The ACA: What
Your Business
Needs to Know
Right Now!
A Seminar Hosted by Benefits Network, Inc.
Thursday, April 2, 2015
Agenda
 Welcome and Introductions
 Thanks to CTR for co-sponsoring
today’s program
 Brief Overview – Setting the Stage
– David Straight, President & CEO,
Benefits Network, Inc.
David Straight
President & CEO
30+ years in insurance and health
care industries, former head of
marketing & sales for two major
carriers, former hospital
administrator and consultant
 Today’s Keynote Presenters
– Dr. Kristin Kahle, CEO and Founder,
NavigateHCR
– Mike Patterson, CTR
 Q&A
2
Benefits Network Overview
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Leading employee benefits
consultant and full-service
insurance agency
Solid team of industry experts
Founded in 1998, affiliated with
NFP Benefits Partners in 2005
Serve more than 1,200 customers
Customer Satisfaction Survey
results indicate 100% satisfaction
rate, 86% highly satisfied
Compliance Certified
– All employees are healthcare reform
certified through the National
Association of Health Underwriters
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Excellent credentials, experience
and reputation
Relationships with insurance
carriers at the highest levels
Administer three major healthcare
coalitions (REHA, E.MAP and
COGCare) representing more
than 2,000 employers
Three-time #1 “Best Places to
Work” honoree
Routinely named to “Pittsburgh
100” list of fastest growing firms
3
Exciting News
 New venture with VCS Group in Somerset, PA
– Effective April 1, 2015
 Positions Benefits Network as one of the largest
employee benefits and insurance firms in Western PA
– Volume leaders with UPMC Health Plan and Highmark
– 30 employees
4
Benefits Network Comprehensive
Solutions and Expertise
Employee Benefits
Medical
Dental
Vision
Disability
Life/AD&D
Voluntary Plans
HSAs, HRAs
Wellness
Property & Casualty
Commercial Insurance
Workers’ Compensation
Compliance
PPACA (Reform)
COBRA
HIPAA
ERISA
Risk Management
Individual Market
Senior Products
Medicare Advantage
Medicare Supplements
Individual & Family
Human Resources
HR Consulting Services
Payroll Services
HRIS
Executive Benefits
Disability Income
Long Term Care
Executive Life
Key Life
Retirement Planning
401K
Pension
5
Client Centric Service Model
Employee
Benefits
Business
Insurance &
Workers
Comp.
Compliance
Client
NFP Benefits
Partners
Individual
and Senior
Products
International &
Nationwide
Resources
HR
Technology
and Payroll
Solutions
6
The Affordable Care Act
What’s New?
 Focus of today’s seminar
 Compliance has become the #1 concern among Human
Resources professionals and business owners
 Why?
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Increased frequency of DOL audits
Complexity of the Affordable Care Act (ACA)
Potential penalties at every turn (ACA and beyond)
Desire to obey the law
7
Common Misnomers
We’re not concerned…
What are the chances
of an audit?
I’m a small
employer, I don’t
have to worry
about fines or
penalties
We’re OK…
our carrier
handles
everything
for us
Our carrier
provides us with
our SPD
8
Common Concerns
What worries me is,
we don’t know what we
don’t know…
I can’t get my
arms around all of
this regulation
stuff…
I have a
business to
run; I can’t
make this a
priority!
It’s information
overload…
You send us great
information, but
who has time to
read it?
9
Compliance Consequences
“How am I supposed to think about
consequences before they happen?”
 DOL Audits are
happening at a record
pace and will continue
 Wide range of potential
penalties for various
notices and various
timeframes
 Impacts groups of all
sizes
Acronym Alert
DOL – Department of Labor
10
Compliance Penalty Categories
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Healthcare reform
COBRA
ERISA
FMLA
Taxation
Medicare/TRICARE
HIPAA Privacy
HIPAA Portability
Cafeteria Plans
Nondiscrimination
Other Federal Mandates
Types of Penalties
Company Fines
Personal Fines
Legal Action
Even Prison
Many employers are under the misconception that the “pay or play”
penalties for large employers are the only penalties to fear
11
Example: Notices
New Hire/Upon Eligibility Notices
Notice
Potential Penalties
Employer Chip Notice
Up to $100 per day per failure
HIPAA Notice of Special Enrollment Rights
$100 per failure up to $25,000
FMLA General Notice
Employers may be liable for compensation
or benefits lost, actual monetary losses, or
other equitable relief
Medicare Part D Creditable/Non-creditable
Disclosure Notice
No monetary penalties as of yet, but
employer may lose eligibility in Retiree
Drug Subsidy program
Exchange Notice
No specific penalty, but possibility of civil
action
Summary of Benefits and Coverage (SBC)
Penalty of up to $1,000 per failure; may
also target excise tax of $100 per day
under the IRC
12
Example: Notices
Notices Upon Enrollment
Notice
Potential Penalties
Summary of Benefits and Coverage (SBC)
