Author Archives: ACA Reporting Service

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Employee Benefit Brokers, ACA Reporting. Huge Prospecting Opportunity, OR Administrative Pitfall?

Posted on by ACA Reporting Service

The Million Dollar Question most employee benefit brokers are considering currently is should our firm try to perform this ACA reporting via an in-house technology solution that we purchase, or recommend having our clients use an outside vendor.  The reality is that every operation is different, has different needs and have promised their clients different things.  Some brokers take a full service approach and look to take administrative burdens off of their clients.  Other brokers take a more consultative approach.  Neither avenue is ‘wrong’, but each works for different type of benefit broker operations.

Regardless of which option you choose, here are some things you should be thinking of as you consider the question:

  • Do we have the necessary resources internally to do a good job with this IRS form filing function?
  • Do we have the knowledge internally to complete the job well?
  • What approach will be most comfortable to our clients?
  • What are the security ramifications of the solution we choose?  (Knowing that having employee social security numbers compromised could be a disaster for your company.)
  • If you decide upon an outsourced solution, will you want to refer your clients to someone who also competes with your company as a benefit broker?
  • Do we need a solution to talk with employers about right now?  What is gained or lost by waiting longer into the year before bringing a good solution to the table?
  • How much time, money and staff will it take to deploy our solution?
  • Would our time be better spent prospecting for new clients during this time using this issue as opposed to trying to manage the process internally?
  • Which option is more profitable to our business?
  • What is the logic of the system we intend to use?  Are the codes and amounts for 1095c lines 14, 15 and 16 automatically generated?  Will our staff or clients be responsible for completing these fields without the assistance of smart technology to intuitively figure out what the codes should be?
  • How will customer service be handled for this whole process?

Often the reality for an employee benefit broker is that a mixture of different solutions makes best sense for their operation.  When it comes to full service ACA 6056 reporting and efiling, we are here to help.

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Employee Benefit Brokers, ACA Reporting. Huge Prospecting Opportunity, OR Administrative Pitfall?

Posted on by ACA Reporting Service

The Million Dollar Question most employee benefit brokers are considering currently is should our firm try to perform this ACA reporting via an in-house technology solution that we purchase, or recommend having our clients use an outside vendor.  The reality is that every operation is different, has different needs and have promised their clients different things.  Some brokers take a full service approach and look to take administrative burdens off of their clients.  Other brokers take a more consultative approach.  Neither avenue is ‘wrong’, but each works for different type of benefit broker operations.

Regardless of which option you choose, here are some things you should be thinking of as you consider the question:

  • Do we have the necessary resources internally to do a good job with this IRS form filing function?
  • Do we have the knowledge internally to complete the job well?
  • What approach will be most comfortable to our clients?
  • What are the security ramifications of the solution we choose?  (Knowing that having employee social security numbers compromised could be a disaster for your company.)
  • If you decide upon an outsourced solution, will you want to refer your clients to someone who also competes with your company as a benefit broker?
  • Do we need a solution to talk with employers about right now?  What is gained or lost by waiting longer into the year before bringing a good solution to the table?
  • How much time, money and staff will it take to deploy our solution?
  • Would our time be better spent prospecting for new clients during this time using this issue as opposed to trying to manage the process internally?
  • Which option is more profitable to our business?
  • What is the logic of the system we intend to use?  Are the codes and amounts for 1095c lines 14, 15 and 16 automatically generated?  Will our staff or clients be responsible for completing these fields without the assistance of smart technology to intuitively figure out what the codes should be?
  • How will customer service be handled for this whole process?

Often the reality for an employee benefit broker is that a mixture of different solutions makes best sense for their operation.  When it comes to full service ACA 6056 reporting and efiling, we are here to help. 

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What are the ACA Reporting Penalties?

Posted on by ACA Reporting Service

When an Applicable Large Employer (ALE) fails to comply with their ACA reporting requirement, they will then be subject to various penalties.  These penalties apply both for not providing forms timely to employees as well as not filing timely to the IRS.

