Employers with fully insured health plans that receive MLR rebates Employers that receive rebates should consider their legal options for using the rebate. Any rebate amount must be used for the exclusive benefit of the plan’s participants and beneficiaries within 3 months of receiving the rebate to avoid ERISA trust requirements. Penalty for each violation […]

Group health plans that are subject to the Form 5500 filing and have not extended the deadline via a Form 5558 Employers that are required to file a Form 5500 must provide participants with a summary of the information in the Form 5500, called a summary annual report (SAR). The plan administrator must provide the […]

Group health plans that provide Rx coverage to Individuals eligible for Medicare Part D Employers must notify Medicare Part D-eligible individuals by Oct. 15th of each year about whether the Rx coverage is creditable or non-creditable as discussed above. No specific penalty for employers. Potential penalty for individuals who do not maintain creditable coverage.

ERISA-covered group health plans that do not qualify for the small plan exemption and MEWAs (and have timely requested an extension to the filing deadline) An employer may request a one-time extension of 2.5 months by filing a Form 5558 by the normal due date of Form 5500. Employers are required to file an annual Form […]

All Employers Determine ALE Status (i.e., whether the employer has at least 50 full-time employees (FTEs) each calendar year, considering all common law employees in the entire controlled group and counting each part-time employee as a fraction of the FTE). Determine full-time status using monthly measurement method or look-back measurement method. Offer coverage to FTEs […]

Employers that are an Applicable Large Employer and have variable hour part-time employees. There are two methods for determining full-time employee status. The monthly measurement method or the look-back measurement method. Zywave has more detailed information on each method and reasons an employer may prefer one method over another. “A” Penalty Adjusted for inflation: $2,970 for 2024 […]

Employers that are An Applicable Large Employer There are three safe harbors that an employer may use to determine affordability for purposes of the employer shared responsibility provisions. Employers are allowed to choose from using either the Form W-2 wages, an employee’s rate of pay or the federal poverty limit to make their affordability determination. […]