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ACA Companion Application - Insurance Plan Tab

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The Insurance plan tab is used to define plans that are combined to create benefit packages in the next tab. The purpose of the ACA Companion Application is to produce ACA reporting, so the only plans added to the Companion Application should be ACA-compliant healthcare plans.

DO NOT add:

  • Vision plans
  • Dental plans
  • Life insurance
  • Non ACA-compliant healthcare offerings (fixed indemnity, etc)
  • Tiers of a plan (EE + Spouse, EE + Child, etc).  These are not needed as the IRS instructions tell ALE to report on the EMPLOYEE ONLY monthly contribution amount.

 

 

 

Field  Description
Add an insurance plan link Click the Add an insurance plan link to make a new insurance plan available for selection in the Insurance plans table. 
Insurance plans table

A list of the currently defined insurance plans. Plans can be edited or removed if they have not yet been included in a Benefit Package. Created plans are available for offer to an employee through a Benefit package (next section.)

Plan name field The name of the insurance plan. Plan Names are only visible to users, not employees, so choose a naming convention that works for your team. It is recommended you use the date or year of the plan in the title to allow for easy and proper selection. A combination of insurance plans compose a benefit package (the next tab in the ACA Companion application). The ACA Companion application Insurance plan name does not have to be identical to the transaction types used in the core application to deduct for premiums.
Provider name field The name of the company providing the insurance plan(s).
Monthly employee only minimum contribution radio buttons

The user determines the minimum amount the employee would need to contribute monthly under this plan. This setting allows Avionté to populate Line 15 on employees' 1095-Cs. This setting is the amount an employee would pay as a monthly premium to cover just themselves on the plan (disregard spouse and dependent costs if applicable).

The user may select:

Set amount A specific amount the employee needs to contribute for the plan. If this option is selected, a field is made available for entering a dollar amount. 
% of gross

A percentage of the employee's subject wages that determines what the employee needs to contribute for the plan. If this option is selected, two fields are made available:

 

  • Specific % field - The specific % of the employee's subject wages that the employee will pay for the insurance plan.

  • Max amt. - A cap placed on the amount the employee will pay for the insurance plan. This should indicate the maximum monthly premium cost for this plan.
Plan start month drop-down menu A drop-down menu featuring monthly options defining when the plan takes effect. The plan will go into effect on the first day of the selected month.
Open enrollment start date calendar The first date of a company's annual open enrollment period during which employees are offered an insurance package. Select a month from the first drop-down menu and a specific date from the second drop-down menu.
Open enrollment end date calendar The final date of a company's annual open enrollment period during which employees are offered an insurance package. Select a month from the first drop-down menu and a specific date from the second drop-down menu.
Is this a self-insured plan? radio buttons A self-insured plan is a health plan where the employer, rather than a health insurance company, assumes the financial risk of providing health care benefits to its employees. 
Safe harbor code (opt.) drop-down menu

If the plan offers Safe Harbor relief, a code can be selected from the drop-down menu. This field is optional, or not required, so To avoid paying penalties for providing insufficiently affordable healthcare plans, Safe Harbor guidelines are defined for employers. 

 

An affordability safe harbor code should not be entered on line 16 for any month that the ALE member did not offer minimum essential coverage to at least 95% of its full-time employees and their dependents (that is, any month for which the ALE member checked the “No” box on Form 1094-C, Part III, column (a)).

 