Up to $110 per day; up to 10 years in
prison and a $100,000 fine for
individuals or a $500,000 fine for
companies
Summary of Material Modification (SMM)
Up to $110 per day; up to 10 years in
prison and a $100,000 fine for
individuals or a $500,000 fine for
companies
Initial COBRA Notice
$110 per day under ERISA; must self
report with IRS using Form 8928 and civil
penalty of $100 per day would be
assessed
13
Example: Notices
Ongoing/Annual Notices
Notice
Potential Penalties
Medicare Part D Creditable/Non-creditable
Disclosure Notice
No monetary penalties as of yet
Summary Annual Report (5500)
No specific civil penalties but possible criminal
penalties up to 10 years in prison and $100,000
fine
Employer Chip Notice
Up to $100 per day per failure
Notice of Availability of Reasonable Alternative
Standard for Wellness Program
Violation of HIPAA discrimination rules could lead
to employer having to repay surcharge amounts
Summary of Benefits and Coverage (SBC)
Penalty of up to $1,000 per failure
Women’s Health and Cancer Rights Act Annual
Notice
Legal action may be brought by the participant;
$110 per day penalty under ERISA
FMLA Eligibility Notice, FMLA Rights and
Responsibility Notice, FMLA Designation Notice
Employers may be liable for compensation or
benefits lost, actual monetary losses, or other
equitable relief
14
Coverage Termination Notices
Notice
Potential Penalties
COBRA Election Notice
Legal action by the participant (may be
liable for medical costs incurred); ERISA
$110 per day penalty; must self-report on
Form 8928 and pay $100 per day civil
penalty
FMLA Notice of Nonpayment of Premium
Employers may be liable for compensation
or benefits lost, actual monetary losses, or
other equitable relief
Notice of Rescission of Coverage
Must self-report violation on Form 8928
and $100 per day penalty
15
Compliance
16
ACA Compliance Solutions
NFP Benefits Partners
Compliance Team
 NFP is the 5th largest benefits
firm worldwide
 Legal support from ACA experts
– Comprised of ERISA attorneys, former
D.C. Beltway lawyers, and former DOL
auditors
– Provide valuable information, client
facing webinars, “Compliance Corner”
online newsletter, and legal advice
pertaining to the ACA
17
ACA Compliance Solutions
Compliance Dashboard
 Online dashboard designed
to help employers get and
stay compliant
– The leading web based
solution for helping employers
comply with the federal laws
that govern health & welfare
plans including the ACA
– This interactive portal gives
employers the information they
need when they need it
 Benefits Network is the
exclusive distributor in
Western PA
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ACA Compliance Solutions
HR360
 Comprehensive HR resource
 Healthcare reform newsfeed
 Plus, WrapDoc360
– New SPD wrap document application
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ACA Compliance Solutions
NavigateHCR
 Components
– Compliance Communication
• Employer Express – Push notices to employer
• Employee Express – Push notices direct to employees
• SPD/Wrap
– Exposure Analysis
• Look Back Analysis
• Full-Time Equivalents Calculations
– Measurement Analysis and Reporting
• Tracker – Monthly variable hour tracking
• Quarterly Tracker Reporting (6055 and 6056)
– ACA Consulting Services
 Benefits Network is the exclusive distributor in Western PA
20
Keynote Presenter
Dr. Kristin L. Kahle
 CEO and Founder of NavigateHCR
 Nationally recognized leader in Health Care
Reform
 Certified Health Care Reform Specialist (CHRS)
 Dissertation on Health Care Reform
 National speaker and educator
 Benefits strategist and broker with 20+ years of
experience
 Awarded: 2014 Most Influential Women in
Benefit Advising
As a chief compliance officer, Kristin has tackled the regulations and impact of the Patient
Protection and Affordable Care Act (PPACA) on behalf of employers both small and large
Utilizing this knowledge and strategic planning, inspired Kristin to develop a compliance
solution for advisors to deploy to their clients
Dr. Kristin Kahle, Ph.D.
Navigatehcr.com
@EasyHCR
21
Ball of Confusion
ACA Topics to Discuss
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2015 Compliance Checklist
Notices by Size
Ready, Set, Track
IRS Code: 6055/6056 - Reporting of Coverage
Fines, Fees and Filings - Oh my!
Are you an employer with 50 or more employees?
Get ready, your storm is coming!
 NavigateHCR as a solutions vendor!
2015 ACA Compliance Checklist
Many Changes for Employers
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Plan Design
Penalty Rules
Reporting of Coverage
Transition Relief
Affordability
Compliance
2015 ACA Compliance Checklist
Plan Design
It is important to understand plan status, limitations and reporting
requirements. Rules are constantly changing so you need to make
sure your groups understand what is required of them.
Do you know the status of these items?
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Grandfathered Status
