Deal Smartly with ACA Challenges to Stay Compliant!


Affordable Care Act (ACA) has hit the employers’ serenity in a big way and forced them to remain compliant with the new changes. According to reports, in 2015, only 70% full-time employees had to be offered health care coverage, which after some new amendments, rose to 95%. This has led to more burden on the employers adding up more compliance issues, affordability calculations and high concerns regarding employment status and calculations.

Here are the four topmost employer concerns revolving around ACA Compliance:

Employers Are Getting False Hopes!

After witnessing stringent rules and complexities, most of the employers get a false hope that compliance requirements will be delayed or removed (due to its complications). As a result, they wait for the expected outcome. But, most of them, get severe penalties due to late filings. Sometimes, Internal Revenue Service (IRS) does give the extension, but this does not mean that employers can get away from penalties in case of non-compliance or missing any important deadlines.

Lack Of ACA Knowledge!

Understanding the basic requirements and employee eligibility for offering coverage as per ACA mandates is the major requirement in attaining compliance and saving yourself from the heavy penalties. But, most of the employers don’t know which workers qualify as full-time employees and what they have to do as per the rules. This creates a baffling situation for most of the employees and makes the whole process little troublesome.

Clearly, ACA eligibility is one of the toughest parts and remains an area of concern for the employers as they move through the calendar. For this, you need to have an ongoing, accurate, and focused team to track evolving federal rules and regulations. This will help you stay compliant.

Lack Of Proper Resources!

Filling a simple IRS form is not so easy task as it seems to be. Most of the HR departments assumed IRS filing as a cakewalk and did not put much efforts to contemplate on the vital requirements. But, now they are realizing that they need a lot of information and tech assistance from different departments to comply by all the requirements and submit the forms to IRS within the given time limit.

How Can An Experienced Broker Help?

It is no surprise that with the rising complexities and challenges revolving around ACA compliance, employers do need an expert assistance to fulfill the requirements. This is how a broker’s role comes into picture!

But, many employers get into trouble after choosing the wrong broker. As they couldn’t handle the basics and also provide their clients with wrong information leading to ACA troubles. Therefore, choosing the right broker is the way to get things through without any violations.

 A broker can help his/her clients by providing the solutions rather than just doing the business. They can act as a consultant and trusted advisor to their clients and can save them big from the heavy ACA penalties. Therefore, it is very important to have a right broker by your side. Do proper research before choosing any!

Putting All Together:

Observing things superficially and not understanding the complete scheme can cost you big and may increase your burden. Therefore, it is better to have proper details and knowledge of each and everything that is related to ACA before it gets too late. A comprehensive broker can help you largely by guiding you to the right path alleviating your ACA troubles.



Learn About HIPAA Implication for Completing Forms 1095-C

ACA Reporting HIPAA Implications

2016 is the year of ACA Reporting! All the employers have reporting requirements at the top of their priority list and leaving no stone unturned to execute it perfectly!

Thus, you must be extra cautious while completing and submitting the reporting forms-1094/95. Form 1095-C is the crucial one as it is used by the employers to report their minimum essential coverage offerings to employees (Part I and II), as well as to report the employee enrollment in self-insured minimum essential coverage (Part III).

The employer’s medical plan is a covered entity that is subjected to HIPAA security, privacy and breach notification rules. In case the plan is insured, then the carrier will be liable to comply with the HIPAA rules (but, the employer must not receive any Protected Health Information (PHI), except for a few limited reasons). Whereas, if the plan is self-insured, then the plan is subject to HIPAA rules and not the employer. Thus, it must depend on members who are involved in plan administration and TPAs for administering the plan.

The employee information cannot be considered as PHI if the employer extracts information from general employee records and not from the self-insured medical plan records. Moreover, if the employer is handling the medical plan enrollment activities for employees, then it is not PHI and is not subjected to HIPAA. This is known as enrollment exception and must be well understood before using it in the form. For any information to get subjected to HIPAA depends on how the employer obtained it and what part of the information is used in the Form.

