figures reflect the most recent IRS guidance, including the 10.22% affordability percentage for plan years beginning in 2027 (Rev. Proc. 2026-26) and the 2027 penalty amounts of $3,780 and $5,670 (Rev. Proc. 2026-22).

For a complete walkthrough of how these pieces fit together, see ACA Compliance for Employers: The Complete Guide to the Employer Mandate and Penalties.

What Is an Applicable Large Employer?

Applicable Large Employer (ALE). An employer that averaged at least 50 full-time employees, including full-time equivalents, during the prior calendar year, according to the IRS. ALE status is determined fresh each year, and it is the threshold that brings an employer under the employer shared responsibility provisions and annual reporting.

Full-Time Equivalent (FTE) calculation. The method for converting part-time hours into a full-time headcount. For each month, total the hours of service for all employees who are not full-time (counting no more than 120 hours per person) and divide by 120. Add the result to that month’s full-time headcount, then average all 12 months.

ALE member and aggregated ALE group. Companies under common ownership are generally combined under IRS controlled group rules to determine ALE status. Each company in the group is an ALE member, even if it has fewer than 50 employees on its own. Our post on IRS controlled group designation explains how aggregation works.

Seasonal worker exception. An employer is not treated as an ALE if its workforce exceeds 50 full-time employees and FTEs for 120 days or fewer during the year, and the employees above 50 during that period are seasonal workers. Seasonal employers can find more detail in our post on seasonal staffing coverage requirements.

How Does the ACA Define a Full-Time Employee?

Full-time employee. An employee who averages at least 30 hours of service per week, or 130 hours per month. The ACA definition applies regardless of how a role is classified internally. Our posts on full-time vs. part-time benefits and ACA misclassification cover the most common classification gaps.

Variable-hour employee. An employee whose hours are not predictable at the time of hire, making it unclear whether they will average 30 hours per week.

Monthly measurement method. Full-time status is determined month by month based on hours worked that month, as described by the IRS.

Look-back measurement method. An approach that sets full-time status for a future period based on hours worked in a past period. It uses three components:

  • Standard measurement period: A period of 3 to 12 months during which an employee’s hours are tracked and averaged.
  • Administrative period: An optional window of up to 90 days between the measurement period and the stability period, used to determine eligibility and process enrollment.
  • Stability period: The period during which the employee’s status (full-time or not) is locked in. It must be at least six months and no shorter than the measurement period.

Employers with variable-hour, seasonal, or part-time staff typically use the look-back method because it keeps eligibility stable from month to month.

What Coverage Terms Should Applicable Large Employers Know?

Minimum Essential Coverage (MEC). Health coverage that meets the ACA’s baseline requirements for employer-sponsored coverage. Offering MEC to enough full-time employees is the first test under the employer mandate. Our explainer on what MEC is and what it covers walks through common plan designs, and SBMA’s Acute Care (MEC) coverage shows how it works in practice.

MEC offer (the 95% requirement). An ALE must offer MEC to at least 95% of its full-time employees and their dependents to address the Section 4980H(a) penalty, according to the IRS.

Dependent. For employer mandate purposes, a dependent is an employee’s child under age 26. Spouses are not included in the definition, so offering spousal coverage is optional. Stepchildren and foster children are also excluded from the requirement.

Minimum Value (MV). A plan provides Minimum Value when it pays at least 60% of the total allowed cost of benefits and includes substantial coverage of inpatient hospital and physician services, as defined by the IRS. Minimum Value is the coverage standard behind the Section 4980H(b) penalty. SBMA’s Restricted Medical (MV) coverage is designed to meet it.

Minimum Value Calculator. A calculator published by the U.S. Department of Health and Human Services that employers and plan administrators use to test whether a plan design meets the 60% Minimum Value standard. The IRS’s Minimum Value and affordability page explains when the calculator can be used.

Essential Health Benefits (EHB). Ten categories of services, including emergency care, hospitalization, prescription drugs, and preventive care, that individual and small group plans must cover, as listed by HealthCare.gov. Large group and self-insured plans are not required to cover every EHB category, which gives ALEs flexibility in plan design.

Grandfathered plan. A group health plan that existed on March 23, 2010, when the ACA was signed, and has not made significant changes since. These plans are exempt from some ACA requirements and are now uncommon.

For a side-by-side look at how MEC and Minimum Value plans work together, see MEC vs. Restricted Medical: How Employers Meet Both Sides of ACA Compliance.

What Does Affordability Mean Under the ACA?

Affordability percentage. Coverage is affordable when the employee’s share of the premium for the lowest-cost, self-only plan offering Minimum Value does not exceed a set percentage of household income. That percentage is 10.22% for plan years beginning in 2027, up from 9.96% in 2026, per Rev. Proc. 2026-26. The percentage follows the plan year, so a plan year that begins mid-2026 uses 9.96% until it renews.

Affordability safe harbors. Because employers can’t see household income, the IRS allows three alternative tests. Coverage that passes any one of them is treated as affordable:

  • Form W-2 safe harbor: The employee’s contribution does not exceed the affordability percentage of their Box 1 wages.
  • Rate of pay safe harbor: For hourly employees, the hourly rate is multiplied by 130 hours, and the monthly contribution is compared with the affordability percentage of that amount. At $18 an hour in 2027, the limit is $239.14 per month.
  • Federal poverty line safe harbor: The contribution does not exceed the affordability percentage of the single-person federal poverty line, divided by 12. Using the 2026 poverty guideline of $15,960, the 2027 limit is $135.92 per month in the 48 contiguous states.

Our post on the ACA affordability threshold works through each safe harbor with examples.

What Terms Relate to ACA Penalties?

Premium tax credit (PTC). A refundable tax credit that helps eligible individuals and families pay for coverage purchased through the Health Insurance Marketplace, as described by the IRS. An employer penalty can apply only when at least one full-time employee receives a premium tax credit.

Employer shared responsibility payment (ESRP). The formal name for an ACA employer penalty under Internal Revenue Code Section 4980H.

Penalty A, Section 4980H(a). Applies when an ALE does not offer MEC to at least 95% of full-time employees and their dependents, and at least one full-time employee receives a premium tax credit. For 2027, the penalty is $3,780 per full-time employee, minus the first 30 employees.

Penalty B, Section 4980H(b). Applies when an ALE meets the 95% offer requirement, but coverage is unaffordable or does not provide Minimum Value, and a full-time employee receives a premium tax credit. For 2027, the penalty is $5,670 per employee who receives a credit, capped at the Penalty A amount.

Letter 226-J. The IRS letter that proposes an employer shared responsibility payment, as described by the IRS. For tax years beginning in 2025 and later, employers have at least 90 days to respond. Our post on what to do after receiving an ACA penalty walks through the response process.

For current figures and what changed this year, see ACA Employer Penalties and Compliance: What Employers Need to Know Heading Into 2027.

What Reporting Terms Do ALEs Need to Know?

Form 1094-C. The transmittal form an ALE member files with the IRS to summarize its Forms 1095-C and report information about the employer.

Form 1095-C. The form that shows, month by month, what coverage was offered to each full-time employee, what it cost, and whether a safe harbor applies. The IRS uses it to determine whether a penalty is owed. For 2026 coverage, Forms 1095-C must be furnished to employees by March 2, 2027, and electronic filing with the IRS is due March 31, 2027, per the IRS instructions.

Reporting entity. ALE status is determined across the aggregated group, but reporting happens company by company. Each ALE member files its own Forms 1094-C and 1095-C under its own EIN, even if that member has fewer than 50 employees, according to the IRS.

For year-round reporting practices, see ACA Reporting Starts Long Before Filing Forms 1094 and 1095.

ACA Terms Quick Reference

Term Key Figure Source
ALE threshold 50 full-time employees, including FTEs IRS
Full-time employee 30 hours per week or 130 hours per month IRS
FTE calculation Part-time hours (max 120 per person) ÷ 120 IRS
MEC offer requirement 95% of full-time employees and dependents IRS
Minimum Value Plan pays at least 60% of allowed costs IRS
Affordability percentage (2027) 10.22% Rev. Proc. 2026-26
FPL safe harbor (2027) $135.92 per month ASPE / Rev. Proc. 2026-26
Penalty A (2027) $3,780 per full-time employee, minus 30 Rev. Proc. 2026-22
Penalty B (2027) $5,670 per employee receiving a PTC Rev. Proc. 2026-22
Waiting period limit 90 days 26 CFR 54.9815-2708
Letter 226-J response At least 90 days IRS

Frequently Asked Questions About ACA Terms

What is the ACA and how does it affect employers?

