Everything below goes into the report as it reads here. Nothing is scored until you generate it.
56
asked
56
answered
4
not sure, to verify
0
still open
Not asked, and why
∅
ACA, 1 question (Q7)
Employer was indicated as an ALE on question 2 of the ACA section of the assessment. To view hidden question(s), please change your answer to question 2 in the ACA section of the assessment.
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Medicare / MSP Rules, 2 questions (Q3, Q4)
Number of full-time employees on the intake questionairre was below the threshold of asking these questions Earlier answers are kept.
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HIPAA, 5 questions (Q2, Q3, Q6, Q7, Q8)
Question 1 in this section was indicated as ”Yes - employer is self-insured but hands-off (level-funded with no FSA or HRA and no claims analytics drill-down)” To view hidden questions, please change the answer to question 1 in the HIPAA section of the assessment.
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Non-Discrimination Rules, 2 questions (Q4, Q5)
FSA coverage checkbox was not checked on the intake questionnaire.
This block is what makes the report defensible: it says which questions were not asked, and why.
ERISA/5500
9 of 9
QQuestionAnswerChange
Q1Select all of the documents currently on file for the employer:ERISA wrap document and Summary Plan Description (SPD)Change
Q2What is the ERISA plan year listed on the ERISA wrap document?ERISA plan year date:Change
Q3When the wrap was first adopted, was the wrap distributed to plan participants within 120 days?NoChange
Q4Ongoing: Is the Wrap SPD provided to new plan participants within 90 days of plan enrollment?NoChange
Q5Does the employer have 100 or more participants (includes active employees, retirees or COBRA QBs) enrolled on any of their current benefit plans as of the first day of the plan year, including employer-paid life or disability?YesChange
Q6Has the employer filed a Form 5500 with the Department of Labor for the health and welfare benefits 7 months following the end of the plan year (or up to 2.5 months on extension)?YesChange
Q7Does the employer distribute the Summary Annual Report (SAR) to all plan participants within 9 months of the end of the plan year or within 2 months of filing Form 5500 on extension?YesChange
Q8Are ERISA recordkeeping rules followed, requiring plan sponsors to maintain ERISA documents for not less than 6 years after the filing date of a Form 5500 (or the date it would be filed but for an exemption)?YesChange
Q9Is the electronic disclosure safe harbor being met for electronic delivery of ERISA documents and required notices?YesChange
ACA
8 of 8
QQuestionAnswerChange
Q1Does the employer sponsor a Grandfathered health plan?YesChange
Q2Is the employer considered an "Applicable large Employer" (ALE) under the ACA? (ALE = Generally 50+ FT employees plus FT equivalents in prior calendar year)YesChange
Q3Does the ALE track variable hour employees in a look-back measurement period?YesChange
Q4Does the ALE offer minimum essential coverage (MEC) to at least 95% of all FT eligible employees and their dependents to age 26?YesChange
Q5Which of the 3 affordability safe harbors does the ALE use?Rate of PayChange
Q6Does the ALE complete Section 6056 ACA reporting (1095/1094-C forms)?YesChange
Q8Does the employer remit the PCORI fee each year to the IRS on Form 720 for self-insured plans (including level-funded & HRAs)?YesChange
Q9Are the number of actual days an employee has to wait in the waiting period 90 days or less for major medical coverage?YesChange
Medicare / MSP Rules
2 of 2
QQuestionAnswerChange
Q1Is the employer providing Medicare Part D Creditable Coverage Notices to participants annually by 10/15?YesChange
Q2Is the employer submitting the online Creditable Coverage Disclosure to CMS 60 days after the start of the plan year?YesChange
COBRA
5 of 5
QQuestionAnswerChange
Q1What coverage continuation rules apply to this employer? States with state continuation laws (“mini-COBRA”): AZ, AR, CA, CO, CT, DE, D.C., FL, GA, HI, IL, IA, KS, KY, LA, ME, MD, MA, MN, MS, MO, NE, NV, NG, NJ, NM, NY, NC, ND, OH, OK, IR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY
COBRA
State Continuation (mini-COBRA)
COBRA and additional post-COBRA state continuation rules
Q2Has the employer adopted a Section 125 Cafeteria Plan Document Premium Only Plan (POP) with required contents/language?YesChange
Q3Is the employer allowing prospective mid-year plan changes only upon the appropriate qualifying life events?NoChange
Q4Are self-employed owners allowed to participate pre-tax through the cafeteria plan, including Health FSA?NoChange
HIPAA
3 of 3
QQuestionAnswerChange
Q1Does the employer have any exposure to Protected Health Information (PHI)?Yes - employer is self-insured but hands-off (level-funded with no FSA or HRA and no claims analytics drill-down)Change