Grandmothering Status
Cost Sharing Limits
FSA Contributions
Reinsurance Fees
HIPAA Certification
Plan Design - Part 1
Grandfathered Status
Cost Sharing Limits
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Maintain Grandfathered Status
for 2015
Lose Grandfathered Status for
2015
Keep Grandfathered Status communicate with employees:
Notice of Grandfathered Status
Grandmothering Status
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Offering Employees existing
plans and new ACA Plans
Communicate with employees if
accepting any ACA plans
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Out of Pocket maximum: $6,600
for individual and $13,200 family
2015 this can be divided across
multiple categories of benefits
If multiple service providers,
confirm that the plan will
coordinate or they will divide to not
exceed the maximum
HSA must be lower than the ACA
limit, $6,450 individual and
$12,900 family
Small group deductible limit no
longer applies to small groups
Plan Design - Part 2
FSA Contributions
HIPAA Certification
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Limit is $2,550
Does not apply to employer
contributions to the health FSA
Communicate to employees about
the limit as well as the $500 roll over
Reinsurance Fees
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First 3 years of the Exchange
operation (2014-2016)
Based on a national contribution rate
from HHS
HHS announced for 2015 rate of $44
per enrollee per year, about $3.67
per month
Communication to employee about
the reinsurance fees
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This information is released from HHS
Employer plan is considered a CHPs
(Controlling Health Plans)
Insurance carrier might step in and
provide, but employer is required to
give HIPAA certificates to employees
Acronym Alert
FSA – Flexible Spending Account
HHS – Department of Health & Human Services
CHPs – Controlling Health Plans
2015 ACA Compliance Checklist
Penalty Rules
Many companies have been contemplating their options regarding
offering benefits, deciding whether to “Pay or Play”.
Understanding exposure to penalties based on the new ACA
employee status definitions is crucial to understanding
your exposure to penalties.
Have YOU calculated the following numbers?
Do YOU understand potential fines based on the calculations?
 Are you an ALE?: Yes or No
 Do you have fewer than 100 full-time employees? Yes or No
Acronym Alert
ALE – Applicable Large Employer
Penalty Rules
 Employer Shared Responsibility - 1/1/2015
 Special Rule to determine:
• Employer may select a period of at least six consecutive calendar
months during the 2014 calendar year in order to count its full-time
employees
 Determine ALE status for 2015:
•
•
•
•
Determine which 6 consecutive calendar months to use in 2014
Calculate the number of full-time employees: 30 hours per week
Count the number of FTE’s, calculate hours and divide by 120
Add the number of full-time employees and FTE’s for each month (6
months)
• What is the number? Over 100 or Under 100?
2015 ACA Compliance Checklist
Reporting of Coverage
ACA has provided guidelines on information that must be
reported by employers for their groups
Understanding the requirements and timing reduces audit risk
and potential penalties for non-compliance
Do you understand the reporting requirements and
which one needs to be filed and when?
 1094-C 1095-C
 1094-B 1095-B
 Section 6056
 Section 6055
Reporting for 6055
1094-B
1095-B
 Filing for:
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Health insurance issuers
Self insured health plan sponsors
Government agencies
Any other entity that provides MEC
 1094-B: Transmittal of Health Coverage Information
Returns
 1095-B: Health Coverage
Acronym Alert
MEC – Minimum Essential Coverage
Reporting for 6056
1094-C
1095-C
 ALE’s eligible for a one year
delay must still report on
6056
 ALE must certify that it meets
the three eligibility conditions
 No plan change after 2/9/14 moving effective date
 1095-C: Employer-Provided
Health Insurance Offer and
Coverage
 1094-C: Transmittal of
Employer-Provided Health
Insurance Offer and Coverage
Information Returns
1. Limited workforce of at least 50
but fewer than 100
2. May not have a reduction in
workforce size or overall hours
of service
3. May not eliminate or materially
reduce the health coverage as
of 2/9/14-12/31/15
Reporting of Coverage
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General Method
Alternative Method
Section Code 6055
Section Code 6056
MEC Reporting
1094-B
1095-B
1094-C
1095-C
General Method
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The regulations provide that, as a general method, each ALE member may
satisfy the requirement to file a section 6056 return by filing:
 A Form 1094-C (transmittal) for each full-time employee
 A Form 1095-C (employee statement), or other forms the IRS may designate