The Affordable Care Act is a federal law that expanded access to health coverage. For employers, its central requirement is the employer mandate: Applicable Large Employers must offer affordable coverage that provides Minimum Value to at least 95% of full-time employees and their dependents, and report those offers to the IRS each year.

How is an Applicable Large Employer determined?

An employer is an ALE for the current year if it averaged at least 50 full-time employees, including full-time equivalents, during the prior calendar year. Companies under common ownership are generally counted together.

What is MEC and why does it matter?

Minimum Essential Coverage is health coverage that meets the ACA’s baseline requirements. Offering MEC to at least 95% of full-time employees and their dependents addresses the Section 4980H(a) penalty.

How can I check whether a plan meets the Minimum Value standard?

A plan meets Minimum Value when it pays at least 60% of total allowed costs and substantially covers inpatient hospital and physician services. Plan administrators typically confirm this using the HHS Minimum Value Calculator or an actuarial certification.

What are affordability safe harbors?

They are three IRS-approved tests (Form W-2, rate of pay, and federal poverty line) that let employers confirm affordability without knowing each employee’s household income. For 2027, the affordability percentage used in each test is 10.22%.

What penalties could an Applicable Large Employer face?

For 2027, Penalty A is $3,780 per full-time employee (minus the first 30) when MEC is not offered to at least 95% of full-time employees. Penalty B is $5,670 per employee who receives a premium tax credit when coverage is unaffordable or lacks Minimum Value. Either applies only if at least one full-time employee receives a premium tax credit.

Are small businesses exempt from the employer mandate?

Employers with fewer than 50 full-time employees, including FTEs, are not subject to the employer mandate. Related companies must be counted together, so a small company that belongs to a larger controlled group may still be part of an ALE.

How can employers keep ACA reporting accurate?

Track hours, offers, and enrollment monthly throughout the year, confirm that each ALE member files under its own EIN, and review Form 1095-C codes before filing. Clean data during the year makes the forms accurate on the first pass.

How do premium tax credits affect employers?

An employer penalty can apply only when a full-time employee receives a premium tax credit through the Marketplace. Offering affordable, Minimum Value coverage generally makes employees ineligible for the credit, which removes the trigger for a penalty.

How often do ACA figures change?

The affordability percentage and penalty amounts are updated every year by the IRS, usually in late spring and summer for the following year. SBMA tracks these changes on its Compliance Updates page.

Putting ACA Terms Into Practice

A shared understanding of ACA terms gives HR teams, finance leaders, and brokers a common starting point for every benefits decision. With ALE status confirmed, full-time employees identified, and coverage measured against current Minimum Value and affordability standards, employers can plan each year with clarity.

SBMA administers ACA-compliant benefits for Applicable Large Employers, including Acute Care (MEC) and Restricted Medical (MV) coverage, with the MEC Calculator available to model costs for a specific workforce. To review your current structure, contact the SBMA team.

 

 

ACA Employer Penalties and Compliance: What Employers Need to Know Heading Into 2027

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Quick Overview

The IRS has published every figure that governs ACA employer mandate compliance for 2027. The affordability percentage for plan years beginning in 2027 is 10.22 percent, up from 9.96 percent in 2026, and it marks the first time the threshold has exceeded 10 percent. The 4980H(a) penalty rises to $3,780 per full-time employee and the 4980H(b) penalty to $5,670.

This guide lays out the 2026 and 2027 numbers side by side, the safe harbor amounts employers can build 2027 contributions around, where premium tax credits stand heading into marketplace open enrollment, and the dates for Forms 1094-C and 1095-C in early 2027.

What Changed for 2027?

Two IRS revenue procedures set the 2027 figures. Rev. Proc. 2026-22, released May 4, 2026, indexed the employer shared responsibility penalty amounts. Rev. Proc. 2026-26, released July 21, 2026, set the affordability percentage.

ACA Employer Mandate Figures: 2026 vs. 2027
Figure 2026 2027
4980H(a) penalty (annual, per full-time employee) $3,340 $3,780
4980H(a) penalty (monthly) $278.33 $315.00
4980H(b) penalty (annual, per affected employee) $5,010 $5,670
4980H(b) penalty (monthly) $417.50 $472.50
Affordability percentage 9.96% 10.22%
FPL safe harbor (monthly, 48 contiguous states) $129.89 $135.92
Sources: Rev. Proc. 2025-26, Rev. Proc. 2026-22, Rev. Proc. 2026-26

These figures run on two calendars. Penalty amounts follow the calendar year, so the 2026 amounts apply to every month of 2026 and the 2027 amounts begin January 1, 2027. The affordability percentage follows the plan year, so a plan year that begins in 2026 keeps the 9.96 percent figure through its final month, and the 10.22 percent figure takes effect at the first renewal in 2027.

Which Employers Must Comply With the ACA Employer Mandate?

Applicable Large Employers are organizations that averaged 50 or more full-time employees, including full-time equivalents, during the prior calendar year.

A full-time employee is generally one who averages at least 30 hours of service per week or 130 hours per month. Full-time equivalents are calculated separately from the aggregate hours worked by part-time staff. For definitions of the terms that drive this calculation, see our ALE term guide.

ALE status is determined annually and applies to the entire following year, which means 2026 headcount sets 2027 obligations. Employers that cross the threshold unintentionally often discover their exposure after penalties are assessed. Franchise groups and multi-entity businesses carry an added layer here: IRS controlled group rules can combine related entities into a single ALE calculation even when each location operates independently day to day. Our guide to structuring health benefits for franchise portfolios covers how aggregation shapes plan design.

What Does ACA-Compliant Coverage Require?

Under the Employer Shared Responsibility provisions, ALEs must offer health coverage to at least 95 percent of full-time employees and their dependents. That coverage must meet three standards, and each one is evaluated on its own.

Minimum Essential Coverage. MEC establishes the offer of coverage and addresses 4980H(a) exposure. SBMA’s MEC plans are built to meet this standard with preventive care, wellness visits, and telehealth employees use.

Minimum Value. A plan meets Minimum Value when it covers at least 60 percent of total allowed costs and includes substantial coverage of inpatient hospital and physician services. Restricted Medical (MV) coverage is designed to meet this standard when paired with MEC.

Affordability. Affordability measures the employee’s required contribution for the lowest-cost, self-only plan that meets Minimum Value against the threshold in effect for that plan year.

Many ALEs combine MEC with a Minimum Value plan to address both penalties in one benefits structure. For a closer look at how these plan types work together, see Acute Care (MEC) vs. Restricted Medical (MV).

How Much Are ACA Employer Penalties in 2026 and 2027?

Both penalties are triggered when at least one full-time employee enrolls in marketplace coverage and receives a Premium Tax Credit.

4980H(a): Failure to Offer Coverage

The 4980H(a) penalty applies when an ALE fails to offer Minimum Essential Coverage to at least 95 percent of full-time employees and their dependents. It is calculated across the full-time workforce, minus the first 30 employees.

The amount is $3,340 per full-time employee for 2026 ($278.33 per month) and $3,780 for 2027 ($315.00 per month). For an ALE with 130 full-time employees that misses the offer threshold for all of 2027, that comes to 100 employees multiplied by $3,780, or $378,000.

4980H(b): Coverage That Is Unaffordable or Lacks Minimum Value

The 4980H(b) penalty applies when coverage is offered but is unaffordable or falls below Minimum Value, and a full-time employee receives a Premium Tax Credit. It is assessed per affected employee.

The amount is $5,010 for 2026 ($417.50 per month) and $5,670 for 2027 ($472.50 per month). The total 4980H(b) assessment is capped at the amount the employer would have owed under 4980H(a) for the same period.

How Penalties Are Assessed

Both figures are indexed annually and assessed retroactively from reported data, typically through IRS Letter 226-J, which often arrives a year or more after the relevant tax year closes. Employers have at least 90 days to respond to a proposed assessment, using Form 14764.

What Is the 2027 ACA Affordability Threshold?

For plan years beginning in 2027, coverage is affordable when the employee’s required contribution for the lowest-cost, self-only plan that meets Minimum Value does not exceed 10.22 percent of household income. The increase from 9.96 percent gives employers additional room in setting 2027 employee contributions.

Because employers rarely know household income, most use one of three IRS safe harbors.

Federal Poverty Line safe harbor. For calendar-year 2027 plans, employers apply 10.22 percent to the 2026 federal poverty line of $15,960 for the 48 contiguous states, which produces a monthly employee contribution of about $135.92. Plan years that began in 2026 continue to use $129.89. This safe harbor applies uniformly across the workforce with no individual calculations.

Rate of pay safe harbor. Employers multiply an hourly employee’s rate of pay by 130 hours, then by 10.22 percent. An employee earning $20 per hour can be charged up to $265.72 per month for self-only coverage in a 2027 plan year.