Code Series 2 codes Description from the IRS' 1094-C and 1095-C instructions
2A Employee not employed during the month. Enter code 2A if the employee was not employed on any day of the calendar month. Do not use code 2A for a month if the individual was an employee of the ALE Member on any day of the calendar month. Do not use code 2A for the month during which an employee terminates employment with the ALE Member.
2B Employee not a full-time employee. Enter code 2B if the employee is not a full-time employee for the month and did not enroll in minimum essential coverage, if offered for the month. Enter code 2B also if the employee is a full-time employee for the month and whose offer of coverage (or coverage if the employee was enrolled) ended before the last day of the month solely because the employee terminated employment during the month (so that the offer of coverage or coverage would have continued if the employee had not terminated employment during the month).
2C Employee enrolled in health coverage offered. Enter code 2C for any month in which the employee enrolled for each day of the month in health coverage offered by the ALE Member, regardless of whether any other code in Code Series 2 might also apply (for example, the code for a section 4980H affordability safe harbor) except as provided below. Do not enter code 2C in line 16 for any month in which the multiemployer interim rule relief applies (enter code 2E). Do not enter code 2C in line 16 if code 1G is entered in line 14. Do not enter code 2C in line 16 for any month in which a terminated employee is enrolled in COBRA continuation coverage or other post-employment coverage (enter code 2A). Do not enter code 2C in line 16 for any month in which the employee enrolled in coverage that was not minimum essential coverage.

2D

Employee in a section 4980H(b) Limited Non-Assessment Period. Enter code 2D for any month during which an employee is in a section 4980H(b) Limited Non-Assessment Period. If an employee is in an initial measurement period, enter code 2D (employee in a section 4980H(b) Limited Non-Assessment Period) for the month, and not code 2B (employee not a full-time employee). For an employee in a section 4980H(b) Limited Non-Assessment Period for whom the ALE Member is also eligible for the multiemployer interim rule relief for the month, enter code 2E (multiemployer interim rule relief) and not code 2D (employee in a section 4980H(b) Limited Non-Assessment Period).

2E

Multiemployer interim rule relief. Enter code 2E for any month for which the multiemployer arrangement interim guidance applies for that employee, regardless of whether any other code in Code Series 2 (including code 2C) might also apply. This relief is described under Offer of Health Coverage in the Definitions section of these instructions.

2F

(W2 Form)

Enter code 2F if the ALE Member used the section 4980H Form W-2 safe harbor to determine affordability for purposes of section 4980H(b) for this employee for the year. If an ALE Member uses this safe harbor for an employee, it must be used for all months of the calendar year for which the employee is offered health coverage. To determine this option, take an employee’s W-2 wages for the month and multiply by 0.0966 (in other words, 9.66%). That number defines the monthly maximum that the company could take from the employee’s wages each month to pay for a minimally qualifying health plan. If, for example, an employee’s W-2 showed monthly pay of $1,500, then:

1500 × 0.0966 = $144.90

To meet affordability requirements under the W-2 calculation, an employer would need to offer one plan for which the employee’s monthly contribution was no more than $144.90.

2G

(Federal Poverty Line)

The Federal Poverty Line (FPL) calculation has been described as the simplest and easiest to use. This is done by calculating 9.66% of the one-person household federal poverty figure for 2016 ($11,880) and dividing that by 12 to get the monthly employee premium, which would be $95.63. If you offer a plan that costs less than that for employee-only coverage, your company meets ACA affordability criteria.

2H

(Rate of Pay)

To calculate ACA affordability based on employee compensation, multiply an employee’s monthly salary by 9.66%, which gives you the maximum amount you can charge that employee this year for qualifying coverage. For hourly employees, assuming 130 work hours in a typical month, calculating affordability is based on the lower overall figure when the two following options are calculated:

  • Employee hourly rate of pay on the first day of the plan year times 130 days per month, multiplied by 9.66%
  • Employee’s lowest hourly pay rate during the calendar month times 130 days per month, multiplied by 9.66%
2I Reserved for future use.
Offer of coverage code drop-down menu

 

For each calendar month, enter the applicable code from Code Series 1. If the same code applies for all 12 calendar months, you may enter the applicable code in the “All 12 Months” box and not complete the individual calendar month boxes, or you may enter the code in each of the boxes for the 12 calendar months. If an employee was not offered coverage for a month, enter code 1H. Do not leave line 14 blank for any month (including months when the individual was not an employee of the ALE Member).