The information related to employee’s enrollment in medical plan coverage is put in Part III and is considered enough to be called PHI. Also, if the information is obtained from any medical plan information or a TPA medical plan administrator and not from the general employment database, then it will get subjected to HIPAA. Similarly, demographic details of employee (Part I) and offered coverage information (Part II) is not subject HIPAA depending on source of information.

Self-insured employers who need to complete Part II for enrollment in coverage should, preferably, consider the data to be filled in as PHI. Thus, such employers must follow the following considerations to stay HIPAA compliant while completing the Forms 1095-C:

  • Educate the employees on HIPAA compliance and how to complete the Forms.
  • To make sure that you complete, distribute and file forms accurately, take assistance from the experts and consultants who will help you get the job done efficiently.
  • Ensure that the forms are well-placed in a secured environment with limited access.
  • In case, any error has occurred such as the Form is delivered to wrong recipient or is lost or stolen, then you must notify the HIPAA privacy and security officials who will further look into the matter.

These are a few HIPAA implications while completing the IRC Section 6055 and 6056 reporting forms. In order to stay compliant, you must learn about the privacy, security and breach consideration of the data and should take care of them while completing the forms.

Get Health Insurance or Get Ready to Pay All-Time High Penalties!

It’s the third year of open enrollment under Affordable Care Act’s (ACA) provisions and unlike the previous two years, the millions of people who will not get enrolled, will have to pay much higher penalties in their 2016 tax returns. Similarly, employers not offering minimum essential coverage with minimum affordable cost will also have to pay hefty penalties.

The tax penalty created by the government, and promoted by the Supreme Court will push people to obtain health coverage in order to avoid such sky rocketing penalties. The major goal of implementing ACA and proving its financial viability will only get accomplished if majority of Americans get coverage. Or else people will only buy coverage when they get sick.


Though, many Americans are exempted from the tax or the shared responsibility payment, but the ones who did not have the coverage, were subjected to pay relatively smaller penalties when the ACA marketplaces first went online in 2014. During that period, an individual without coverage had to pay the larger of $95 or 1% of income over $10,000 and that amount was even capped at $2,448. It cannot be said as to how many people will have to pay penalty until the 2014 tax returns processing is completed by the IRS.

However, for the year 2015, the penalties have been raised to $325 per individual and $162.5 per child with family cap of $975 or 2% of the total countable income (whichever is greater) with an overall cap of $2,484 per individual upto $12,420 for a family. People who do not have an adequate coverage and are not exempted from the tax will pay the penalties in their tax returns for year 2015.

While these penalties are for those without a coverage in 2015, the penalties for those who will go without coverage in 2016 will be much much higher if they are not exempted. It will be $695 per adult and $347.5 per child up to a family cap of $2,085 or 2.5% of countable income (whichever is greater) with expected overall maximum of $2,676 per individual and up to $13,380 per family.With higher penalties, people will preferably like to buy health insurance instead of paying heavy penalties while remaining out of coverage.

Dovetailing the above, it can be said that the soaring penalties for not getting coverage may encourage more Americans to buy insurance as paying penalties and still remaining uninsured is anyway a bad idea! And getting affordable coverage can benefit people not just in time of medical crisis, but can also help them manage finances effectively.

Get Answers to All Your ACA Queries & Concerns!

Open Enrollment season is here!

Still many doubts… many questions… unanswered?

TeemWurk is here to answer all your doubts relating to ACA compliance, benefits management, employer roles, etc.!

#1 Employer Responsibilities Under ACA

ACA’s Employer Mandate

Affordable Care Act mandates all applicable large employers to provide health benefits to their employees. As per the Employer Shared Responsibility Provision, employers who do not offer the coverage or their coverage does not meet the minimum essential coverage requirements, will be subjected to pay penalties. This article is a tell-all on ACA’s Employer Mandate!

#2 Top Compliance Concerns


As majority of employers are affected by the Affordable Care Act and are still struggling to meet the complex provisions and requirements of the law, the question in concern is What are the top ACA Facts That You Must Know To Stay Compliant and What Major Challenges Companies Face and How To Overcome Them?