ALE members that maintain self-insured plans also use Form 1095-C to
satisfy the reporting requirements under section 6055
 The Form 1095-C will have separate sections to allow ALE members that
sponsor self-insured group health plans to combine reporting to satisfy both the
section 6055 reporting requirements and the section 6056 reporting
requirements, as applicable, on a single return

Non-ALE members that sponsor self-insured plans will file Forms 1094-B and
1095-B to satisfy the reporting requirements under section 6055
 Non-ALE applies to employers not subject to the employer shared responsibility
provisions under section 4980H and therefore not subject to the information
reporting requirements under section 6056 - companies under 100 employees
Alternative Method
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Two alternative methods of reporting
under section 6056
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–
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–
Developed to minimize the cost and
administrative tasks for employers
Detail in Subsections A through D of
the preamble to the section 6056
regulations
Consistent with the statutory
requirements to file an information
return with the IRS and furnish an
employee statement to each full-time
employee
In certain situations, may permit
employers to provide less detailed
information than under the general
method for reporting
The alternative reporting methods are:
–
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Reporting Based on Certification of
Qualifying Offers
Option to Report Without Separate
Identification of Full-Time Employees if
Certain Conditions Related to Offers of
Coverage Are Satisfied (98 Percent
Offers)
The information provided to the IRS
and the employee pursuant to section
6056 is important for administering
section 4980H and the premium tax
credit
–
However, in some circumstances, only
some of the information required under
the general method is necessary
Section 6055/6056
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Final IRS regulations released March
2014 on reporting requirements
In 2016, employers will be required
to provide data to the IRS
– Must start collecting in 2015
MEC Reporting
–
–
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Any entity that provides Minimum
Essential Coverage is required to file
an annual return with information
about each individual for whom MEC
is provided
Includes health insurance issuers
and sponsors of self-insured health
plans
ALE Reporting
–
Each ALE (50+ employees) must file
an annual return that reports terms
and conditions of health care
provided to its full-time employees
during the calendar year

