With the ACAPrime White Glove Service
We do everything for you – we just need the data:
Data Request Check List:
- ✓Employer Information (for each employer in aggregated ALEs)
- ✓Implementation Questionnaire
- ✓Employee Payroll Report(s) | AKA Census/Demographics
- ✓Enrollment Data
- ✓Employee Hours by Pay Period or Month (only needed for hourly employees)
(Please provide employer information for all commonly owned EINs.)
Employer Information
| Code | Field Description | Your Response |
|---|---|---|
| ER.1 | Employer Name | |
| ER.2 | DBA | |
| ER.3 | EIN | |
| ER.4 | Address Line 1 | |
| ER.5 | Address Line 2 | |
| ER.6 | City | |
| ER.7 | State | |
| ER.8 | Zip | |
| ER.9 | Phone | |
| ER.10 | Contact First Name | |
| ER.11 | Contact Last Name | |
| ER.12 | Contact Title | |
| ER.13 | Contact Email address (ACAPrime Communications) | |
| ER.14 | Industry Sector | |
| ER.15 | Approximate Total W-2 Employee Count | |
| ER.16 | Health Insurance carrier(s)? | |
| ER.17 | Health Insurance Broker Email Contact | |
| ER.18 | Can you provide details on all payroll, ben admin, HRIS and hours tracking systems that you have access to and can be used to provide data? We use this determine which scripts and processes to use in our analysis. |
Implementation Questionnaire
| Code | Question | Your Response |
|---|---|---|
| Q.1 | Health Plan Funding Type: Describe and give details of all health plans offered [e.g.: Fully Insured, Self-Funded, Level-Funded, ICHRA, None, Other] during the given calendar year. | |
| Q.1.1 | Health Plan Funding by Class: Were different plans offered based on employee classifications? And/Or did plan funding switch during the calendar year? If so, please describe in detail. | |
| Q.1.2 | Health Plan Renewal Month: What is the plan renewal month for all applicable plans? [e.g.: June effective date] If multiple plans were offered with different renewal months, please provide details. | |
| Q.2 | Health Plan Cost: What was the monthly employee portion in dollars for single (employee only) coverage of the least expensive health plan offered (January – December)? For non-calendar year plans, please provide applicable amounts per plan year as this cost typically changes. [e.g.: Jan-May: $106.78 // Jun-Dec $123.45]. | |
| Q.2.1 | Health Plan Cost Variation by Employee Class or Attribute: If the employee-only cost varies by plan year, salary, age, location, or any other categorization, please note here and/or submit needed documents. [e.g.: Age-Banded – Rate table submitted] | |
| Q.3 | Health Plan ACA Compliance: Did all applicable health plan(s) offered provide Minimum Essential (MEC) Coverage and/or Minimum Value (MV)? Please provide details by plan. | |
| Q.4 | Health Plan Offer: Were spouses and/or dependents eligible to enroll in a MEC & MV health plan(s) offered? | |
| Q.5 | Part-Time Employee Guidance: Are Part-Time (PT), Variable Hour (VH), or other non-medical eligible employees included in the data provided? If so, how are they indicated in the data? Please provide details on these employees types relevant to their ACA Reporting as applicable. If employees switched between PT and FT during the year, how is this indicated in the data provided? If all employees are not included in the data provided, please provide total employee counts by month as applicable. | |
| Q.6 | Health Plan Affordability: Was the least expensive health plan(s) offered [Ref. Q.2] affordable per ACA Guidelines? Please indicate the applicable safe harbor(s) if known. Include W-2 Box 1 wages and/or rate of pay amounts for employees if unknown. Skip this section if MEC & MV was not offered. | |
| Q.7 | Health Plan Waiting Period: When would coverage become effective for newly eligible employees? (new hire, rehire, status changes) [e.g.: First of the month following 60 days] Does this waiting period vary by employee class or otherwise? If so, please describe. | |
| Q.8 | Health Plan Termination Rule: When was coverage terminated if an employee became ineligible? [e.g.: End of the month] Does this rule vary by employee class or otherwise? If so, please describe. | |
| Q.9 | Hours Worked: If you are providing hours worked monthly, what is your payroll cycle? | |
| Q.10 | Special Employee Classes or Types: Are there any special employee classes or types [e.g. Union, SCA, PRN, Piece Workers, H1A] included in the data provided? If so, please provide details on their health plan eligibility, Full Time status, and how these employee classes are identified in the data provided. For non-employees, please identify self-employed individuals such as outside directors of a corporation, partners, or more than 2% shareholders of an S corporation. | |
| Q.11 | ACA Eligibility and Full Time Status Determination: Do you utilize the Look-Back Measurement Method (LBMM) for any employee classes? If so, please describe how it is applied including an example if available [e.g.: LBM. 12-1-12 / 12-2-12] and provide the results of any eligibility determinations—specifically, the applicable start and end dates of stability periods for employees who qualified. If you employ part-time or variable-hour employees but do not use LBMM, how are you determining whether they qualify as Full-Time under the ACA? Are you applying the Monthly Measurement Method (MMM), or do you use a different approach? If another method is used, please describe with examples if possible. | |
| Q.12 | Miscellaneous: Please provide any additional notes or guidance that may affect the employer’s ACA Reporting. |
Data Collection Requirements
Note: The following Data Sets should be uploaded in Excel or CSV format
Employee Payroll Report (AKA Census/Demographics)
Include any employee considered Full Time. Please ensure part time (ineligible) employees are clearly identifiable.
