Eligibility Tracking Calculators

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Isn’t my insurance carrier responsible for ACA filing?

If you are an Applicable Large Employer, your insurance carrier is only responsible for 1095B forms for dependents IF you are on a Fully Insured plan. You are ALWAYS responsible for filing 1095C forms for your employees AND, if you are on a Self-insured plan, you are also responsible for filing on behalf of their dependents.

Do I still need to file if I have less than 50 full time employees

Yes, your Applicable Large Employer status is based on full time equivalent counts from the previous year. You will be relieved of a filing responsibility in the following year if your entire tax year keeps you below the 50 FTE mark.

Do I need to include dependent information on our 1095 forms?

For Applicable Large Employers, if you offer a Fully-Insured medical benefit plan your carrier will be responsible for providing ACA information for your dependents through using a 1095-B; however, they do not report any information on the Employer Responsibility section or 1095-C. The IRS is looking for who was made an offer and whether that offer was affordable. Carriers do not have this information. For medical plans that are Self-Insured or Level fundedit is your responsibility to supply dependent information as well as employee information using the 1095 form.

Who should be listed as the Point of Contact on my 1095 forms?

The point of contact on the 1095C form should be an internal employee, who can answer employee and IRS questions regarding the data included on their 1095 form.

What do I do if I receive a 226J, 5699 or 972CG penalty letter from the IRS?

Call the number on the top of your letter if you receive a 226J or 5699 and ask for an extension, take down the name and badge number of the person you speak with, Then, contact ETC immediately. You do not need to be an ETC 1095 filing company to utilize the services of our preferred partner firm, Haff & Raggio PLLC. If you receive a 972CG, contact ETC immediately to discuss as there is no phone number you can request an extension. To date, partners Haff & Raggio have saved client’s over $1 million + in IRS penalties.

Has ACA gone away now that there is no longer an employee mandate?

The individual mandate penalty has been changed to $0, however the Employer Mandate is still in full force and applies to all groups with more than 50 Full Time Equivalent employees. The IRS alerts show all signs that ACA reporting will continue at least through 2021.

Do I need a form for every single employee?

Employees only receive a 1095 form if they became eligible for benefits in the filing year (Jan-Dec).

What is a Controlled Group?

In regard to ACA, a Controlled Group is two or more companies that share ownership or stock. There are several types of Controlled Groups, including Parent-Subsidiary, Brother-Sister and Combined. This impacts your ACA filing because companies with less than 50 Full Time Equivalent employees are not subject to “pay or play” penalties, however if you have several small companies that are part of a Controlled Group, all employees from all entities are counted to determine if you are an Applicable Large Employer and therefore subject to ACA filing. If you would like a Controlled Group analysis to determine if your companies are indeed part of a Controlled Group, please let ETC know. These confidential analysis are handled by our preferred partner, Haff & Raggio, PLLC.

What are the fines associated with ACA?


How do I know if I have to track my employees?

If you hired your employees as full time and offer them benefits after a waiting period less than 91 days, you do not need to track their hours. In ACA terms, this is considered using “Monthly Measurement Method.” If you hired an employee as part time or variable hour, you will need to set up a measurement period to determine when to offer benefits. Choosing the right measurement period can be complicated itself since it has to coordinate with a standard measurement period. There are two distinct periods to measure which include an “initial measurement period” and then a “stability period” and then that employee after having completed a full “standard measurement period” is considered an “on-going” employee and therefore measured once a year for annual enrollment purposes. Measuring hours can be confusing when moving employees from the initial measurement period to the standard measurement period and a little tricky when reporting to the IRS. That is an ETC specialty, call ETC for assistance.

How do I know if I am an Applicable Large Employer (ALE) and need to file for ACA in a given tax year?

For purposes of determining if the employer is an ALE, the formula requires the following steps to be applied to the previous calendar year (Ex. What do I do in 2020, run the below for 2019):

• Determine the total number of full-time employees working 130+ hours in a given month (including any full-time seasonal workers) for each calendar month in the preceding calendar year;
• For everyone not included in the above, take the total number of part-time hours worked each month, regardless of the number of persons working these hours and divide this number by 120;
• Add the number of full-time employees from step 1 and full-time equivalents in step 2 for each month of the calendar year;
• Perform this calculation for every month in the calendar year;
• Add up the 12 monthly numbers; and
• Divide by 12 and round down.

If the average is 50 or more, the employer is an Applicable Large Employer and must comply with offering health coverage or face potential 4980H penalties.

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