 

Code Series 1 codes Description from the IRS' 1094-C and 1095-C instructions Displayed in Plan summary window
1A

Qualifying Offer: Minimum essential coverage providing minimum value offered to full-time employee with Employee Required Contribution equal to or less than 9.5% (as adjusted) of mainland single federal poverty line and at least minimum essential coverage offered to spouse and dependent(s).

 

This code may be used to report for specific months for which a Qualifying Offer was made, even if the employee did not receive a Qualifying Offer for all 12 months of the calendar year. However, an ALE Member may not use the Alternative Furnishing Method for an employee who did not receive a Qualifying Offer for all 12 calendar months.
  • Minimum essential coverage and value for employee.
  • Includes employee required contribution for self-only coverage, equal to or less than 9.5% of federal poverty line (48 contiguous states)
  • Provides minimum essential coverage to spouse and dependent(s).
1B Minimum essential coverage providing minimum value offered to employee only.
  • Plan covers employee only. NO spouse or dependents are covered.
  • Provides ACA minimum essential coverage.
  • Provides ACA minimum essential value.
1C Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) (not spouse).
  • Plan covers employee and dependent(s). NO spouse is covered.
  • Provides ACA minimum essential coverage.
  • Provides ACA minimum essential value.
1D Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to spouse (not dependent(s)). Do not use code 1D if the coverage for the spouse was offered conditionally. Instead use code 1J.
  • Plan covers employee and spouse. NO dependents are covered.
  • Provides ACA minimum essential coverage.
  • Provides ACA minimum essential value.
1E Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) and spouse. Do not use code 1E if the coverage for the spouse was offered conditionally. Instead use code 1K.
  • Plan covers employee, spouse, and dependent(s).
  • Provides ACA minimum essential coverage.
  • Provides ACA minimum essential value.
1F Minimum essential coverage NOT providing minimum value offered to employee; employee and spouse or dependent(s); or employee, spouse and dependents.
  • Plan covers employee and any combination of spouse and dependent(s).
  • Provides ACA minimum essential coverage.
  • Does NOT provide ACA minimum essential value.
1G

Offer of coverage for at least one month of the calendar year to an individual who was not an employee for any month of the calendar year or to an employee who was not a full-time employee for any month of the calendar year (which may include one or more months in which the individual was not an employee) and who enrolled in self-insured coverage for one or more months of the calendar year.

 

Code 1G applies for the entire year or not at all. Therefore, if code 1G applies, an ALE Member must enter code 1G on line 14 in the “All 12 Months” column or in each separate monthly box (for all 12 months).

  • Not a full time employee for any month of calendar year.
  • Enrolled in self-insured employer-sponsored coverage for one or more months of calendar year.
1H No offer of coverage (employee not offered any health coverage or employee offered coverage that is not minimum essential coverage, which may include one or more months in which the individual was not an employee).
  • NO offer of coverage (no offer of health coverage or offered coverage NOT minimum essential)
1I Reserved for future use.  
1J Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage conditionally offered to spouse; minimum essential coverage not offered to dependent(s). (See Conditional offer of spousal coverage, above, for an additional description of conditional offers.)
  • Minimum essential coverage and value for employee.
  • Minimum essential coverage conditionally offered to spouse.
  • Minimum essential coverage NOT offered to dependent(s).
1K Minimum essential coverage providing minimum value offered to employee; at least minimum essential coverage offered to dependents; and at least minimum essential coverage conditionally offered to spouse. (See Conditional offer of spousal coverage, above, for an additional description of conditional offers.)  
Plan summary read-only field

The Plan summary field provides a simple description of the plan selected in the Insurance plans area.  

Once an insurance plan has been created, a window of available insurance plans is listed to the right of the data fields. By default, when opening the application, the first plan is selected and its data is populated in the data fields. 

 

Click X to delete a plan. If a plan has been applied to a benefit package, it cannot be deleted.

Edit plan button

Select a plan and click the Edit plan button to make plan fields editable. 

Update plan button

After editing plan fields, click the Update plan button to save changes. 

Cancel link

Click the Cancel button instead of the Update employer button to revert the window to its last saved state.

 


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