The penalties are as follows:

  • Did you fail to file a return, and on-time?  The penalty will be $250 for each return up to a maximum of $3,000,000.
  • Did you fail to provide your employees with their statements, and on-time?  The penalty will be $250 for each return up to a maximum of $3,000,000.

If there ever is intentional disregard of the requirement to provide employee statements, the total penalties stand to be increased from the base fines listed above.
The waiver of penalty and special rules under section 6724 and the applicable regulations, including abatement of information return penalties for reasonable cause, may apply to certain failures under section 6721 or 6722.

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What are the ACA Reporting Penalties?

Posted on by ACA Reporting Service

When an Applicable Large Employer (ALE) fails to comply with their ACA reporting requirement, they will then be subject to various penalties.  These penalties apply both for not providing forms timely to employees as well as not filing timely to the IRS.

The penalties are as follows:

  • Did you fail to file a return, and on-time?  The penalty will be $250 for each return up to a maximum of $3,000,000.
  • Did you fail to provide your employees with their statements, and on-time?  The penalty will be $250 for each return up to a maximum of $3,000,000.

If there ever is intentional disregard of the requirement to provide employee statements, the total penalties stand to be increased from the base fines listed above.
The waiver of penalty and special rules under section 6724 and the applicable regulations, including abatement of information return penalties for reasonable cause, may apply to certain failures under section 6721 or 6722.

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Payroll Vendor Doing ACA Reporting … MUST be HIPAA Compliant

Posted on by ACA Reporting Service

For payroll companies performing ACA reporting, we are increasingly finding that they forgot one very important detail … HIPAA and HITECH Compliance.

The reason most payroll companies forget about this detail is that they normally work with employee specific information regarding payroll records.  For payroll record specific information, HIPAA privacy rules have an exception that allow for the data to not be considered Protected Health Information (PHI).

When it comes to ACA Reporting however, there is no similar exception.

The information that is necessary to complete ACA reporting (list here)  contains employee Social Security Numbers that are connected with medical plan enrollment details.  For this reason, the data necessary to complete ACA Reporting must include PHI and thus the HIPAA and HITECH Compliance rules come into effect.

These rules require many various things, including the following:

  • Employers must enter into a Business Associate Agreement with any vendor they share PHI to in order to complete ACA reporting.
  • Once the vendor (payroll company in this case) comes into contact with the PHI, they have responsibilities to encrypt and safeguard this information.
  • Any communication that includes PHI (emails, etc) must be sent encrypted in order to ensure compliance
  • Once the payroll company receives the data, they must maintain all other HIPAA and HITECH compliance items regarding how the data is accessed and stored.

….So one quick question you can ask yourself is, “Did I sign a Business Associate Agreement with the payroll company I hired to do my Affordable Care Act Reporting?”.  If the answer to that is No, then you might have a problem.

This link is a blog article from the American Institute of CPAs that you might find helpful on this topic. (link here)

If you are curious how we handle HIPAA Compliance for our clients, you can learn more here.

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Payroll Vendor Doing ACA Reporting … MUST be HIPAA Compliant

Posted on by ACA Reporting Service

For payroll companies performing ACA reporting, we are increasingly finding that they forgot one very important detail … HIPAA and HITECH Compliance.

The reason most payroll companies forget about this detail is that they normally work with employee specific information regarding payroll records.  For payroll record specific information, HIPAA privacy rules have an exception that allow for the data to not be considered Protected Health Information (PHI).

When it comes to ACA Reporting however, there is no similar exception.

The information that is necessary to complete ACA reporting (list here)  contains employee Social Security Numbers that are connected with medical plan enrollment details.  For this reason, the data necessary to complete ACA Reporting must include PHI and thus the HIPAA and HITECH Compliance rules come into effect.