Filing to the IRS no later than 2/28/16
or 3/31/16 if electronically
–
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Each reporting entity will also be
required to furnish statements annually
to individuals who are provided MEC
on or before 1/31/16
For reporting it is 50+ full-time
employees including full-time
equivalents (FTEs), those employees
on average with at least 30 hours of
service per week
Self-Funded employers with fewer
than 50 full-time employees are also
required to report under Section 6055
MEC Reporting
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Reporting elements

Individuals not enrolled in coverage do not need to
be reported
The portion of the premium paid by an employer is
not needed to determine if an individual is covered
by MEC, and therefore not required
Specific dates not needed because MEC applies
month by month
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 Entity-basic information
 Employee-basic information
 Each covered individual including spouses and
dependents
 Whether coverage is offered through a Small Business
Health Options Program (SHOP)
 Combined reporting: Some ALEs may use single
combined form
1094-B
1095-B
1094-C
1095-C
1095-A
2015 ACA Compliance Checklist
Transition Relief
Employer Groups must determine if they qualify for Transition Relief which
delays complying with the Pay or Play rules until the start of their plan year or
calendar year. It is important to understand if they hit certain 2014
requirements that would have made them eligible for Transition Relief.
Do you understand when you are required to begin
offering benefits to full-time employees?
(Non-Calendar Year Plans)
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ALE - Yes or No
Plan Renewal Date
Pre-2015 Eligible Employers
Significant % All employees
Significant % Full-time employees
Plan Renewal Date as of 12/27/12
2015 ACA Compliance Checklist
Affordability
As part of ACA, employer groups must offer “affordable” benefits to all
eligible employees. Eligible employees are those that are FTEs (30
hours of service per week/130 hours in calendar month).
Which way are you defining full-time employees?
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Look-back measurement method?
Monthly measurement method?
Measurement period: counting hours of service
Administrative period: allowing time for enrollment and disenrollment
Stability period: coverage needs to be provided
Affordability
Which method are you using
to define minimum value?
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MV calculator provided by HHS
Design-based safe harbor
checklists - “Add in checklists”
Actuarial certification
Small Business Groups - Do you
offer one of these? Metal level or
“grandmothered?”
–
–
–
–
Affordability Rule
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9.56% or 9.5%
Safe Harbors (due to the fact the
employer does not know
“household income”)
– Employee’s W2
– Rate of Pay
– Federal Poverty level for single
individual
Bronze
Silver
Gold
Platinum
Acronym Alert
MV – Minimum Value
Variable Hour Flowchart
Measurement Period
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The IRS developed an optional
look-back measurement method
as an alternative to the monthly
measurement method

– Gives employers flexible and
workable options and greater
predictability for determining fulltime employee status

Varies depending on whether:
– The employees are ongoing or
new
– And whether new employees
are expected to work full-time or
are variable, seasonal or parttime employees

An employer has discretion in
deciding how long these periods will
last, subject to specified IRS
parameters
Employers can use the look-back
measurement method for new
variable hour employees, seasonal
employees and ongoing employees
However, if an employee is
expected to work full-time, the
employer must offer coverage to
that employee by the end of the first
three calendar months of
employment
Example of Measurement Periods
Preparing for 2015
Employers Need a Compliance Strategy