#3 Impact of Cadillac Tax


Cadillac Tax or the 40% non deductible tax was initially supposed to affect only the luxury heath care plans, but many believe it is going to largely affect the benefits industry and can affect millions of health coverage plans. Find out everything about Impact of Cadillac Tax on Employers & Employees!

#4 Role of Brokers or Benefit Professionals

Role of Brokers or Benefit Professionals

The season of Open enrollment is that crucial time when healthcare agents and brokers are the most called upon for advice and guidance on various healthcare aspects. Thus, they need to be ready for all the answers from explaining different coverage options to legal requirements to how technology can help. Here is How Do Employers Benefit From An Insurance Broker?

#5 Integration of Technology & Benefits

ACA, Compliance & Technology Co-exist

Till now, ACA is one of the most complex health care laws set forth in front of Americans, that just don’t let employers, employees and brokers relax for a moment. With the ever-changing provisions and a lot of regulations to be taken care of, none of the individual involved gets a chance sit back and relax. This has resulted in employers’ sudden inclination towards software and technology to make things simpler. Find out How ACA, Compliance & Technology Co-exist!

Having learned about all these terms, their significance and impact will help you carry out this year’s open enrollment period smoothly with employees making more well-informed decisions and employers staying fully complaint and avoiding any penalties!

Happy Enrollments!

Obamacare Still Struggling To Be Convincing – Challenges Continue…

TeemWurk - Obamacare Still Struggling To Be Convincing Challenges Continues

Right from the time Obamacare has come into effect, consequential obstacles such as presidential election, two significant Supreme Court challenges and dozens of abolition efforts in Congress have blocked its way

Here are 5 main hurdles that still persist and continue to bother the law in one way or the other –

Healthcare costs are still too high.

Enrollees are discovering that the “Affordable” Care Act is not affordable in any sense as healthcare costs continue to rise much faster than wages, thereby putting a financial burden on people who are availing the related benefits. Deductibles and other out-of-pocket costs are constantly on the rise because businesses opt for plans with lower premiums, as “Cadillac tax” pressurize employers to offer skimpy health coverage or simply pass the taxes’ cost on to their employees. This eventually means that the employee/patient has to bear most of the health care costs.

Extending the scope of Medicaid expansion.

Nearly 4 million Americans were supposed to be covered under the Medicaid expansion, over the next decade. But when the Supreme Court ruled that it is not mandatory for the states to follow this provision in the health-care law, many states took up the option. Around, 21 states with Republican governors or GOP-controlled legislatures are not willing to adopt Medicaid expansion posing various reasons backing their statement, like ideological objections, budget pressures and their disbelief in Washington’s long-term commitment to pay most of the costs.

What if Republicans Capture the White House in 2016?

As the 2016 presidential race seems extremely competitive, with many Republican candidates in both houses of Congress, the ultimate challenge to Obamacare persists. It’s not clear if Republicans will completely knock over Obamacare, as it would abandon nearly 20 million Americans who are already covered, back into the pool of uninsured. But we are certainly going to experience substantial change in some way.

The Effect Of Ever-Changing Market.

In the first two years of the marketplaces, healthcare premiums have not increased much nationwide but this could substantially change in the near future. Insurers are being constantly protected by the Federal Government from paying high medical bills, but the comfort is soon to disappear. Insurers, concurrently, have gained enough experience with their initial customers to analyze whether their premiums are enough to cover healthcare costs. Those who have not, are likely to expect a significant high rise.

Enrollment Isn’t Strong Enough.

Around 18 million Americans eligible to buy insurance in federal and state marketplaces haven’t showed any interest in buying it. The major challenge that those marketplaces faced was to attract Hispanics, young adults and those who don’t like to be forced to buy the insurance. There has been a considerable decrease in the federal funding used to enroll people and advertise for the insurance. States like Vermont, Hawaii, Colorado and Rhode Island are among those who are still searching for ways to be self-sufficient as the penalty for going without coverage is likely to rise next year to $695 per adult or 2.5 percent of the total family income—whichever is larger.

In the five year tenure of Obamacare, it has faced many major ups and downs but the law has kept its stronghold in between all the oppositions and challenges. Now only the future will decide what its fate is and how long it can hold its grounds?