These rules require many various things, including the following:

  • Employers must enter into a Business Associate Agreement with any vendor they share PHI to in order to complete ACA reporting.
  • Once the vendor (payroll company in this case) comes into contact with the PHI, they have responsibilities to encrypt and safeguard this information.
  • Any communication that includes PHI (emails, etc) must be sent encrypted in order to ensure compliance
  • Once the payroll company receives the data, they must maintain all other HIPAA and HITECH compliance items regarding how the data is accessed and stored.

….So one quick question you can ask yourself is, “Did I sign a Business Associate Agreement with the payroll company I hired to do my Affordable Care Act Reporting?”.  If the answer to that is No, then you might have a problem.

This link is a blog article from the American Institute of CPAs that you might find helpful on this topic. (link here)

If you are curious how we handle HIPAA Compliance for our clients, you can learn more here.

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ACA Affordability Safe Harbors must work for Everyone in a Class …

Posted on by ACA Reporting Service

The IRS regulations for ACA reporting require an employer to show that they offered the ‘right type of plan’ at the ‘right type of cost’ or else face penalties.  This means that an employer must have offered minimum essential coverage and minimum value coverage at a cost no greater than 9.5% of the employees household income.

Problem!  When you hired an employee you didn’t hire their whole household, so how are you to know what that number actually is?  To deal with this issue the IRS allows for employers to make assumptions on what the household income is for an employee.  It is important to note however, the Affordability Safe Harbor MUST work for everyone within a class of employees in order to use it.  Lets take an example …

Example:  The employer has a class of hourly employees that they are applying the rate of pay safe harbor for affordability purposes.  There are 100 employees in this class.  The safe harbor works for 99 of the employees but does NOT work for 1 person.  This safe harbor cannot be used for ANY employees in this class.  Instead, line 16 of their form 1095-C would simply be left blank and the IRS would use the final, actual household income of the employee to determine if a penalty could apply.

Of course for our clients, we perform all of this analysis on their behalf.  If by chance you used a different vendor for reporting and need assistance, we can assist you through our consulting services.

To see specifically where this information and guidance comes from, you can visit this link here to see the Federal Register Vol.79, No.29.  On page 57 of this document you will find the following language:

(i) Conditions of using an affordability safe harbor. An applicable large employer member may use one or more of the affordability safe harbors described in this paragraph (e)(2) only if the employer offers its full-time employees and their dependents the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan that provides minimum value with respect to the selfonly coverage offered to the employee.  Use of any of the safe harbors is optional for an applicable large employer member, and an applicable large employer member may choose to apply the safe harbors for any reasonable category of employees, provided it does so on a uniform and consistent basis for all employees in a category. Reasonable categories generally include specified job categories, nature of compensation (hourly or salary), geographic location, and similar bona fide business criteria.  An enumeration of employees by name or other specific criteria having substantially the same effect as an enumeration by name is not considered a reasonable category.

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1095-C Code Calculator Released

Posted on by ACA Reporting Service

The most confusing portion of the entire Affordable Care Act employer reporting comes to bear when considering the lines 14, 15 and 16 for form 1095-C.


There are nearly 100 various logic combinations to create the codes necessary for the IRS reporting to be completed correctly.  To assist employers and organizations in checking the validity of the logic of these lines 14, 15 and 16 of form 1095-C, we have created a calculator.

Here is how it works … Simply select the codes below for lines 14 and 16 below and then press ‘search’.  You will then see the full logic as to why certain code combinations work or do not work.
Click here to load this Caspio Online Database.

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ACA Affordability Safe Harbors must work for Everyone in a Class …

Posted on by ACA Reporting Service


The IRS regulations for ACA reporting require an employer to show that they offered the ‘right type of plan’ at the ‘right type of cost’ or else face penalties.  This means that an employer must have offered minimum essential coverage and minimum value coverage at a cost no greater than 9.5% of the employees household income.