| Code | Data Field | Requirements/Notes |
|---|---|---|
| EE.1.1 | Social Security Number | Unmasked, Full SSN is required |
| EE.1.2 | First Name, Last Name, MI, Suffix | In Separate Columns or separated by a delimiter such as a comma between each element as shown |
| EE.1.3 | Employee Date of Birth | Needed for age-banded premium contributions and ICHRA |
| EE.1.4 | Address 1, Address 2, City, State, Zip | In Separate Columns or separated by a delimiter such as a comma between each element as shown |
| EE.1.5 | Dates of Employment | Hire Dates, Term Dates, rehire dates, eligibility status change dates as necessary |
| EE.1.6 | Medical Eligibility Class (FT or PT) | Full Time (FT), Part-Time (PT), Variable Hour (VH), ACA Eligible FT |
| EE.1.7 | Employee Class | e.g. Hourly vs Salaried or Staff / Management |
| EE.1.8 | Employer Identification Number (EIN) | Required when ACAPrime is processing multiple Employers (EIN/FEINs) |
| EE.1.9 | Health plan offer date | If this is not provided elsewhere |
| EE.1.10 | Health plan waiver or accepted status | If this is not provided elsewhere |
| EE.1.11 | Box 1 W-2 wages, annualized salary or base hourly pay rate | Required when ACAPrime is calculating affordability. [Ref. Q.6] |
| EE.1.12 | Any other data elements that may affect ACA coding | Please Include Any other data elements or employee attributes that may affect the ACA Reporting |
| EE.1.13 | Email Address | Used for Form 1095 distribution as applicable |
Enrollment Report (Medical or Health Only)
This can be split per plan year. Alternatively, we can take health insurance payroll deductions by employee (Including SSN) per pay period in lieu of an enrollment report in Excel or CSV format
| Code | Data Field | Requirements/Notes |
|---|---|---|
| EN.1 | Employee Social Security Number | Unmasked, Full SSN is required |
| EN.1.1 | First Name, Last Name, MI, Suffix | In Separate Columns or separated by a delimiter such as a comma between each element as shown. |
| EN.1.2 | Health plan coverage by month | Alternatively, we can take health insurance payroll deductions by employee SSN by pay period in lieu of an enrollment report. |
| EN.2 | Employer Identification Number (EIN) | Required when ACAPrime is processing multiple Employers (EIN/FEINs) |
| EN.3 | Dependents & Spouses Social Security Number or DOB | Only required for Self Funded, Level-Funded or ICHRA Groups. |
| EN.3.1 | Dependents & Spouses First Name, Last Name, MI, Suffix | Only required for Self Funded, Level-Funded or ICHRA Groups. |
| EN.3.2 | Dependents & Spouses Health plan coverage by month | Only required for Self Funded, Level-Funded or ICHRA Groups. |
| EN.4 | COBRA Enrollees *May be housed in a separate system* | Only required for Self Funded, Level-Funded or ICHRA Groups. Include all Enrollment Data fields above for all covered individuals. |
Hours Worked (Typically from payroll system – Optional)
Please include all hourly employees who received a W-2 form for the current (and prior reporting calendar years if available) in Excel or CSV format
| Code | Data Field | Requirements/Notes |
|---|---|---|
| HW.1.1 | Social Security Number | Unmasked, Full SSN is required |
| HW.1.2 | First Name, Last Name, MI, Suffix | In Separate Columns or separated by a delimiter such as a comma between each element as shown |
| HW.1.3 | Pay Period Start & End dates or Month | Please avoid using check date only as this can impact accuracy |
| HW.1.4 | Hours Worked during that pay period or month | Total hours worked for hourly employees during that month or pay period. This helps us determine each month an employee measured as FT or PT. |
| HW.1.5 | Employer Identification Number (EIN) | Required when ACAPrime is processing multiple Employers (EIN/FEINs) |
📧 Questions? Contact ACAPrime Support
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