As employers, dealerships must comply with numerous reporting and disclosure requirements throughout the year in connection with their group health plans. Navigating compliance in this area can be difficult due to considerations like “Plan Year versus Calendar Year” and determining if the dealership falls under requirements due to the number of employees.

For example, an employer is an Applicable Large Employer (ALE) if an employer had at least 50 full-time employees, including full-time equivalent employees, on average during the prior year; then that employer is an ALE for the current calendar year.

Below are some examples of compliance deadlines dealers should be aware of:

File Affordable Care Act (ACA) Forms 1094-C and 1095-C (paper filing deadline) - February 28 or April 1 Electronic

Applicable large employers (ALEs) must report information about their health plan coverage to the IRS using Forms 1094-C and 1095-C. This deadline applies only to filing paper versions of these forms; the deadline for electronic filing is April 1, 2024. Beginning in 2024, paper filing is an option only for very small employers (i.e., employers that file fewer than 10 information returns during the year). A hardship waiver may be requested from the electronic filing requirement by submitting Form 8508 to the IRS.

All electronic filed ACA reporting forms must be completed and submitted the IRS Affordable Care Act Information Returns (AIR) system. The AIR system (https://www.irs.gov/e-file-providers/affordable-care-act-information-returns-air) requires an XML schema coding formatting for transmission. The IRS advises this is generally not something that a typical employer could navigate on their own, without the support of an ACA reporting vendor.

1094-B and 1095-B - Non-ALEs with self-insured health plans must report information about their health plan coverage to the IRS using Forms 1094-B and 1095-B. The February 28 deadline applies only to filing paper versions of these forms; the deadline for electronic filing is April 1, 2024. Beginning in 2024, paper filing is an option only for very small employers (i.e., employers that file fewer than 10 information returns during the year). Again, a hardship waiver may be requested from the electronic filing requirement by submitting Form 8508 to the IRS.

ACA Form 1095-C to Employees

March 1, 2024

ALEs must provide information about their health plan coverage to their employees each year using IRS Form 1095-C. In general, these statements were required to be provided to employees on or before Jan. 31. However, the IRS extended this annual deadline by 30 days. With the extension, the deadline is normally March 2. However, since 2024 is a leap year, the deadline was March 1, 2024.

Non-ALEs with self-insured health plans must provide information about their health plan coverage to their employees each year using IRS Form 1095-B.

Submit the prescription drug data collection report for Group health plans and health insurance issuers by June 1

A transparency law requires employer-sponsored health plans and health insurance issuers to report information about prescription drugs and health care spending to the federal government annually. This reporting process is referred to as the “prescription drug data collection” (or “RxDC report”). Most employers will rely on third parties, such as issuers, third-party administrators (TPAs) or pharmacy benefit managers (PBMs), to prepare and submit the RxDC report for their health plans.

Report and pay PCORI Fee for Employers with self-insured health plans and HRAs - July 31

Employers with self-insured health plans, including HRAs, must pay an annual fee to fund the Patient-Centered Outcomes Research Institute (PCORI). Employers use IRS Form 720 to report and pay PCORI fees.

File Form 5500 for ERISA-covered group health plans that do not qualify for the small plan exemption - July 31 for Calendar Year Plans

Employers with ERISA-covered welfare benefit plans are required to file an annual Form 5500 unless a reporting exemption applies. The Form 5500 must be filed by the last day of the seventh month following the end of the plan year. For calendar-year plans, this deadline is July 31. An employer may request an automatic one-time extension of 2.5 months by filing IRS Form 5558 by the normal due date of the Form 5500.

Small health plans (fewer than 100 participants) that are fully insured, unfunded or a combination of insured/unfunded are generally exempt from the Form 5500 filing requirement.

Provide SAR for Group health plans that are subject to the Form 5500 filing requirement (and have not extended the Form 5500 deadline) - September 30 for Calendar Year Plans

Employers that must file a Form 5500 must provide participants with a summary of the information in the Form 5500, called a summary annual report (SAR). The SAR must be provided within nine months of the close of the plan year. For calendar-year plans, this deadline is Sept. 30. If an extension of time to file the Form 5500 is obtained, the plan administrator must furnish the SAR within two months after the close of the extension period.

Plans exempt from the annual 5500 filing requirement are not required to provide a SAR. Large, completely unfunded health plans are also generally exempt from the SAR requirement.

Provide Medicare Part D Notices for Group health plans that provide prescription drug coverage to individuals eligible for Medicare Part D by October 14

Employers with group health plans that provide prescription drug coverage must notify Medicare Part D-eligible individuals by Oct. 14 of each year about whether the drug coverage is at least as good as Medicare Part D coverage (in other words, whether their prescription drug coverage is “creditable” or “non-creditable”).

In addition, all employers must self-certify that their RX plan is creditable (or non-creditable) on CMS’s website at the following address: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/CCDisclosureForm.html. This must occur within 60 days after the beginning of each plan year.

In addition, annual notices may include:

Summary of Benefits Coverages

Women’s Health and Cancer Rights Act (WHCRA)

CHIP Notice

Summary Plan Description (SPD)

Summary of Material Modifications (SMM)

General Notice of COBRA Rights

ACA Grandfathered Plan Notice

Notice of Patient Protections

HIPPA Privacy Notices

HIPAA special enrollment notice

Wellness notice—HIPAA

Wellness notice—ADA

PAA Insurance Agency

The Brokers Who Know Your Business

Employees value health care coverage perhaps more than any other benefit, but employers are struggling with the escalating costs of providing quality programs and the compliance burden for their Controllers and HR Professionals. PAA’s Regional Managers are the dealership’s conduit to PAA’s services, offering a number of insurance carriers in all areas of Pennsylvania with a wide range of benefit choices. These choices will enable employers to design benefit packages that meet their needs and fit their budget. In addition, PAA Regional Managers can assist dealers with compliance questions and offer services and programs to minimize the Affordable Care Act’s compliance workload. 

AF Comply By American Fidelity

American Fidelity offers a software solution that handles reporting obligations from data import to mailing and reporting data to the IRS. The system also tracks employee hours and alerts HR managers when employees are eligible for an offer of coverage.

For more information on compliance obligations and programs that PAA recommends, contact a Regional Manager:

 

REGIONAL MANAGERS

Darren Miller, Senior Regional Manager

[email protected]: 717-439-8693

Deni Cecco.

[email protected]: 717-678-2675

Matt Rhodes

[email protected]: 717-773-6855

Mark Johnson

[email protected]: 717-743-5208

Debra Shoemaker

[email protected]: 717-319-1816

Tara Shaffer

[email protected]: 717-648-1489