For Applicable Large Employers [ALEs], complying with the Affordable Care Act (ACA) is the primary focus of health benefits compliance. But New Jersey’s new Medicaid Employer Fee — also known as the Medicaid Employer Assessment — creates a separate state requirement that orgnaizations with NJ employees should evaluate independently. The key takeaway: Employers that are […]
In NJ, ACA Compliance May Not Be Enough Read More »
Overlapping federal and state regulations for PFML [Paid Family and Medical Leave] create major compliance hurdles and noisy disconnects in the benefits data and workflows of employers and their carriers. The legacy “unified” architecture of Payroll, HCMs, or specialist benefit systems is easily disrupted by conflicting eligibility rules, divergent job-protection guidelines, misaligned definitions of family
PFML: How To Align Federal & State Laws Read More »
Paid Family and Medical Leave (PFML) is too complex and dynamic for Payroll/HCM platforms to manage either as stand-alone solutions or through legacy linear integration with specialist benefit systems and tactical APIs. Changing platforms or adding more systems and tools doesn’t solve the challenge of efficiency, accuracy, and trust for employers and their partners. More
Why PFML Needs An Ecosystem Solution Read More »
PCORI fees are federal taxes mandated by the Affordable Care Act and levied on both insured and self-funded health plans, retiree health plans, and HRAs. The purpose of these mandatory annual fees is to fund healthcare research carried out by the Patient-Centered Outcomes Research Institute. Carriers pay the PCORI fees for insured medical plans, and
PCORI Fees Due July 31. Download Our Employer Guide Read More »
Starting July 2026, employers can make voluntary, tax-free contributions of up to $2,500 annually per employee to Section 530A Trump Accounts, which act as starter traditional IRAs for minors. The new law, established by the One Big Beautiful Bill Act (OBBBA), evidences growing federal support for family wealth-building and financial well-being. ____________________________ Companies intending to
Trump Accounts: What Employers Need to Know Read More »
On May 15, the Centers for Medicare & Medicaid Services [CMS] issued the HHS Notice of Benefit and Payment Parameters for 2027, introducing a broad set of changes to the federal ACA Health Insuracne Marketplace. These changes lower marketplace user fees; eliminate the requirement for marketplace insurers to offer standardized plan options; and grant states
Increased Federal Scrutiny for ACA Eligibility Read More »
The AI revolution is fueling far-reaching business transformation. These ‘AI & RegTech’ posts have been created by the tech and benefits specialists at BENEFITSCAPE to help employers and everyone in the benefits ecosystem understand better the emerging benefits of AI for ben admin and compliance. In PART 2 we dig deeper into the different types
AI & Regtech for Employee Benefits [Part 2/3] Read More »
State-mandated benefit programs, including Paid Family and Medical Leave [PFML], place a growing compliance burden on employers and their HCM systems — from tracking eligibility and monitoring protected leave status to avoiding assumed retaliation for employee terminations. Two recent Massachusetts PFML updates — a new private plan exemption procedure and a significant jury verdict in
Updates: Massachusetts PFML Highlights Compliance Challenges Read More »
Last month’s IRS Revenue Procedure 2026-22 signalled another substantial hike in penalties for non-compliance with the ACA’s Employer Shared Responsibility Provisions [or Employer Mandate]. These penalties fell in TY 2025 but have risen substantially for the current TY 2026 [reporting in 2027]. See ACA-To-Z Blog: Time to Get Ahead of ACA Changes. They are now
ACA Penalties Set To Rise Again in TY27 Read More »
ACA Reporting & Compliance continues to evolve. New reporting requirements, changing penalty rates, and updated affordability thresholds are among the changes for TY 2026 [filing in 2027]. A number of government marketplace subsidies on healthcare are also set to expire, meaning more employees are likely to be considering employer plans. In short, now is the
Time To Get Ahead of ACA Changes for TY26 Read More »
As an active participant in LIMRA’s LDEx standards and technology committee, BENEFITSCAPE is helping shape the future of how data moves across the complex benefits ecosystem. To this end, BENEFITSCAPE Chief Technologist Max Ignatov will be taking part in a key panel discussion at the upcoming LIMRA Workplace Benefits Conference in Tampa, Fl [May 4-6].
BENEFITSCAPE Helping Drive the LDEx Revolution Read More »
Bipartisan legislation giving employees greater control over their employer contributions was introduced on April 15 by two members of the influential House Ways and Means Committee. Below we outline the opportunities unlocked by this proposed legislation — and by BeneSphere’s regtech-enabled orchestration of increasingly complex and dynamic benefits data. _________________________ What is the OPTIONS Act?