Small Employers, Get Ready! June 30 Deadline Is Approaching!

June 30 is the last date for small business owners to make changes in the individual policies that they are paying for their employees on pre-tax basis. If they fail to do so, they might face heavy penalties.

For small employers, these individual policy premiums cost lower than the group insurance premiums. Thus, these individual policies are taken up by small employers as an affordable option. This can be achieved by special account call Health Reimbursement Account (HRA) or Flexible Spending Account (FSA).

But, as per the ACA provisions, this practice is prohibited and any employer found practicing the same, would be subjected to pay a fine of up to $100 per day. The enforcement date for the provision was extended to give these business owners an adequate time to adjust the plans accordingly. Business owners having 50 or less employees were given this transition relief till June 30, 2015.

Some other components are also associated with the strategy that makes it difficult for the employers. For instance, if the employer promises to provide individual benefits reimbursements after 90 days from employment, it is not necessary that they would be able to keep up the promise as the individual market strictly follows the open-enrollment rules and regulations. In case you miss out during the open enrollment period or don’t qualify for the special enrollment period, then an employee might not be able to apply for the individual coverage.

For the new hires, who pay IRS penalty and do not enroll, they will have to wait till next open enrollment period to get coverage. This may lead these employees to leave the organization and join the ones that offer better benefit options. Thus, in order to retain these employees, employers can pay them higher salaries and ask them to buy their coverage while the company pays their payroll taxes. Though, in this option, the employer and employees may not be able to fully enjoy the tax advantages as employee will have to pay premium with after tax dollar and employer will pay the taxes on the basis of the amount given to the employee.

The small business owners that are planning to provide the small group plan to their employees now can enjoy the revised participation requirements from the carriers. As per the relaxed requirements, instead of covering for 70-75% of eligible employees, carriers have now taken it to as low as 25%. Moreover, ACA provisions liberate employers from paying entire premium for the employees. Employers can even designate fixed amount as their premium contribution.

Dovetailing the facts, if you are a small employer practicing the individual policy practice, then it’s time to change your benefit offerings as the June 30 deadline is approaching soon!

Saving For Retirement Made Easier: IRS Facilitates Automatic Enrollment in 401(k) Plans

Good news for the taxpayers!

IRS and the Treasury Department have taken the initiative to make the enrollment easier for taxpayers. They have issued a guidance for automatic enrollment of taxpayers in retirements plans i.e. 401(k) and 403(b) offered by their employers. This will also help in simplifying correction methods when any error occurs.

The guidance was issued in Revenue Procedure 2015-28 and is mainly developed to make easy the automatic enrollment and contribution increases in different retirement saving plans. This also adds up to the self-correction programs where plan sponsors can easily make changes or resolve any administrative errors without having to ask for any approval from IRS or risking plan’s tax qualification.

IRS Auto Enrollment in 401K

This move will simplify the correction methods and encourage the plan sponsors to adopt the advanced features and practices that may assist employees to save for retirement. Furthermore, it will reduce the administrative burden and costs incurred in running the correction process if 401(k) or 403(b) plan fail to implement the employee contribution amount correctly.

See Related >> Integrating 401(k) Plan With Payroll Can Be A Good Option For Small Businesses

In this safe correction program for plans with automatic contribution features, plan sponsors are required to make employer matching contributions that had to be made with respect to the employee contributions that were missed and thus, additional amount has to be contributed to compensate for the earnings that could have accrued under the respective plan on those matching contributions. Moreover, the participants of errors and corrections need to be notified through the plan about the given chance to make up for employee contributions that were missed.

The guidance also offers other methods for alleviating costs involved in making corrections in certain errors of 401(k) and other similar plans irrespective of whether they use automatic increases or automatic enrollments.

The new methods are effective instantaneously and can be applied to all the administrative errors that occur before 2021. The guidance has also asked the public to openly give comments for improvement.

It’s a good option to have automatic enrollment in retirement plans in order to increase retirement savings. This improvement will help small businesses to establish retirement plans for their employees with the automatic enrollment feature and help middle-class Americans in making considerate savings for their retirement.