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)
- Employee Hours by Pay Period or Month (only needed for hourly employees)
- Enrollment Data (typically a file your Insurance Carrier provides)
(Please provide employer information for all commonly owned EINs.)
| Employer Information | Employer 1 | |
| ER_1 | Employer Legal 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 | |
| Questionnaire | Employer 1 | |
| Q_1 | Health Plan Funding: Describe and give details of all health plans offered [e.g.: Fully Insured, Self-Funded, Level-Funded, ICHRA, None, Other] during the given calendar year. | |
| Q_1.1 | Health Plan Funding: Were different plans offered based on employee classifications? And / Or did plan funding switch during the calendar year? If so, please describe in detail. | |
| Q_1.2 | Health Plan Renewal Month: What is the plan renewal month for all applicable plans? [e.g.: June effective date] If multiple plans were offered with different renewal months, please provide details. | |
| Q_2 | Health Plan Cost: What was the monthly employee portion in dollars for single (employee only) coverage of the least expensive health plan offered (January – December)? [e.g.: $89.76] | |
| Q_2.1 | Health Plan Cost: If the employee-only cost varies by plan year, salary, age, location, or any other categorization, please note here and/or submit needed documents. [e.g.: Age-Banded. Rate table submitted] | |
| Q_3 | Health Plan ACA Compliance: Did all applicable health plan(s) offered provide Minimum Essential (MEC) Coverage and / or Minimum Value (MV)? Please provide details by plan. | |
| Q_4 | Health Plan Offer: Were spouses and/or dependents eligible to enroll in a MEC & MV health plan(s) offered? | |
| Q_5 | Health Plan Offer: Are Part Time, non-medical eligible employees or other special employee types (e.g. Union, SCA, PRN, Piece Workers) included in the data provided? Please provide details on these employees types relevant to their ACA Reporting as applicable. | |
| Q_6 | Health Plan Affordability: Was the applicable least expensive health plan(s) offered affordable per ACA Guidelines? Please indicate the applicable safe harbor(s) if known. Include W-2 Box 1 wages and / or rate of pay amounts for employees if unknown. | |
| Q_7 | Health Plan Waiting Period: When would coverage become effective for newly eligible employees? (new hire, rehire, status changes) [e.g.: First of the month following 60 days] | |
| Q_8 | Health Plan Termination Rule: When was coverage terminated if an employee became ineligible? [e.g.: End of the month] | |
| Q_9 | Miscellaneous: Please provide any additional notes or guidance that may affect the employer’s ACA Reporting | |
| Q_10 | ACA Eligibility Calculations: Did you use the look-back or monthly method? Can you describe your measurement, admin, and stability periods? [e.g.: LBM. 12-1-12 / 12-2-12]. Please provide any results of any applicable eligibility determinations | |
| Q_11 | Data Collection Assistance: Can you provide details on all payroll, ben admin, HRIS and hours tracking systems that you have access to and can be used to provide data? | |
| The following Data Sets should be uploaded in Excel or CSV format | ||
| C_1 | Employee Census (Typically from payroll system) | Include any employee considered Full Time. Please ensure part time (ineligible) employees are clearly identifiable. |
| C_1.1 | Social Security Number | Unmasked, Full SSN is required |
| C_1.2 | First Name, Last Name, MI, Suffix | In Separate Columns or separated by a delimiter such as a comma between each element as shown |
| C_1.3 | Address 1, Address 2, City, State, Zip | In Separate Columns or separated by a delimiter such as a comma between each element as shown |
| C_1.4 | Dates of Employment | Hire Dates, Term Dates, rehire dates, eligibility status change dates as necessary |
| C_1.5 | Employer EIN | Required when ACAPrime is processing multiple EINs. |
| Optional Employee Census Fields (As applicable) | Please Include Any other data elements or employee attributes that may affect the ACA Reporting in Excel or CSV format : | |
| C_1.6 | Employee Class / Type | FT, PT, VHE, other. Salaried vs Hourly |
| C_1.7 | Health plan offer date | If this is not provided elsewhere |
| C_1.8 | Health plan waiver or accepted status | If this is not provided elsewhere |
| C_1.9 | Employee date of birth | Needed for age-banded premium contributions and ICHRA |
| H_1 | Hours Worked by Employee by Pay Period / Month (Typically from payroll system) (Optional) | Please include all hourly employees who received a W-2 form for the current (and prior reporting calendar years if available) in Excel or CSV format |
| H_1.1 | Social Security Number | Unmasked, Full SSN is required |
| H_1.2 | First Name, Last Name, MI, Suffix | In Separate Columns or separated by a delimiter such as a comma between each element as shown |
| H_1.3 | Pay Period Start & End dates or Month | Please avoid using check date only as this can impact accuracy |
| H_1.4 | Hours Worked during that pay period or month | Total hours worked for hourly employees during that month or pay period. This helps us determine each month an employee measured as FT or PT. Very helpful for those without an ACA measurement method. |
| H_1.5 | Employer EIN | Required when ACAPrime is processing multiple EINs. |
| H_1.6 | Box 1 W-2 wages, annualized salary or base hourly pay rate | Required when ACAPrime is calculating affordability. Lowest amount of the year needed. |
| EN_1 | Enrollment Data (Typically 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 in Excel or CSV format |
| EN_1.1 | Employee Social Security Number | Unmasked, Full SSN is required |
| EN_1.2 | First Name, Last Name, MI, Suffix | In Separate Columns or separated by a delimiter such as a comma between each element as shown. |
| EN_1.3 | Health plan coverage by month | Alternatively, we can take health insurance payroll deductions by employee SSN by pay period in lieu of an enrollment report. Reports can be split per plan year as applicable. |
| EN_1.4 | Employer EIN | Only required when ACAPrime is processing multiple EINs. |
| EN_1.5 | Include Dependents & Spouses: Full Name, SSN, DOB (if no SSN), relationship to employee, and months or dates of coverage | Only required for Self Funded, Level-Funded or ICHRA Groups. Include all Enrollment Data fields above for all covered individuals; Dependents, Retirees, etc. |
| EN_1.6 | COBRA Enrollees | Only required for Self Funded, Level-Funded or ICHRA Groups. Include all Enrollment Data fields above for all covered individuals. **May be housed in a separate system** |
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.