W-2 safe harbor. Employers apply 10.22 percent to an employee’s Box 1 W-2 wages for the year. This method is confirmed after year-end, so employers using it often build in a margin when setting contributions.

SBMA’s MEC Calculator can help estimate cost and penalty exposure across these scenarios.

How Do Non-Calendar Plan Years Apply the Threshold?

The affordability percentage attaches to the plan year start date. A plan year beginning July 1, 2026 uses 9.96 percent through June 30, 2027, and the July 1, 2027 renewal moves to 10.22 percent. Employers with off-cycle plan years should confirm that payroll and reporting systems carry the correct percentage for each plan year as it renews.

How Do Premium Tax Credits Affect Employer Exposure in 2027?

Premium Tax Credits are the trigger for both 4980H penalties, so marketplace subsidy policy shapes employer exposure directly.

The enhanced Premium Tax Credits expired at the end of 2025. The House passed a three-year extension on January 8, 2026, and no extension has been enacted since. Marketplace open enrollment for 2027 coverage begins November 1, 2026 under the standard subsidy rules. Marketplace enrollment for 2026 fell to 22.8 million, down 3.4 percent from the prior year.

As individual marketplace coverage costs more, employees tend to look more closely at their employer’s offer, and that places more weight on whether employer coverage meets affordability and eligibility standards. Planning 2027 contributions around the current subsidy structure gives employers a stable baseline, and any change from Congress can be layered onto that plan as it develops.

When Are ACA Reporting Forms Due in 2027?

Forms 1094-C and 1095-C filed in early 2027 report 2026 coverage, so they are measured against the 2026 figures: the 9.96 percent affordability percentage and the 2026 penalty amounts. Based on the IRS filing rules and the 2027 calendar, the dates are:

  • March 1, 2027: Paper filing deadline with the IRS (February 28 falls on a Sunday). Paper filing is limited to employers with fewer than 10 information returns in total.
  • March 2, 2027: Deadline to furnish Form 1095-C to employees. This 30-day extension from January 31 is now permanent and applies automatically.
  • March 31, 2027: Electronic filing deadline with the IRS.

Employers filing 10 or more information returns, counted across all return types combined, must file electronically. That aggregate count includes W-2s and 1099s, so nearly every ALE files electronically.

Employers may also use the alternative furnishing method, which allows a clear, conspicuous notice on the company website explaining how employees can request a copy of Form 1095-C. Under this method, the notice must be posted by the furnishing deadline and remain available through October 15, and requested forms must be provided within 30 days. The underlying data carries the same accuracy standard under either method.

Several states run their own coverage reporting requirements with separate deadlines, including California, Massachusetts, New Jersey, Rhode Island, and the District of Columbia. California also requires employers to furnish forms directly to employees.

Where Do ACA Penalties Usually Originate?

Penalty exposure most often traces back to day-to-day administration. The most common sources are:

  • Eligibility tracking errors
  • Late or missed offers of coverage after a measurement period
  • Affordability safe harbor calculations that carry forward a prior year’s percentage
  • Inconsistent payroll and HRIS data
  • Incorrect or incomplete coding on Forms 1094-C and 1095-C

Employers that offered coverage in good faith can still receive a Letter 226-J when reported data differs from what employees experienced. Clean offboarding plays a large part here. Coverage terminations and eligibility changes that go untracked create the same reporting gaps that lead to IRS notices, and our ACA offboarding checklist walks through each checkpoint.

What Should Employers and Brokers Do Before the 2027 Plan Year?

Set 2027 contributions at 10.22 percent. Recalculate employee contributions for plan years beginning in 2027 using the safe harbor that fits the workforce, and confirm the result before open enrollment materials are finalized.

Keep 2026 calculations at 9.96 percent. The remaining months of 2026, along with Forms 1095-C filed in early 2027, are measured against 2026 figures.

Update payroll and reporting systems. Confirm that 2027 safe harbor figures load for plan years starting in 2027 and that 2026 figures stay attached to 2026 reporting.

Audit eligibility tracking and offer timing. Review measurement periods, stability periods, and the timing of offers for newly eligible employees.

Calendar the 2027 reporting dates. Build data review into January so Forms 1095-C are ready for the March 2 furnishing deadline and the March 31 electronic filing deadline.

Bring 2027 figures into renewal conversations. Brokers can use the updated thresholds and penalty amounts to model contribution strategies with clients. SBMA’s broker resources support those conversations.

Frequently Asked Questions

What is the ACA affordability percentage for 2027?

The affordability percentage for plan years beginning in 2027 is 10.22 percent, up from 9.96 percent for 2026. It is the first time the threshold has exceeded 10 percent.

How much are the ACA employer penalties for 2027?

For 2027, the 4980H(a) penalty is $3,780 per full-time employee (minus the first 30), and the 4980H(b) penalty is $5,670 per full-time employee who receives a Premium Tax Credit. For 2026, the amounts are $3,340 and $5,010.

What is the 2027 Federal Poverty Line safe harbor amount?

For calendar-year 2027 plans, the FPL safe harbor allows a monthly employee contribution of about $135.92 for self-only coverage in the 48 contiguous states, based on the 2026 federal poverty line of $15,960.

Which affordability percentage applies to a plan year that started in mid-2026?

A plan year that began in 2026 uses 9.96 percent for its full duration. The 10.22 percent figure applies when that plan renews in 2027.

When are Forms 1095-C due in 2027?

Forms 1095-C reporting 2026 coverage are due to employees by March 2, 2027. Electronic filing with the IRS is due March 31, 2027, and paper filing, available to employers with fewer than 10 total information returns, is due March 1, 2027.

How long do employers have to respond to Letter 226-J?

Employers have at least 90 days to respond to a proposed employer shared responsibility assessment, using Form 14764.

Were the enhanced Premium Tax Credits extended for 2027?

As of early October 2026, no extension has been enacted. The enhanced credits expired at the end of 2025, and marketplace open enrollment for 2027 begins November 1, 2026 under the standard subsidy rules.

Does a MEC plan address both ACA penalties?

A MEC plan offered to at least 95 percent of full-time employees addresses 4980H(a). Pairing MEC with a plan that meets Minimum Value and affordability standards addresses 4980H(b) as well. Learn more about how MEC and Minimum Value plans work together.

Building the 2027 Plan Year on Published Numbers

With every 2027 figure now published, employers and brokers can set contributions, confirm eligibility processes, and prepare reporting systems around a complete set of numbers. For a broader look at how ALE status, coverage requirements, and reporting fit together, see the Ultimate Guide to Applicable Large Employer Benefits, and connect with SBMA to build a 2027 strategy around MEC and Minimum Value coverage. 

1094/1095 and PCORI Compliance: What Employers Must Do After Filing

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For many employers, submitting Forms 1094 and 1095 feels like the finish line. In reality, filing is only one part of your Affordable Care Act (ACA) compliance responsibility.

Once reporting is complete, Applicable Large Employers (ALEs) must shift focus to post-filing risk, potential IRS exposure, and upcoming Patient-Centered Outcomes Research Institute (PCORI) fees.

Here’s what you need to know.

Filing Forms 1094 and 1095 Is Only Step One

Applicable Large Employers are defined as organizations with 50 or more full-time employees, including full-time equivalent employees, during the prior calendar year.

ALEs must:

  • Offer ACA-compliant coverage to at least 95 percent of full-time employees and their dependents
  • Ensure coverage meets affordability and minimum value standards
  • Accurately complete and submit Forms 1094-C and 1095-C

Form 1094-C is the transmittal form submitted to the IRS summarizing employer-level data. Form 1095-C provides detailed information about the coverage offered to each full-time employee.

Electronic filing is required for employers who meet the IRS electronic filing threshold. Deadlines typically fall in late March for electronic submission, but employers should confirm current IRS guidance each year.

Filing late or submitting inaccurate data can trigger penalties.

Understanding Employer Shared Responsibility Penalties

The IRS enforces two primary employer mandate penalties:

Penalty A

Triggered if an ALE fails to offer coverage to at least 95 percent of full-time employees and at least one employee receives a premium tax credit through the Marketplace.

This penalty applies across the employer’s full-time population, not just to uncovered employees.

Penalty B

Triggered when coverage is offered but is either unaffordable or fails to provide minimum value, and at least one employee receives a premium tax credit.

Penalty B is assessed per affected employee.

Accurate reporting and defensible affordability calculations are critical to reducing risk exposure.

Common Post-Filing Risks Employers Overlook

Many compliance issues surface after reporting season ends. These include:

Data inconsistencies

Payroll, HRIS, and benefits platform misalignment often leads to incorrect coding on Form 1095-C.

