Benefits compliance checklist

The Affordable Care Act (ACA) includes requirements for employers regarding health care coverage. The size and structure of your company determines your responsibility. If you have Gusto-managed benefits, click here to learn about how Gusto will help keep you compliant.

The “employer mandate” (also known as "employer responsibility) of the ACA requires employers with 50 or more full-time equivalent (FTE) employees to provide benefits to at least 95% of their full-time employees and their dependents, as well as file Forms 1094-C and 1095-C. Coverage offered to eligible employees must be considered affordable and meet other ACA regulations, such as providing the minimum essential value. Learn more about employer responsibility from the IRS.

Smaller businesses (less than 50 FTE) choosing to offer benefits to their employees are subject to many ACA rules, but there are no filing or reporting requirements.

Gusto only sells ACA-compliant plans— if you choose to manage your benefits through Gusto, here’s how we’ll help keep you compliant:

• Manage your pre-tax payroll deductions, and provide the Section 125 document that permits them. 
• Prepare filings 1094-C and 1095-C for companies with 50 or more FTE in the previous calendar year and distribute the 1095-C to employees.
• Provide newly hired employees with the ACA Marketplace Notice. 
• Electronically distribute the Summary of Benefits and Coverage (SBC) to your employees during health benefits enrollment. 
• Keep you aligned with your current policies and insurance carrier requirements.

COBRA is a federal program that provides temporary continuation of health insurance coverage when an employee’s job ends or hours are reduced. 

Employers with 20+ employees in the prior year are required to offer COBRA as part of their group health plan.

Depending on the state, employers with fewer than 20 employees may also be required to offer continuation coverage according to state-specific requirements.

If you have Gusto-managed benefits, click here to learn how we’ll help you navigate continuation of coverage.

Employers must stay compliant under DOL regulations connected to employment, anti-discrimination laws, etc. They must also disclose information to participants that may impact their cost or eligibility for Medicare.

If you have Gusto-managed benefits, click here to learn about how Gusto will help keep you compliant.

ERISA protects plan participants and their beneficiaries, and requires plan administrators to provide plan information to them.

If you have Gusto-managed benefits, click here to learn about how Gusto will help keep you compliant.

HIPAA requires people who work with protected health information (PHI) to do so properly or face potential fines or criminal prosecution. There are additional restrictions on what information employers can have access to and how that information can be utilized.

If you have Gusto-managed benefits, click here to learn about how Gusto will help keep you compliant.

Employers who offer pre-tax benefits must meet IRS requirements for providing benefits in this way. This includes meeting Section 125 requirements, like plan documents and proper management of plans in accordance with participation rules for group benefits.

Note: Gusto does not provide tax or legal advice, but we help you comply with required regulations.

If you have Gusto-managed benefits, click here to learn about how Gusto will help keep you compliant.