Problem!  When you hired an employee you didn’t hire their whole household, so how are you to know what that number actually is?  To deal with this issue the IRS allows for employers to make assumptions on what the household income is for an employee.  It is important to note however, the Affordability Safe Harbor MUST work for everyone within a class of employees in order to use it.  Lets take an example …

Example:  The employer has a class of hourly employees that they are applying the rate of pay safe harbor for affordability purposes.  There are 100 employees in this class.  The safe harbor works for 99 of the employees but does NOT work for 1 person.  This safe harbor cannot be used for ANY employees in this class.  Instead, line 16 of their form 1095-C would simply be left blank and the IRS would use the final, actual household income of the employee to determine if a penalty could apply.

Of course for our clients, we perform all of this analysis on their behalf.  If by chance you used a different vendor for reporting and need assistance, we can assist you through our consulting services.

To see specifically where this information and guidance comes from, you can visit this link here to see the Federal Register Vol.79, No.29.  On page 57 of this document you will find the following language:

(i) Conditions of using an affordability safe harbor. An applicable large employer member may use one or more of the affordability safe harbors described in this paragraph (e)(2) only if the employer offers its full-time employees and their dependents the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan that provides minimum value with respect to the selfonly coverage offered to the employee.  Use of any of the safe harbors is optional for an applicable large employer member, and an applicable large employer member may choose to apply the safe harbors for any reasonable category of employees, provided it does so on a uniform and consistent basis for all employees in a category. Reasonable categories generally include specified job categories, nature of compensation (hourly or salary), geographic location, and similar bona fide business criteria.  An enumeration of employees by name or other specific criteria having substantially the same effect as an enumeration by name is not considered a reasonable category.

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CPAs Performing ACA Reporting … Pay Attention to HIPAA Compliance

Posted on by ACA Reporting Service

In working with CPAs across the county, we have found that the overwhelming majority have not been aware that in order to perform Affordable Care Act (ACA) reporting on forms 1095-B and 1095-B for their clients that they must be HIPAA Compliant.  The confusion is understandable, since this likely is the first time they have ever really dealt with Protected Health Information (PHI).  Employee benefit brokers typically work with PHI on a daily basis every day, and thus are familiar with the requirements, such as entering into a business associate agreement with your client.  However on the whole, we are finding out that CPAs are not aware.

This link here from HHS.gov will be helpful to anyone who is looking to further research this issue regarding how business associate agreements work.  In addition, you will see CPA firms listed as examples of business associates.

Well what about employment and payroll records?  The immediate defense of CPAs normally is that they already are working with this type of information and are not required to be HIPAA compliant.  However, it is important to understand that HIPAA Privacy rules exclude these type of records that CPAs often work with. When it comes to working with PHI for this Affordable Care Act reporting though, this is a different story.

This link is a blog article from the American Institute of CPAs that you might find helpful on this topic. (link here)

What is PHI?

In terms of ACA reporting, whoever performs this reporting will indeed become in possession of PHI when they receive medical plan participants enrollment dates, dis-enrollment dates and social security numbers.  Since the information that is being received is connected with a health plan, this information becomes PHI.  Anytime you come into contact with PHI, you must enter into a business associate agreement and take certain other steps to maintain HIPAA compliance.

What is required of CPAs to be HIPAA compliant?

We would strongly suggest you speak with an attorney (as we do not give legal advice).  When you speak with an attorney, you will likely find the following items below as necessary:

  • Entering into a business associate agreement with clients
  • HIPAA training of all staff
  • Internal HIPAA security measures to ensure compliance with HITECH Regulations
  • Ensuring the servers and other computers in which you hold PHI are encrypted, fire walled, have server logs and audits, etc.
  • Rules on how data breaches are handled and communicated
  • Normally it is recommended to have Cyber Security insurance policies in place
  • It is also a very good idea to ensure your E&O insurance will cover you for these activities

Again, don’t take our word for it … definitely speak with an attorney.  And if we can help you, please let us know.  We partner with CPAs across the country to assist them with delivering an ACA reporting solution to their clients.