Affordability miscalculations

Using the wrong safe harbor or misapplying affordability percentages can create exposure months later.

Measurement period errors

Variable hour and seasonal employee tracking mistakes are common audit triggers.

Controlled group complications

Employers with shared ownership structures frequently miscalculate ALE status and reporting responsibility.

Filing forms does not eliminate liability if the underlying data is flawed.

PCORI Fees: What Employers Must Pay After Filing

After ACA reporting is complete, certain employers must pay PCORI trust fund fees.

What Is PCORI?

The Patient-Centered Outcomes Research Institute was created to fund research that helps patients and providers make informed healthcare decisions.

To fund this research, employers sponsoring applicable self-insured health plans must pay an annual fee.

Who Is Responsible for Paying PCORI?

PCORI fees generally apply to:

  • Employers with self-insured health plans
  • Employers offering certain level-funded arrangements
  • Employers sponsoring Health Reimbursement Arrangements (HRAs)

Fully insured employers typically do not pay PCORI directly, as the carrier handles the fee.

How Is the Fee Calculated?

The fee is calculated based on the average number of covered lives under the plan. This includes:

  • Employees
  • Spouses
  • Dependents
  • COBRA participants
  • Retirees, if covered

The per-covered-life rate adjusts annually and depends on the plan year end date. Employers must confirm the current IRS rate applicable to their specific plan year.

When Is PCORI Due?

PCORI fees are generally due July 31 following the end of the plan year and are reported using IRS Form 720.

If July 31 falls on a weekend or federal holiday, the deadline moves to the next business day.

PCORI fees are currently authorized through 2029.

Why 1094/1095 and PCORI Compliance Often Reveal Bigger Issues

Reporting season frequently exposes operational gaps that go beyond form submission.

Employers may discover:

  • Misclassified employees
  • Inaccurate full-time eligibility tracking
  • Incorrect controlled group analysis
  • Inconsistent documentation of safe harbor calculations
  • Gaps between payroll and enrollment systems

These risks do not disappear once forms are filed. In fact, IRS enforcement activity often begins months after submission.

How SBMA Reduces Compliance Risk Beyond Filing

At SBMA, 1094 and 1095 processing is only part of the solution.

Our approach includes:

  • Pre-filing data validation and eligibility review
  • Affordability modeling and safe harbor analysis
  • Controlled group assessment support
  • Electronic filing and correction handling
  • PCORI calculation assistance
  • Ongoing support if IRS notices are received

Compliance is not just about meeting a deadline. It is about creating defensible systems that withstand scrutiny.

Final Takeaway

Submitting Forms 1094 and 1095 is not the end of your ACA responsibility. It is a checkpoint in a year-round compliance strategy.

With PCORI fees approaching and IRS enforcement continuing to evolve, employers must ensure their reporting, calculations, and documentation are accurate and defensible.

If you are unsure whether your post-filing processes are fully aligned, now is the time to review them.

ACA Reporting Starts Long Before Filing Forms 1094 and 1095

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For many employers, ACA reporting feels like a once-a-year obligation. Forms are generated, deadlines approach, and the focus turns to getting Forms 1094 and 1095 filed correctly and on time.

But those forms are not where ACA compliance begins. They are simply the final output of decisions, data, and processes that occur all year long.

When ACA reporting issues arise, the problem is rarely the forms themselves. The issue almost always traces back to how employee data, eligibility, and enrollment were handled months earlier.

ACA Reporting Is a Reflection of Your Year, Not a Snapshot

Forms 1094 and 1095 do not ask employers to make judgment calls at filing time. They report what has already happened.

The IRS uses these forms to confirm whether an employer:

  • Offered coverage to eligible employees
  • Offered coverage on time
  • Offered coverage that met Minimum Essential Coverage requirements
  • Offered coverage that met affordability standards
  • Tracked eligibility consistently across the year

If the data behind those answers is incomplete or inconsistent, reporting errors follow.

This is why ACA compliance should be viewed as a year-round operational process, not a year-end administrative task.

Eligibility Tracking Drives Reporting Accuracy

One of the most common ACA reporting issues stems from eligibility misalignment.

Applicable Large Employers must track:

  • Hours worked
  • Measurement periods
  • Stability periods
  • Changes in employee status

When this tracking is done manually or inconsistently, it becomes difficult to determine when coverage should have been offered and to whom.

Errors in eligibility tracking often lead to:

  • Missed offers of coverage
  • Incorrect Line 14 and Line 16 codes
  • Increased exposure to Penalty B assessments

Accurate reporting depends on knowing exactly when an employee became eligible and whether an offer was made at the correct time.

Enrollment Decisions Affect Reporting Outcomes

Another frequent breakdown occurs when enrollment data is disconnected from eligibility and payroll data.

Enrollment changes throughout the year matter. New hires, terminations, leaves of absence, and status changes all impact how offers of coverage are reported.

If enrollment records are incomplete or not updated in real time, reporting becomes a cleanup exercise instead of a confirmation process.

Common challenges include:

  • Offers made but not documented correctly
  • Employees waiving coverage without proper records
  • Delays between eligibility and enrollment processing
  • Conflicting data between payroll and benefits systems

When enrollment accuracy suffers, reporting accuracy suffers with it.

Payroll and Benefits Data Must Stay Aligned

ACA reporting relies heavily on payroll data, especially for affordability testing and eligibility determination.

When payroll and benefits systems are not aligned, discrepancies appear in:

  • Hours worked
  • Employee classifications
  • Offer dates
  • Coverage tiers

Trying to reconcile these differences at filing time is risky and time-consuming. It also increases the likelihood of errors that can trigger IRS notices later.

Ongoing data alignment throughout the year reduces the need for corrections and minimizes compliance exposure.

Reporting Errors Are Usually Process Failures

Most ACA reporting issues are not caused by a misunderstanding of the forms. They are caused by gaps in the process.

These gaps often include:

  • Manual tracking of hours and eligibility
  • Delayed updates to employee status
  • Disconnected payroll and benefits systems
  • Limited visibility into ACA measurement periods
  • Reactive rather than proactive compliance management

By the time Forms 1094 and 1095 are generated, it is often too late to correct these issues without amendments or increased risk.

Why a Year-Round Administrative Approach Matters

A strong ACA compliance strategy focuses on prevention rather than correction.

Year-round administration supports:

  • Continuous eligibility monitoring
  • Timely and documented offers of coverage
  • Accurate enrollment records
  • Reliable reporting data at year-end

This approach reduces administrative burden, lowers compliance risk, and gives employers confidence that their reporting reflects reality.

Turning Reporting Season Into a Review Opportunity

February is an ideal time for employers to assess what worked and what did not during the most recent reporting cycle.

Questions worth asking include:

  • Were eligibility determinations clear and consistent?
  • Did enrollment records align with payroll data?
  • Were reporting issues identified late or early?
  • Did the process rely too heavily on manual work?

Using reporting season as a diagnostic tool helps employers strengthen systems before the next compliance year begins.

ACA Compliance Is Built Throughout the Year

Forms 1094 and 1095 are important, but they are not the foundation of ACA compliance. They are the result of months of data tracking, monitoring, and administration.

Employers who treat ACA compliance as an ongoing process rather than an annual filing obligation are better positioned to reduce risk, avoid penalties, and simplify reporting year after year.

The work starts long before the forms are filed.

2026 Health Benefits Planning for CHROs: Compliance, Cost Control and Smarter Administration

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Providing Affordable Benefits with Gold Standard Administration in 2026

Large and mid-market employers cannot afford to settle for “just a health plan” As we enter 2026, employers face a changing benefits landscape. Rising costs, evolving regulatory demands and workforce complexity mean that the traditional health-plan model no longer suffices. For CHROs, CFOs and brokers working with large or mid-market employer groups, the question is no longer whether you should offer benefits, but how you can offer meaningful benefits in an affordable way and administer them with precision.

Here at SBMA, we believe there is a better path: benefits that deliver value to employees, backed by gold-standard administration for HR teams. 

The challenge: Traditional group health plans are under pressure

Historically, large employers have used fully insured or self-funded group medical plans to provide comprehensive coverage. Yet, for many organizations today this model presents significant friction:

  • Premiums continue to rise faster than budgets.
  • High deductibles and complex networks reduce employee utilization and satisfaction.
  • Administrative complexity grows as the workforce becomes more variable: part-time, seasonal, hybrid, remote, distributed.
  • Regulatory burdens (reporting, ACA employer mandate compliance, data transparency) are increasing.
  • HR and finance teams are spending more time managing vendor integrations, enrollment issues and compliance tracking—leaving less time for strategic work.