The OPTIONS Act & Employee-Directed Benefits Read More »
The AI revolution is fueling exciting and far-reaching business transformation — but also a good deal of hype, misunderstanding and even risk. Unlike other tehnology revolutions, many of the most avid early adopters of AI are the least expert. This can lead to organizations into misapplications, missed opportunities or, far worse, costly pitfalls and even unsafe
AI & RegTech for Employee Benefits [Part 1/3] Read More »
Paid interns can impact ACA Compliance for ALEs by adding to their full-time employee count. If hired to work at least 30 hours per week, paid interns are considered full-time employees for the ACA purposes. Misclassification of short-term employees, such as summer interns, can result in a failure to meet the employer’s requirement under the
ACA FACT CHECK: Should ALEs Offer Paid Interns Medical Coverage? Read More »
On December 23, 2024, President Biden signed new legislation affecting ACA reporting, namely, the Paperwork Burden Reduction Act [PBRA]. This act eases the burden on Applicable Large Employers [ALEs] to furnish their employees with a FORM 1095-B [self-insured employers] and/or FORM 1095-C [both self-insured and fully insured employers]. These are the forms reporting on offers
ACA FACT CHECK: What Are the Eased Demands for FORM 1095 Reporting? Read More »
If you read only one ACA Compliance & Reporting guide this year, make sure it’s this one! There are plenty of ACA guides out there. A lot contain errors, some are plain wrong, and more and more are loosely AI-generated. Most are confusing, to say the least. As if ACA governance, risk management & compliance
ACA TY24: IRS Changes, Tips, & Common Errors Read More »
When passed, the Affordable Care Act [ACA] required individuals to purchase & maintain qualifying health insurance coverage – or face a federal penalty. By reducing these penalties to zero in 2019, the federal Tax Cuts & Jobs Act [TCJA] effectively repealed the ACA individual mandate [as distinct from the ACA employer mandate]. Eleven US states
ACA TY24: State Mandates Guide & Checklist Read More »
The IRS ACA reporting DEADLINES for TY24 [filing in 2025] are as follows: MARCH 3, 2025: Deadline to furnish IRS FORMs 1095-B & C to individual eligible employees. MARCH 31, 2025: Deadline to e-file FORMs 1095-B & C and employer Form 1094-C plus all other required ACA documentation to the IRS. » NOTE: NO MORE
ACA TY24: IRS Deadlines & Penalties Read More »
The annual Dayforce Discover event starts in Vegas on Monday, November 11. BENEFITSCAPE will be participating this year as a Dayforce Consulting Partner for Benefits & Compliance. HCMs DELIVER BEST-IN-CLASS BEN ADMIN. Dayforce’s deep BENEFITSCAPE partnership reflects the industry-leading work BENEFITSCAPE has done pioneering ACA COMPLIANCE and other benefits administration for employers on the major HCMs.
Dayforce Strengthens BENEFITSCAPE Partnership Read More »
The IRS has published the TY2024 ACA Compliance & Reporting templates for employee FORM 1095-B and FORM 1095-C. The TY24 deadlines for distributing these forms to employees and for filing to the IRS are as follows: Forms 1095 Distribution Deadline: March 3, 2025 FORMS 1095 IRS E-Filing Deadline: March 31, 2025 FORMS 1095 & STATE-MANDATED
IRS Publishes Forms 1095-B & C for TY24 Read More »
The TY25 AFFORDABILITY THRESHOLD for calculating employer ACA compliance has been increased to 9.02% of the employee’s household income. This move by the IRS follows three years of decreases — from 9.83% in 2021 down to 8.39% for the current TY 2024. The increased threshold will take some of the budgetary pressure off the health cover
TY25: IRS Sets ACA Affordability at 9.02% Read More »
All Applicable Large Employers [ALEs] are subject to the ACA’s employer shared responsibility [ESR] provisions. They must report on ACA compliance to the IRS. Below is an explanation of how to calculate ALE status. If in any doubt, please contact BENEFITSCAPE, the leading specialist in ACA compliance. It provides an ALE calculation service and can answer any other
ACA TY24: ‘Is My Company an ALE?’ Read More »
This three-part series on AI & REGTECH has been created by the data scientists and benefits specialists at BENEFITSCAPE to provide a high-level framework for understanding how AI can support ben admin and compliance. In this final post, we sum up the key takeaways for employers from Parts 1 & 2. 1. AI comes with
AI & Regtech: The 7 Key Takeaways Read More »
The AI revolution is fueling far-reaching business transformation. This short series of ‘AI & REGTECH’ posts has been created by the data scientists and benefits specialists at BENEFITSCAPE to help employers understand better the emerging benefits of AI for ben admin and compliance. In Part 2 BENEFITSCAPE digs deeper into the different types of AI
AI & Regtech: A Framework for Employers [Part 2] Read More »
We all agree. AI is changing many, many business practices forever. The AI revolution, like the first .com wave, is fueling far-reaching business transformation — but also a fair amount of misguided and misleading hype. In itself, this hype is pretty harmless; no more than window dressing by marketing departments. But it can also lead employers
AI & Regtech: A Framework for Employers [Part 1] Read More »
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