Overview

Handshake over a business agreement document.

Our Partners in Compliance

Expert Resources. Trusted Support.

At MD Insurance Guide, we collaborate with a network of proven partners to help ensure your business stays compliant with today’s evolving health insurance regulations. Whether you're navigating ACA reporting, ERISA documentation, COBRA administration, or HIPAA privacy, we connect you with the right tools and experts.

✅ ACA Compliance Checklist for Employers (2025)

Stay on Track. Stay Compliant.

Use this checklist to ensure your business remains compliant with the Affordable Care Act (ACA) requirements throughout the year. This is especially important for Applicable Large Employers (ALEs) with 50+ full-time equivalent employees.

📅 Annual Requirements

  • Determine ALE Status
    Calculate your full-time equivalent employee count for the prior year to confirm if ACA rules apply.
  • Offer Affordable Minimum Essential Coverage
    Provide health coverage to at least 95% of full-time employees and their dependents.
  • Ensure Plans Meet Minimum Value Standards
    Health plans must cover at least 60% of total expected costs of benefits.

🧾 Forms and Reporting

  • File 1094-C With the IRS
    Employer summary form due annually (typically in Q1).
  • Distribute 1095-C to Employees
    Must be provided to all full-time employees (even those who declined coverage).
  • Keep Records of Offers and Waivers
    Document employee decisions and maintain signed waivers where applicable.

📋 Monthly Tracking

  • Track of Full-Time Employee Hours
  • Monitor Eligibility and Benefits Status
  • Record New Hires and Terminations
  • Update Plan Changes and Qualifying Events

⚠️ Common Compliance Risks

  • Failing to Offer Coverage to All Eligible Employees
  • Offering Unaffordable Plans (Per IRS Affordability Thresholds)
  • Missing Deadlines for Forms or Reporting
  • Not Updating Plan Documents to Reflect ACA Requirements

📘 ERISA Compliance Overview for Employers

(Employee Retirement Income Security Act)

ERISA is a federal law that sets minimum standards for most voluntarily established retirement and health plans in industry. It applies to all employer-sponsored group health plans, unless the employer is a government or church organization.

✅ Key ERISA Requirements for Health Plans

📄 Plan Documentation

  • Wrap Document or SPD (Summary Plan Description)
  • Employers must provide a written document that explains the plan’s benefits, rules, and participant rights. This can be a standalone Wrap Document or combined with insurance materials into a full SPD.
  • Plan Document vs. SPD
  • 1. The plan document governs the operation of the plan.
  • 2. The SPD must be distributed to all eligible employees within 90 days of coverage.

📊 Form 5500 Filing (for larger plans)

  • If your plan covers 100+ participants, you may be required to file Form 5500 annually with the Department of Labor (DOL).

📢 Participant Disclosure

Provide notices and disclosures such as:

  • HIPAA Notice of Privacy Practices
  • COBRA Rights
  • WHCRA (Women’s Health and Cancer Rights Act)
  • Michelle’s Law (student coverage)
  • Mental Health Parity Notice

🧾 Important Notes

Provide notices and disclosures such as:

  • ERISA does not require employers to offer health insurance—but if they do, it must be compliant.
  • Noncompliance can result in penalties from the DOL and IRS.
  • ERISA-compliant plan documents must be updated whenever a material change is made to the plan.

🛠 Need Help Creating a Wrap Document or SPD?

We can help! MD Insurance Guide partners with ERISA document experts to make sure your plan meets all federal requirements.

🧾 COBRA & HIPAA Quick Reference Guide

Know Your Responsibilities. Stay Compliant.

🚨 COBRA – Continuation of Health Coverage

What is COBRA?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows employees and their dependents to continue group health coverage for a limited time after certain qualifying events.

✅ Applies to

  • Employers With 20 or More Employees on More Than 50% of Typical Business Days
  • Group Health Plans (Medical, Dental, Vision, HRAs—not Life Insurance or Disability)

🔑 Qualifying Events Include

  • Termination of Employment (Voluntary or Involuntary)
  • Reduction in Hours
  • Divorce/legal Separation
  • Death of the Covered Employee
  • Dependent Child Aging Out of Coverage

🗓 Coverage Duration

  • Typically 18 Months (Can Extend to 36 Months in Some Cases)

📬 Employer Responsibilities

  • Notify Plan Administrator Within 30 Days of Qualifying Event
  • Send COBRA Election Notice Within 14 Days of Notification
  • Track Election Timelines and Premium Payments
  • Maintain documentation and communication logs

🔒 HIPAA – Privacy & Portability

What is HIPAA?

The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy and security of individuals’ health information and allows special enrollment rights for group plans.

🔑 Key Employer Responsibilities

  • Privacy Notice Distribution
  • Must distribute a Notice of Privacy Practices if your group health plan is self-funded.
  • Limit Use of PHI (Protected Health Information)
  • Employers can access PHI only for plan administration purposes, not employment-related decisions.
  • Appoint a HIPAA Privacy Officer (typically HR or benefits admin)
  • Responsible for safeguarding health information and responding to access requests.
  • Allow Special Enrollment
  • Employees may request mid-year enrollment due to:
    Marriage/divorce
    Birth/adoption
    Loss of other coverage
  • Protect ePHI
  • Ensure systems storing or transmitting PHI are secure and encrypted.

⚠️ Penalties for Noncompliance

  • COBRA: Up to $110/day per beneficiary for failure to provide notices
  • HIPAA: Fines range from $100 to $50,000 per violation, depending on severity and intent

✅ Best Practices

  • Use a COBRA Administrator or TPA to Manage Notices and Billing
  • Keep HIPAA Documentation Updated and Staff Trained Annually
  • Review Employee Communication Materials for Compliance Clarity