In short: The benefits market demands more cost-effective models, and HR demands simpler administration.

2026 regulatory and compliance priorities

Large and mid-market employers (especially those qualifying as an “Applicable Large Employer” or ALE) must pay particular attention to key 2026 updates under the Affordable Care Act (ACA) and related rules.

Affordability threshold increases

For plan years beginning in 2026, the affordability percentage under the employer mandate climbs to 9.96% of employee household income for self-only coverage, up from 9.02% in 2025. This change gives employers slightly more flexibility in structuring employee contributions—but it also demands careful planning so you don’t inadvertently trigger non-compliance.

Employer shared-responsibility penalties rise

Penalties under Code § 4980H for employers that fail to offer minimum essential coverage (MEC) to substantially all full-time employees or that offer unaffordable or non-minimum value coverage are increasing for 2026. For example:

  • The annualized Section 4980H(a) penalty rises to $3,340 per full-time employee (minus the first 30) for 2026.
  • The Section 4980H(b) penalty rises to $5,010 per full-time employee who receives a premium tax credit and whose employer coverage was unaffordable or lacked minimum value.

With such increases, the cost of getting plan design or compliance wrong grows significantly.

Reporting deadlines and out-of-pocket (OOP) maximum updates

Employers must also take note of:

  • The furnishing deadline for Forms 1095-C (for 2025 calendar year) is March 2, 2026 for individuals (with alternate online-notice options) and the electronic filing deadline to the IRS for Forms 1094-C/1095-C is March 31, 2026.
  • Out-of-pocket maximums for non-grandfathered group health plans for 2026 will rise (for example, individual OOP max projected at approx. $10,600).
  • Safe harbor rules for affordability (FPL safe harbor, Rate of Pay safe harbor, W-2 safe harbor) remain in place, and employers must document their approach.

Why the administration matters—especially in 2026

Regulatory compliance is only one pillar of the challenge. The second pillar is operational excellence. Even the best-designed benefits plan will under-perform without smooth administration. For HR teams of large and mid-market employers, the administrative burden becomes a strategic risk unless managed well.

Here is what “gold-standard administration” looks like in practice:

  • Real-time onboarding/offboarding of employees to ensure benefits eligibility and avoid delays or errors.
  • Instant ID-card generation and delivery so employees have coverage proof when they need it.
  • Integrated claims tracking and reporting, enabling employer data visibility and actionability.
  • Consolidated billing and payment management to remove billing fragmentation and manual reconciliation.
  • Mobile/digital access for employees so they can view benefits, access providers, see ID cards and track usage via a single app.
  • Live U.S.–based support for both HR teams and employees, ensuring questions get resolved quickly.

Without these features, the true cost of benefits is not just the premium—it’s hidden in administrative time, employee service issues, vendor hand-offs and compliance risk.

How SBMA delivers meaningful value in 2026

At SBMA we combine two elements: affordable, high-utility benefits design and gold-standard administration. For employers grappling with rising benefits costs, workforce variability and the 2026 regulatory uptick, here’s how that combination pays off:

1. Plan design built for value

Rather than simply replicating traditional group health models, SBMA helps employers design benefits that reflect what employees actually use and what the business can sustain. These include: preventive care, telehealth, dental, vision, diagnostic labs, hospitalization or limited inpatient support and integrated PHM services. By focusing on high-utility services and streamlined networks, we help reduce premium spend while maintaining meaningful coverage.

2. Compliance built-in

Our consulting and administration model ensures that crucial thresholds and mandates are met: affordability tests under the 9.96% threshold, minimum value standards, reporting obligations (Forms 1094/1095), OOP maximum compliance, and safe harbor documentation. We proactively monitor regulatory shifts so your HR team doesn’t become the compliance bottleneck.

3. Administration that scales

With our platform, we eliminate many of the traditional pain points: slow ID card delivery, delayed eligibility updates, fragmented vendor ecosystems and manual billing reconciliation. Employees gain access through our mobile app, HR teams get live dashboards and analytics, and broker/consultant partners have confidence that their employer groups are well served.

4. Cost control meets transparency

By shifting to a model where the employer retains visibility and control rather than handing full risk and profit margin to a carrier, SBMA helps align benefit spend with outcomes. Combined with transparent analytics and employer-level reporting, you get real insight into usage, enrollment trends, cost drivers—and the ability to act.

5. Exceptional employee experience

Ultimately, the value of a benefits plan lies in what the employee perceives and uses. When employees receive prompt ID cards, have access through digital tools, can easily access telehealth, and understand their coverage, participation and satisfaction improve. That reduces HR tickets, improves retention, and ties benefits into your broader talent strategy.

2026 benefits cost-control strategy

As you plan for 2026, here are key action items to ensure you are aligned with both the regulatory environment and operational excellence:

  • Review your employee contribution structure under the new 9.96% affordability threshold and assess whether your lowest-cost, minimum-value plan meets safe-harbor requirements.
  • Evaluate your full-time employee (FTE) counts and full-time-equivalent (FTE) staffing to confirm ALE status and reporting obligations. IRS+1
  • Check your administrative vendor ecosystem: time to issue ID cards, onboarding/off-boarding process, digital access for employees, claims data visibility.
  • Confirm your reporting processes: forms, deadlines, alternative furnishing options (such as online notice for 1095-C statements) for 2026. Newfront+1
  • Conduct usage and enrollment analytics: identify high-utilization services, opportunities to optimize benefits spend, and manufacturer adoptions (telehealth, digital tools, etc.).
  • Partner with a benefits administrator that offers both design consult and operational execution—not simply off-the-shelf.

How SBMA Removes Administrative Friction

When you combine regulatory complexity, cost pressure and workforce dynamics, the margin for error in benefits strategy gets smaller. Choosing a partner like SBMA offers:

  • A single point of accountability for design, compliance and administration.
  • A modern, integrated technology platform that automates key workflows and delivers scalability.
  • A team with deep experience in large and mid-market employer groups, understanding the unique needs of CHROs, CFOs and benefits brokers.
  • Transparent cost models and outcome-oriented analytics—so you don’t just buy a “plan,” you buy value.
  • Flexibility to adapt as your workforce evolves—whether remote/hybrid, part-time, variable schedule or location-based.

Fewer administrative burdens = smarter benefits management for 2026 and beyond

2026 is not just another year in benefits. With the affordability threshold rising, penalties increasing and workforce models shifting faster than ever, employers who rely on “business as usual” are exposing themselves to risk and inefficiency. By contrast, organizations that adopt an approach built around affordability, value and operational excellence will succeed both financially and strategically.

At SBMA, we are committed to enabling that success. Our model helps you deliver benefits employees value, while giving your HR team the tools and processes they need to operate at peak efficiency. If you are ready to build a benefits program that meets today’s realities and is future-ready, reach out to us for pricing and plan options.

What CHROs Should Expect Beyond 2026

The regulatory landscape around employer-sponsored benefits is not stabilizing. Indicators from federal rulemaking, industry trends and enforcement patterns point to continued shifts affecting cost, compliance and operational complexity.

Below is what large and mid-market employers should anticipate in late 2026 and into 2027.

1. Increased Enforcement of ACA Reporting Accuracy

Over the past three filing cycles, the IRS has increased automated detection of discrepancies between coverage, affordability data and reported FTE counts. Employers should expect:

  • Faster assessment of 4980H penalties
  • Less leniency for appeal delays
  • More scrutiny of affordability safe harbor calculations

This places greater importance on clean data and accurate administration.

2. Push Toward Real-Time Eligibility and Digital Verification

Regulators and carriers are signaling movement toward faster verification systems that reduce coverage gaps and accidental termination delays. Employers with outdated systems will face:

  • More employee disputes
  • Greater compliance exposure
  • Higher administrative burden

SBMA’s real-time eligibility tools directly align with where regulations are moving.

3. Continued Growth of Alternative Benefits Models

Restricted medical plans paired with MEC are gaining widespread adoption across industries with variable workforces. The trend is expected to expand due to:

  • Cost pressures on major medical
  • Increased telehealth reliance
  • Demand for modular benefits
  • Shrinking participation minimums in modern benefit structures

2026 will likely be the year when more CHROs move away from “one-size-fits-all” benefit models.

4. Expansion of Telehealth Requirements

Federal agencies continue considering rules that may:

  • Require clearer telehealth cost-share limits
  • Increase network transparency
  • Mandate certain digital access standards

Employers already offering integrated telehealth have a structural advantage.

