Setting up benefits for your company means following federal and state regulations. This checklist can help you stay compliant and avoid penalties. If you manage benefits through Gusto, we handle most compliance requirements for you.
Here's a brief summary of ACA requirements.
ACA sets health care coverage for employers. Your company size and whether you’re a single employer or a group of related employers determine your requirements.
Large employers (50+ full-time equivalent employees): You need to provide affordable coverage to at least 95% of full-time employees and their dependents. You’ll also file Forms 1094-C and 1095-C annually. Coverage offered to eligible employees needs to meet other ACA regulations, like providing the minimum essential value. Learn more about employer responsibility from the Internal Revenue Service (IRS).
Small employers (fewer than 50 full-time equivalent employees): You can choose to offer benefits without filing or reporting requirements, but you need to follow ACA rules.
Gusto sells only ACA-compliant plans. When you manage benefits through Gusto, we help you stay compliant by:
Managing pre-tax payroll deductions and providing Section 125 documents
Preparing and filing Forms 1094-C and 1095-C for companies with 50+ full-time equivalent employees in the previous calendar year. We’ll also distribute Form 1095-Cs to employees.
Providing new employees with the ACA Marketplace Notice
Distributing the Summary of Benefits and Coverage (SBC) documents electronically during enrollment
Keeping you aligned with your current policies and insurance carrier requirements
Here's a brief summary of COBRA requirements.
COBRA is a federal program that allows employees to keep health insurance temporarily after they lose their jobs or their hours are reduced.
Employers with 20+ employees in the prior year: You need to offer COBRA as part of your group health plan.
Employers with fewer than 20 employees: Some states require you to offer continuation of coverage. Check your state requirements.
With Gusto-managed benefits, we help you manage continuation of coverage.
Here's a brief summary of DOL and CMS requirements.
You need to follow DOL employment and anti-discrimination laws. You also need to share information with participants that affects employee Medicare or Medicaid costs or eligibility.
With Gusto-managed benefits, we help you stay compliant with DOL and CMS requirements.
Here's a brief summary of ERISA requirements.
ERISA protects employees and their beneficiaries by requiring plan administrators to share plan information with participants.
With Gusto-managed benefits, we help you meet ERISA requirements.
Here's a brief summary of HIPAA requirements.
HIPAA requires proper handling of protected health information (PHI). Employers have limited access to employee health information and need to use it correctly to avoid fines or criminal charges.
With Gusto-managed benefits, we help you stay HIPAA compliant.
Here's a brief summary of IRS requirements.
When you offer pre-tax benefits, you need to follow IRS rules. These rules include meeting Section 125 requirements, like maintaining proper plan documents and following participation rules for group benefits.
Gusto does not provide tax or legal advice, but we help you comply with regulations.
If you have Gusto-managed benefits, we help you meet IRS compliance requirements.