With the ACAPrime White Glove Service, we do everything for you – we just need the data:
High Level we need:
- Employer Information (for each employer in aggerated ALEs)
- Implementation Questionnaire
- Employee Census (typically from payroll system)
- Enrollment Report (typically a file your Insurance Carrier provides)
(Please provide employer information for all commonly owned EINs.)
| Employer Information | Employer 1 | Notes | |
| ER.1 | Employer Name | ||
| ER.2 | EIN | ||
| ER.3 | Address Line 1 | ||
| ER.4 | Address Line 2 | ||
| ER.5 | City | ||
| ER.6 | State | ||
| ER.7 | Zip | ||
| ER.8 | Phone # | ||
| ER.9 | Contact First Name | ||
| ER.10 | Contact Last Name | ||
| ER.11 | Contact Title | ||
| ER.12 | Contact Email (ACAPrime Communications) | ||
| ER.13 | Industry Sector | ||
| ER.14 | Approximate Total Employee Count | ||
| ER.15 | Health Insurance carrier(s)? | ||
| ER.16 | Health Insurance Broker Email Contact | ||
| Implementation Questionnaire | Employer 1 | Notes | |
| 1 | Health Plan Funding (Full / Self / Level / None) – January Through December 2023 | ||
| 1.1 | Do You Have Different Plan Funding Based On Employee Classifications? | ||
| 1.2 | Did You Switch Plan Funding During The Calendar Year? | ||
| 1.3 | If You Answered “yes” To Either Question Above (1.1, 1.2), Please Provide All Relevant Details. | ||
| 1.4 | What Is Your Plan Renewal Month? (please add notes if multiple plans offered have different renewal months) | ||
| 2 | What was the employee portion (in dollars not percentage) for the least expensive employee only qualifying insurance plan on a monthly basis? | ||
| 2.1 | If The Employee Cost Varies By Salary, Age Bands, Employee Groups, Plan Year, Location, Etc., Please Provide All Relevant Details | ||
| 3 | Did Your Health Plan Provide Minimum Essential (MEC) Coverage And Minimum Value (MV)? Was it a MEC Only Plan? Did you provide multiple plans by Employee Class? Please provide details as necessary. | ||
| 4 | Did You Offer Insurance To Spouses And Dependents As Well? | ||
| 5 | Are Part Time, Non-medical Eligible Employees Included In Your Employee Census And Clearly Identifiable? | ||
| 6 | For Those That Waived, Was The Offer Of Your Lowest Cost Health Insurance Affordable for each plan offered? | ||
| 7 | Health Plan Termination Rule. (i.e. Did you offer insurance through the end of month if an employee terminated during the middle of the month? If not, does insurance end on date of termination?) | ||
| 8 | What is the waiting period or date of Insurance offer Rule we should use to determine offer date (i.e. 1st day of month after 60 days) | ||
| 9 | Are You Able To Provide Hours Worked For All Employees? | ||
| 10 | Are COBRA Enrollees Included In The Data Provided? (Self Funded or Level-Funded Groups only) | ||
| 11 | Do You Employ Unionized Workers? | ||
| 12 | Do You Have Other Special Employee Types? (e.g. SCA, PRN, Piece Workers) | ||
| Supplemental Information: | Employer 1 | Notes | |
| Please provide any and all additional notes and guidance that may affect the employer’s ACA Reporting | |||
| Did you use the look back measurement method? Do you have data on this? Can you describe your measurement, admin, and stability periods? (You can use column G – Notes / Flex) | |||
| Can you provide details on all payroll, ben admin, HRIS, hours tracking systems that you have access to and can be used to provide data? | |||
| Data Collection Checklist | |||
| The following Data Sets should be uploaded in Excel or CSV format | |||
| Element | Description | ||
| Employee Census (Typically from payroll system) | Any employee considered Full Time. Please ensure Part time employees are clearly identifiable. | ||
| SSN | Unmasked, Full SSN | ||
| First Name, Last Name, MI, Suffix | In Separate Columns | ||
| Address 1, Address 2, City, State, Zip | In Separate Columns | ||
| Employer EIN | If filing multiple EINs | ||
| Dates of Employment | Hire Dates, Term Dates, rehire dates as necessary | ||
| Optional Census Fields – As applicable | The following report elements are optional and can be provided as applicable to ACA Reporting. | ||
| Please Include Any other data elements or employee attributes that may affect the ACA Reporting | |||
| Common Additional Data Elements Include: | |||
| Employee Class / Type (FT, PT, VHE, other) or (Salaried vs Hourly) | |||
| Insurance Offer Date | If this is not provided elsewhere | ||
| Waived or Accepted Offer of Insurance | |||
| Date of Birth | |||
| Box 1 W2 Wages for the year, and/or Annualized Salary, and/or Base Hourly Pay Rate | Lowest for year | ||
| Hours by month or pay period | Typically only needed for variable hour or part time employees | ||
| Enrollment Data (Preferred source is from health insurance carrier) | This can be split per plan year. Alternatively, we can take health insurance payroll deductions by employee SSN by pay period in lieu of an enrollment report. | ||
| SSN | Unmasked, Full SSN | ||
| First Name, Last Name, MI, Suffix | In Separate Columns | ||
| Coverage by Month | Dates of Coverage are acceptable as well | ||
| Employer EIN | If filing multiple EINs | ||
| Dependent and Spouse Full Name, SSN, DOB (if no SSN), and months or dates of coverage | Only required for Self Funded or Level-Funded Groups | ||
| COBRA Enrollees | Only required for Self Funded or Level-Funded Groups | ||
Your data & documents can be uploaded and downloaded from our Secure Cloud Service. Click the login on the upper right of this web page to login. Or reach out to us at info@acaprime.com to set up a new login.