5. Expect Rising Penalties for Non-Coverage of Part-Time Populations

Part-time and variable employees remain under federal scrutiny due to insurance gaps. Predicted regulatory direction includes:

  • Higher penalties tied to misclassification
  • Stricter enforcement of monthly measurement methods
  • More guidance on coverage for hybrid or gig-style labor models

SBMA’s low-threshold and no-minimum plans position employers to avoid risk as rules tighten.

Health Benefits Cost Control Options FAQs:

What are the biggest benefits compliance changes employers need to prepare for in 2026?

The primary changes include the ACA affordability threshold increasing to 9.96 percent, rising 4980H penalties, updated out-of-pocket maximums and continued IRS emphasis on accurate 1094-C and 1095-C reporting. Employers must also prepare for stricter enforcement of coverage accuracy and eligibility documentation.

How can CHROs reduce the cost of health benefits in 2026?

CHROs can reduce costs by pairing MEC with restricted medical benefits, adopting modular plans, integrating telehealth, analyzing usage data and eliminating administrative waste. SBMA provides ACA-compliant benefits structures designed to lower premium spend while maintaining high utility.

Why is benefits administration as important as plan design in 2026?

Without strong administration, even well-priced plans fail. Real-time onboarding, instant ID cards, accurate eligibility files, consolidated billing and digital employee access prevent delays, compliance mistakes and unnecessary HR workload. SBMA’s administration eliminates bottlenecks and ensures clean data.

Can employers offer benefits without a traditional major medical plan?

Yes. Employers can provide MEC plus restricted medical plans that include telehealth, preventive care, diagnostic services, dental, vision and limited inpatient benefits. These options meet ACA requirements while reducing cost and complexity.

What ACA penalties will increase in 2026?

The Section 4980H(a) penalty increases to 3,340 dollars per full-time employee and the Section 4980H(b) penalty rises to 5,010 dollars per affected employee. These increases make accuracy, affordability and proper eligibility tracking more important than ever.

How does SBMA help employers stay ACA compliant?

SBMA ensures correct affordability calculations, documentation of safe harbors, accurate eligibility files, complete MEC coverage and timely 1094-C and 1095-C reporting. Our platform reduces the administrative risk that leads to costly penalties.

What makes SBMA’s Gold Standard administration different from other benefits administrators?

SBMA provides real-time eligibility updates, instant digital ID cards, consolidated billing, live U.S.-based support, integrated telehealth, usage reporting and the HealthWallet App. These tools eliminate manual processes and give CHROs and CFOs complete visibility.

How does the HealthWallet App improve the employee experience?

Employees use HealthWallet to access ID cards, find providers, view benefits, schedule telehealth visits and reference plan documents. This reduces HR questions and increases adoption of covered services.

Are SBMA plans effective for large, multi-location employers?

Yes. SBMA’s digital infrastructure supports high-volume onboarding, variable scheduling, multiple worksites and remote or hybrid teams. Plans can be deployed quickly across national footprints.

What types of companies benefit most from restricted medical plans?

Industries with part-time, hourly or high-turnover workers benefit the most, including hospitality, agriculture, logistics, cleaning, food service and retail. These employers gain predictable cost control and strong employee utilization.

Fully Insured vs. Level Funded Plans: A Guide for Qualified ALEs

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As a Qualified Applicable Large Employer (ALE), choosing the right employee health insurance plan is crucial for your organization’s financial health and employee satisfaction. Two popular options for providing healthcare coverage to your employees are Fully Insured Plans and Level Funded Plans. In this comprehensive guide, we will delve into the differences, advantages, and considerations of both options to help you make an informed decision for your company’s healthcare benefits.

Evolving Market Trends in 2025: What Employers Should Consider

As healthcare costs continue to rise in 2025, many Qualified Applicable Large Employers (ALEs) are reevaluating their healthcare options. Employer-sponsored health plans are projected to increase by 5.8% to 8% this year, driven by higher utilization, rising prescription drug costs, and inflationary pressures in the healthcare sector. In this environment, understanding the key differences between Fully Insured and Level Funded Plans is more critical than ever.

Additionally, regulatory updates such as the 2025 ACA affordability threshold increase to 9.02% of household income impact how ALEs structure employee contributions. Employers choosing Level Funded Plans may need to carefully balance cost-sharing with compliance requirements to ensure affordability while maintaining financial sustainability.

Stop-Loss Insurance: A Must for Managing Risk

While Level Funded Plans offer cost savings and flexibility, employers must be mindful of high-claim risks. In 2025, the rising costs of specialty medications, chronic disease treatments, and emergency care mean that a single large claim could create unexpected financial burdens. To protect against this, employers should consider integrating stop-loss insurance, which caps the employer’s financial exposure and helps manage unpredictable healthcare expenses.

When selecting a Level Funded Plan, it is crucial to evaluate the stop-loss coverage options available and ensure they align with your company’s risk tolerance. This safeguard can provide greater budget stability while still allowing employers to take advantage of the cost-saving benefits of self-insurance.

Employee Satisfaction: A Key Factor in Plan Selection

Beyond cost and compliance, employee engagement and retention are critical factors in choosing the right healthcare plan. Recent workforce trends show that competitive healthcare benefits play a major role in employee retention, especially as hiring challenges continue in 2025.

Fully Insured Plans may be ideal for companies with diverse or multi-state workforces, offering consistent, predictable benefits with minimal administrative burden.

Level Funded Plans work well for healthier employee populations looking for customized benefits and potential cost savings but require a strong risk management strategy.

By aligning healthcare benefits with workforce needs, ALEs can enhance employee loyalty, reduce turnover, and create a healthier, more engaged workforce.

 

Understanding Fully Insured Plans: Exploring Benefits and Limitations

Fully Insured Plans are a type of employee health insurance where employers pay fixed premiums to an insurance carrier. In return, the carrier assumes the responsibility for covering employees’ healthcare costs, transferring the financial risk from the employer to the insurer.

Advantages of Fully Insured Plans

Cost Predictability: Fixed premiums allow accurate budgeting for healthcare expenses without unexpected fluctuations. Employers can plan their finances more effectively, knowing the exact cost of providing health insurance.

Simplified Administration: Insurance carriers handle plan administration, including claims processing and customer service, reducing administrative burden for employers. This allows HR teams to focus on other strategic initiatives.

Regulatory Compliance: Fully Insured Plans often come with pre-packaged ACA-mandated benefits, ensuring compliance with regulatory requirements. This helps employers avoid penalties and stay in line with federal healthcare laws.

Limitations of Fully Insured Plans

Limited Customization: Employers have less flexibility to tailor the plan to their workforce’s specific needs. The insurance carrier offers pre-determined benefit packages, which may not align perfectly with the preferences of your employees.

Cost Control: Employers may have less control over healthcare premiums as the insurer assumes financial risk. Premium increases may occur, leading to higher costs for employers without additional benefits.

Understanding these aspects of Fully Insured Plans is crucial for employers in making informed decisions while choosing the most suitable health insurance option for their workforce.

Unveiling Level Funded Plans: A Hybrid Approach to Employee Health Insurance

Level Funded Plans represent a unique approach to employee health insurance, combining elements of self-insurance and traditional insurance. In this arrangement, employers pay fixed monthly premiums to a third-party administrator (TPA), which holds the funds in a claims account. The TPA then uses these funds to cover employees’ healthcare expenses. If claims are lower than expected, the surplus is often returned to the employer at the end of the year, making it a potentially cost-saving option.

Advantages of Level Funded Plans

Cost Savings: Level Funded Plans offer potential cost savings compared to Fully Insured Plans. Unused claims funds may be returned to the employer, reducing overall healthcare expenses. This can be particularly beneficial for organizations with healthier employee populations.

Customization: Employers have more flexibility to tailor plan design and benefits to meet the specific needs of their workforce. This customization can lead to higher employee satisfaction and better alignment with your company’s unique culture and values.

Risks and Considerations of Level Funded Plans

Financial Risk: Although Level Funded Plans provide cost-saving potential, they also carry a higher level of financial risk compared to Fully Insured Plans. Employers are responsible for any claims exceeding the funds in the claims account. It is essential to assess your company’s financial stability and risk tolerance before opting for self-insurance.

Cash Flow Management: Employers must ensure they have sufficient cash flow to cover unexpected high claim costs since they are responsible for funding the claims account. Planning for potential fluctuations in claim expenses is critical to avoiding cash flow issues.

Key Differences: Fully Insured vs. Level Funded Plans

To better understand the distinctions between Fully Insured and Level Funded Plans, let’s explore their key differences in several areas:

Premiums and Payments

Fully Insured Plans: Fixed premiums are paid to the insurance carrier, and the insurer assumes the financial risk. Premiums may be subject to annual adjustments based on claims experience and other factors.