Q4Does the employer have written documented policies and procedures for the handling of PHI?NoChange
Q5Is the employer properly distributing the HIPAA privacy notice?YesChange
CAA
7 of 7
QQuestionAnswerChange
Q1If self or level funded, has the employer performed their Mental Health Parity QTL & NQTL comparative analysis?YesChange
Q2If self or level funded, Has the TPA provided 2 separate Machine-Readable Files of required healthcare costs?NoChange
Q3If self or level funded, does the employer or their TPA provide an online, self-service, searchable tool that provides information on the cost-share for items and services covered by the health plan?YesChange
Q4If self or level funded, has the employer submitted the required Prescription Drug Data Collection (RxDC) reporting to CMS, or are plans in place to complete annually by the June 1st deadline?YesChange
Q5Does the employer apply the in-network cost share when a participant receives out-of-network emergency services, some non-emergency services at an in-network facility, and/or air ambulance? (i.e.- no balance billing)?NoChange
Q6Is the employer providing participants with the No Surprises Act notice as required?Not SureChange
Q7If self or level funded, who will submit the online Gag Clause Prohibition Compliance Attestation (GCPCA) annually by 12/31?EmployerChange
Non-Discrimination Rules
5 of 5
QQuestionAnswerChange
Q1If the benefits offered are not the same for all employees, is the employer using valid business classifications per the Section 125 rules (e.g., salary vs hourly, managers vs staff, geographic location, division, etc.)?YesChange
Q2Is the employer (or a third party) completing the required Section 125 nondiscrimination testing at least annually?YesChange
Q3(If Self-Funded or HRA) has the employer (or a third party) completed the required Section 105h nondiscrimination testing?NoChange
Q6Has the employer added the appropriate “imputed income” to employees who receive in excess of $50,000 of employer-provided group term life?YesChange
Q7Has the employer added the appropriate “imputed income” to employees who cover their domestic partners?NoChange
Notices/ Disclosures
2 of 2
QQuestionAnswerChange
Q1Is the employer providing the appropriate notices prior to enrollment? Including: • Summary of Benefits & Coverage (SBC) • HIPAA special enrollments • Women's Health and Cancer Rights (WHCRA) annual notice • Medicare Part D Creditable Coverage Notice • Marketplace Exchange Notice • HIPAA Privacy notice • Children's Health Insurance Program (CHIP) notice • Wellness Program HIPAA/EEOC notice? These notices are typically placed either in the enrollment guide or as a separate legal notices packet.YesChange
Q2Is the employer including the proper information in their wrap plan document/SPD? (Michelle’s law, Internal Appeals and External Review Procedures, WHCRA notice, Mothers & Newborns notice, Patient Protection Act Notice, Notice of Privacy Practice)YesChange
State Requirements
7 of 7
QQuestionAnswerChange
Q1Is the employer providing any mandatory temporary disability benefits (CA, HI, NJ, NY, RI)?Not SureChange
Q2Is the employer complying with any state required reporting for health coverage and State Individual Mandates (CA, MA, NJ, RI, VT, DC)?YesChange
Q3Does the employer offer unmarried domestic partners the same coverage offered to spouses, as required by state law (CA, CO, HI, IL, ME, NJ, OR, VT, WA)?Not SureChange
Q4Is the employer providing any state-specific health insurance notices, including the Illinois EHB comparison for employees residing in IL?NoChange
Q5Does the employer provide commuter benefits to employees in certain cities/states? (New York City, Philadelphia, Los Angeles, Berkeley, Richmond CA, SF Bay Area, Seattle, Washington D.C., and State of New Jersey)YesChange
Q6Is the employer maintaining the employees coverage for the duration of any applicable state or local leave mandates? RS Resource Tool ; XpertHR ToolNoChange
Q7Is the employer complying with specific health care spending requirements (San Francisco Health Care Security Ordinance; Hawaii Prepaid Health Care Act)?Not SureChange
ICHRA
4 of 4
QQuestionAnswerChange
Q1If offering an ICHRA, Is the employer complying with the employee notice requirements at least 90-days prior to the plan effective date?YesChange
Q2If offering ICHRA, is the employer offering an opportunity to opt out of ICHRA coverage at least annually?NoChange
Q3If offering ICHRA, is the employer complying with the allowable classification and minimum size classification rules?YesChange
Q4If offering ICHRA, is the employer complying with the requirement that each employee provide proof of individual medical coverage or Medicare coverage enrollment?YesChange