Level Funded Plans: Fixed premiums are paid to a third-party administrator, with the employer assuming the financial risk for claims. The TPA holds the claims funds and manages the claims payment process.

Financial Risk

Fully Insured Plans: The insurance carrier bears the financial risk of employees’ healthcare expenses. Employers pay fixed premiums and have no direct financial responsibility for claims costs.

Level Funded Plans: Employers partially self-insure by funding the claims account, assuming a portion of the financial risk. Stop-loss insurance may be used to limit financial exposure for high claim costs.

Regulatory Compliance

Fully Insured Plans: Often come with pre-packaged ACA-mandated benefits, ensuring compliance with federal regulations. Insurance carriers handle compliance-related administrative tasks.

Level Funded Plans: Allow more customization, but employers must ensure they comply with applicable federal and state regulations. HR teams and TPAs share the responsibility of compliance-related tasks.

Understanding these distinctions empowers employers to make well-informed decisions about employee health coverage, considering cost, risk, and regulatory requirements. By choosing the most suitable plan, employers can provide their workforce with comprehensive healthcare while optimizing budget allocation.

Plan Flexibility and Customization: Tailoring Benefits to Meet Your Employees’ Needs

Fully Insured Plans: Fully Insured Plans typically come with standardized benefit packages provided by the insurance carrier. While this offers simplicity and convenience, it may limit the ability to tailor the plan to the specific needs of your employees. Employers have less control over plan design, benefit levels, and cost-sharing arrangements.

Level Funded Plans: One of the primary advantages of Level Funded Plans is the increased flexibility and customization they offer. With Level Funded Plans, employers can work closely with the third-party administrator (TPA) to design a plan that aligns with their employees’ unique healthcare needs. This flexibility extends to benefit design, network selection, and even wellness programs. By having more control over plan features, employers can cater to the preferences of their workforce, leading to higher employee satisfaction and engagement.

Any Questions?

We are in the business of providing healthcare to everyday people, ensuring peace of mind through trust and transparency.

Our customer service is what sets us apart. We work when you work. Our carrier partners have given us exclusive offerings to complement our medical plans, giving you the best possible price. Our speed of implementation and innovative approach to benefit coverage is second to none.
Learn more about us and our services, here.

HMO, PPO, EPO, Captive, MVP, and Restricted Benefits

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The Employers Guide to Health Benefits

Choosing the right health coverage for your business is more than a compliance requirement. It’s a strategic decision that impacts cost management, employee satisfaction, and workforce stability. Today’s employers have a range of plan types to consider, each with distinct structures, cost profiles, and administrative requirements.

This article offers a clear, structured comparison of six major coverage options—HMO, PPO, EPO, Captive Plans, Minimum Value Plans (MVP), and Restricted Medical Coverage—designed to help employers navigate their options and select the approach that best aligns with their workforce needs and business goals.

Understanding the Plan Types

What Is an HMO?

A Health Maintenance Organization (HMO) plan emphasizes cost containment and network coordination. Employees must select a primary care physician (PCP) and obtain referrals to see specialists. Services are limited to in-network providers, except in emergencies.

Key Characteristics

  • Requires referrals for specialist care
  • Services limited to in-network providers
  • Typically lower premiums and out-of-pocket costs

What Is a PPO?

A Preferred Provider Organization (PPO) provides employees with more flexibility in provider selection. It allows both in- and out-of-network care and does not require PCP referrals for specialist access.

Key Characteristics

  • Broad provider network
  • No referral required for specialists
  • Higher premiums and more flexibility

What Is an EPO?

An Exclusive Provider Organization (EPO) blends aspects of HMO and PPO structures. It offers network-based care without requiring referrals but does not cover out-of-network services except in emergencies.

Key Characteristics

  • In-network only coverage
  • No referral required for specialists
  • Balanced cost and access

What Is a Captive Plan?

A Captive Plan is a form of self-funding in which a group of employers pools their resources to form a private insurance entity. Captive arrangements provide transparency, shared risk, and customizable design.

Key Characteristics

  • Offers long-term cost control through pooled risk
  • Enhanced data transparency for claims management
  • Requires stable claims experience and long-term commitment

What Is an MVP Plan?

Minimum Value Plans (MVPs) are designed to meet the Affordable Care Act’s definition of minimum essential coverage. MVPs typically cover at least 60 percent of the total allowed cost of benefits and include substantial inpatient and physician services.

Key Characteristics

  • ACA-compliant
  • Lower monthly premiums
  • Ideal for meeting mandate requirements

What Is Restricted Medical Coverage?

Restricted Medical Coverage offers essential, high-utility healthcare benefits at a lower cost. These plans often include preventive services, office visits, urgent care, basic labs, and limited prescription drug coverage.

Key Characteristics

  • Focused on everyday care needs
  • Lower premiums compared to major medical
  • Ideal for part-time, hourly, or high-turnover workforces
  • Scalable across industries and sizes

SBMA supports Restricted Medical Coverage with a comprehensive administrative platform that enables simple onboarding, ID card delivery, claims management, payment tracking, and employee support. This makes offering coverage efficient and compliant for employers of all sizes.

Plan Comparison: Key Differences

Feature HMO PPO EPO Captive MVP Restricted
Network Type In-network only In- and out-of-network In-network only Custom network In-network focus In-network, focused scope
Referrals Required Yes No No Varies No No
Employer Cost Lower Higher Moderate Varies based on structure Lower monthly premiums Lower premiums with practical coverage
Administrative Complexity Low Moderate Moderate High Low Low with SBMA platform

 

Minimum Enrollment Requirements and Administrative Efficiency

Traditional group health plans often require a minimum number or percentage of eligible employees to enroll in order to activate coverage. This can present challenges for employers with part-time or seasonal staff, high turnover, or lean operations.

SBMA offers health coverage solutions with very low or no minimum enrollment requirements, which provides significant flexibility for employers across industries. Paired with an efficient administrative system—covering onboarding, ID cards, offboarding, claims, and billing—this makes implementation and management more predictable and less resource-intensive.

Affordability: Legal Definition and Practical Impact

Under the Affordable Care Act (ACA), an employer’s offer of coverage is considered affordable if the employee’s share of the premium for self-only coverage does not exceed 8.39 percent of their household income in 2025.

This is a compliance benchmark, but practical affordability depends on more than just premium cost. Deductibles, out-of-pocket maximums, and access to everyday care all influence whether a plan is truly usable.

Plans like Restricted Medical Coverage are designed with real-world application in mind, often avoiding high deductibles in favor of more accessible first-dollar coverage for preventive and routine care.

Which Plan Is Right for Your Business?

There is no universal solution. The right health plan depends on your workforce, your cost structure, and your long-term strategy. Use the following as a guide:

Choose an HMO if your team values structure, and you want predictable, lower-cost premiums.

Choose a PPO if your employees want the freedom to choose providers and access out-of-network care.

Choose an EPO if you want in-network coverage with fewer restrictions but lower cost than a PPO.

Choose a Captive Plan if you have a stable, benefits-engaged workforce and want long-term control over healthcare spending.

Choose an MVP Plan if your goal is to meet ACA compliance with lower monthly premiums and minimal disruption to payroll.

Choose Restricted Medical Coverage if your workforce includes hourly, part-time, or high-turnover employees who benefit from simple, everyday care access at an affordable rate. With SBMA’s platform, employers can scale this coverage with confidence and efficiency.

Choosing The Right Coverage For Your Business

Employers are navigating a more complex benefits environment than ever before. With rising healthcare costs and shifting workforce expectations, plan selection must go beyond compliance and base premiums. It requires clarity, structure, and a system that supports both your business operations and your employees’ health.

SBMA provides the tools, support, and plan options that help employers lead with confidence. When the structure is clear and the delivery is efficient, health benefits become a competitive advantage—not a cost center.

2025 Employers Guide to COBRA

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As we move into 2025, it’s important for employers to know about the Consolidated Omnibus Budget Reconciliation Act (COBRA). This law gives employees and their families the chance to keep their health insurance after certain life events. This guide will explain what COBRA is, what employers need to do, and how to make the process easier for everyone.

What is COBRA?

COBRA is a federal law that lets employees keep their group health insurance for a limited time after specific events. It applies to businesses with 20 or more employees and covers group health plans from private companies and local or state governments.

COBRA is there for employees and their families after they go through a qualifying event, like:

  • Losing their job (unless they were fired for bad behavior)
  • Having their work hours cut
  • Getting divorced
  • The death of the employee
  • Losing dependent status (like a child turning 26)

Why is COBRA Important?

COBRA is really important because it helps people keep their health insurance during tough times. Losing your job or going through a big life change can be stressful, and having health insurance can help ease some of that worry. COBRA gives people the time they need to find new jobs or other insurance options.

What Do Employers Need to Do?

If you’re an employer, it’s crucial to understand your responsibilities under COBRA to stay compliant and avoid fines. Here are the main things you need to know:

1. Notify Employees of Their COBRA Rights

When an employee becomes eligible for COBRA, you must inform them. This means sending a notice within 14 days of a qualifying event. The notice should include:

  • Information about their right to continue health coverage
  • How long can they keep the coverage
  • How much will it cost them
  • Instructions on how to enroll in COBRA coverage

2. Provide Coverage Options

If an employee chooses COBRA, you need to offer the same health benefits they had when they were employed. This means they should still have access to medical, dental, and vision insurance if those were part of their original plan.

3. Handle COBRA Premium Payments

You can charge employees up to 102% of the premium for COBRA coverage. This includes the total cost of the coverage plus a 2% fee for administration. Make sure to communicate clearly about when payments are due and how employees can pay.

4. Keep Records

It’s essential to keep records of all COBRA notifications, elections, and payments. Good record-keeping helps with compliance and can be useful if there are any disputes later.

5. Understand Reporting Requirements

If your business is required to file Form 5500, you must report COBRA enrollment and compliance. This form gives the Department of Labor (DOL) information about your employee benefits plan, including COBRA.

How Long Does COBRA Coverage Last?

COBRA coverage doesn’t last forever. The duration of coverage depends on the qualifying event:

18 months: For employees who lose their jobs or have their hours reduced.

29 months: If a person is disabled (this must be determined within the first 60 days of COBRA coverage).

36 months: For dependents who lose coverage due to the employee’s death, divorce, or legal separation.

Employers should notify former employees when their COBRA coverage is about to end, so they have time to find other options.

Best Practices for Employers

To stay compliant and help employees during transitions, consider these best practices:

1. Create a COBRA Compliance Plan

Make a clear plan that outlines how you will notify employees, manage elections, and handle payments. Assign specific roles to ensure everyone knows what they are responsible for.

2. Use a Third-Party Administrator (TPA)

Think about hiring a TPA that specializes in COBRA administration. They can help manage notifications, elections, and payments, making the process easier for your HR team.

3. Communicate Clearly with Employees

Make sure your communication about COBRA coverage is simple and easy to understand. Provide employees with written materials that explain their rights and responsibilities. Designate HR representatives who can help answer questions.

4. Stay Updated on Changes in the Law

Keep an eye on any changes in COBRA regulations, as laws can change. Regularly review your policies and practices to ensure they are up-to-date.

5. Provide Resources for Alternative Coverage

Help employees transition from COBRA to other health insurance options. Share information about state health insurance marketplaces, Medicaid, or private insurance plans they can consider.

 

Common Misconceptions about COBRA

Let’s clear up some common misunderstandings about COBRA:

Myth 1: COBRA is Free: COBRA allows employees to keep their health coverage, but they have to pay for it. The cost may be higher than what they paid while employed.

Myth 2: Employers Can Deny COBRA Coverage: Employers must offer COBRA coverage unless the employee was fired for serious misconduct.

Myth 3: COBRA Coverage is Indefinite: COBRA coverage is temporary and has set time limits based on the qualifying event.

Final Notes

Understanding COBRA is essential for employers as we head into 2025. By meeting your obligations to notify employees, provide coverage, and keep accurate records, you can help ensure compliance and support your employees during their transitions.

COBRA provides important health insurance continuity for employees facing significant life changes, allowing them to access necessary healthcare services. By proactively managing COBRA responsibilities, you create a supportive workplace that helps employees feel valued and cared for.

For personalized help with COBRA regulations and compliance, consider reaching out to a healthcare benefits expert or legal advisor. They can offer guidance tailored to your organization’s needs and help you implement effective strategies for managing COBRA.

7 Key Strategies to Ensure ACA Compliance and Prevent Penalties

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The Affordable Care Act (ACA) has been a game-changer for employee health care benefits since it was introduced. It’s opened up new opportunities but has also brought along some tricky challenges, especially when it comes to federal reporting compliance. With the IRS becoming more aggressive in enforcing these regulations, it’s crucial for HR and benefits leaders to stay on top of their game.

In this article, we’ll cover why accurate data is essential for ACA compliance and share seven strategies to help you keep your data accurate and complete.

Why Accurate Data is Critical for ACA Compliance

To comply with the ACA, you need to report detailed information about your employees and their health care coverage. This includes data such as names, Social Security numbers, hours worked, and the health benefits offered. Accurate and complete data is not just a formality; it’s essential for staying compliant and avoiding costly penalties.

Penalties for non-compliance can be severe. For example:

  • 4980H(a) Penalty: If your company fails to offer affordable health coverage to at least 95% of full-time employees and one employee receives a Premium Tax Credit (PTC) through the ACA marketplace, the penalty is $247.50 per month per employee. This could add up to over $800,000 annually for a company with 300 employees.
  • 4980H(b) Penalty: This penalty applies if your coverage is either unaffordable or does not meet the Minimum Value standard. In 2024, the penalty is $372 per month, or $4,460 per year, per employee.
  • Failure to File Penalty: Missing the deadline for filing 1095-C forms can result in fines of $310 per return in 2024, increasing to $630 for intentional disregard.
  • Failure to Furnish Penalty: Similar to the failure to file penalty, this can be $310 per return, rising to $630 for intentional disregard.

Keeping accurate records of employee demographics and medical coverage information is crucial for avoiding these penalties.

What Data You Need for ACA Compliance

1. Demographic Data

  • Full Names and Social Security Numbers: Ensure you have the correct information for all employees.
  • Employment Status: Track whether employees are full-time, part-time, or seasonal. Also, record any changes in employment status throughout the year.
  • Dates of Employment: Keep records of when employees are hired and when they leave.
  • Hours Worked: This is important for determining full-time status under the ACA. Full-time status is based on hours worked, not the type of payment.

2. Medical Coverage Information

  • Coverage Dates: Know when each employee’s coverage starts and ends.
  • Coverage Tiers: Record whether employees are covered alone, with a spouse, or with their family.
  • Coverage Offered and Declined: Document what health benefits were offered to employees and whether they accepted or waived them.

7 Strategies to Keep Your ACA Data Accurate

1. Conduct Regular Audits

Regular audits help you catch and fix errors or missing information. Verify Social Security numbers, hours worked, and the health benefits offered. Regular checks will help you stay compliant and avoid last-minute stress.

2. Continuously Track Employee Status

Maintain accurate records of employee status changes—whether full-time, part-time, or seasonal. This includes tracking hiring and termination dates, status changes, and leaves of absence. Keep your system updated in real time to ensure accuracy.

3. Make Technology Your Ally

Invest in HR technology such as HRIS (Human Resource Information System), HRMS (Human Resource Management System), or a benefits administration system. These systems can automate data verification, reduce errors, and ensure accuracy. Look for technology partners with ACA validation features to streamline the reporting process.

4. Track Compliance Benchmarks Efficiently

An advanced HR system can track compliance benchmarks and alert you to important deadlines. This reduces the risk of missing crucial tasks and ensures you stay on top of your compliance requirements.

5. Educate Employees

Educate your employees about the importance of accurate data. This includes initial onboarding and ongoing training about ACA requirements. Keep communication channels open so employees understand how their data impacts compliance.

6. Collaborate with IT

Work closely with your IT department to ensure data integration systems are running smoothly. While benefits and HR focus on data accuracy, IT ensures that systems integrate and function properly.

7. Integrate and Verify All ACA Data

Ensure data accuracy across all platforms. Use automated data integration to reduce human error and conduct regular audits to verify the correctness of integrated data. Centralizing data management makes it easier to access, manage, and verify information.

Making ACA Compliance Simpler

Staying compliant with the ACA can be complex, but it doesn’t have to be overwhelming. Here’s a simplified plan to get started:

  • Robust Onboarding: Collect all necessary data during the new-employee onboarding process.
  • Regular Data Audits: Schedule audits to keep ACA-related employee information up-to-date and accurate.
  • Leverage Technology: Use HR technology to streamline data management and integrate all systems handling employee data.

By implementing these strategies, you can make ACA compliance more manageable and avoid hefty penalties. Start by seeking advice from ACA and benefits administration experts to refine your data practices and stay compliant with ACA regulations.

Still Have Questions?

We serve employers who want to offer their employees affordable benefits. We simplify the complexity of providing those benefits and ensure compliance with the Affordable Care Act. We provide affordable benefits for the everyday person. We are different because of our personal service, speed of implementation, and innovative approach to providing benefits coverage.

Learn more about us and our services, here.

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