Arduous task which is difficult to
implement without the help of outside
resources
Risk of being audited for non-compliance
is increasing as regulations regarding
healthcare become more stringent
Partnering with the right compliance
provider is necessary so that you can
provide appropriate solutions
Employer Notices By Size
1-49
20-49
SPD
SMM and Summary Material Reduction in Covered
Services
Plan Documents
Health Insurance Exchange Notice
SBC
Notice of Modification
Disclosure of Grandfather Status
Notice of Patient Protections
Patient-Centered Outcomes Research (PCORI)
Notice of Special Enrollment Rights
Wellness Program Disclosure
Notice of Privacy Practices
WHCRA
Mental Health
CHIP
Michelle’s Law
Newborns and Mothers Protections
Medicare Part D
General Notice of COBRA
Notice of COBRA QE
COBRA Election Notice
Notice of Unavailability of COBRA
Notice of Underpayment of COBRA
Notice of Early Termination of COBRA Coverage
Employer Notices By Size
50+
50+
SPD
SMM and Summary Material Reduction in Covered
Services
Plan Documents
Health Insurance Exchange Notice
SBC
Notice of Modification
Disclosure of Grandfather Status
Notice of Patient Protections
Patient-Centered Outcomes Research (PCORI)
Notice of Special Enrollment Rights
Wellness Program Disclosure
Notice of Privacy Practices
WHCRA
Mental Health
CHIP
Michelle’s Law
Newborns and Mothers Protections
Medicare Part D
General Notice of COBRA
Notice of COBRA QE
COBRA Election Notice
Notice of Unavailability of COBRA
Notice of Underpayment of COBRA
Notice of Early Termination of COBRA Coverage
50+
FMLA Notice
Notice of FMLA Eligibility Rights
FMLA Designation Notice
100+
Form 5500
SAR
DOL Enforcement Statistics
Enforcement Statistics
 During the 2013 fiscal year, EBSA closed
3,677 civil investigations
 Of these, 72.8 percent resulted in monetary
results for employee benefit plans or other
corrective action
 EBSA filed 111 civil lawsuits and closed
320 criminal investigations
 EBSA's criminal investigations led to the
indictment of 88 individuals including plan
officials, corporate officers and service
providers for offenses related to
employee benefit plans
Acronym Alert
EBSA – Employee Benefits Security Administration
DOL Audit Triggers
A DOL audit can be triggered for a variety of reasons.
In most cases, the DOL investigator will not disclose to an employer
why its health plan was selected for audit.
Common triggers for a DOL audit include:

Participant complaints to the DOL about potential ERISA violations
 In 2013, according to a DOL audit summary, 775 new investigations were
opened as a result of participant complaints


Answers on the plan’s Form 5500
The DOL’s national enforcement priorities or projects, which target the
DOL’s resources on certain issues
 For example, the DOL’s Health Benefits Security Project focuses on making
sure health plans and health insurance issuers comply with the ACA’s
mandates
Disclosures on Request
Upon receipt of written request, must provide:


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


Plan Document
Current SPD
Insurance Contracts
Other instruments under which the plan is established or operated
Form 5500
Miscellaneous disclosures
NavigateHCR Compliance Solutions
Products Offered by NavigateHCR
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

Employer Express
Employee Express
SPD
Plan Document
Transition Relief Testing
Look Back Analysis/Measurement
Full-Time Equivalent Calculations
Tracker - Monthly
Tracker - Reporting Quarterly
ACA Hotline
ACA Consulting Services
Compliance
Communications
Exposure
Analytics
Functional
Data
ACA
Concierge Services
Employer Express and Employee Express
Notices and Requirements
All employers, regardless of employee count, are required to
provide employees with notices regarding their rights as they relate
to benefits throughout the year.
Some states are requiring employers to provide proof that notices
are delivered to employees throughout the year.
Examples of these include:
ERISA- 7 Parts of ERISA
 Part 1: Reporting and
Disclosure
 Part 4: Fiduciary
Responsibilities
 Part 5: Administration and
Enforcement
 Part 6: COBRA
 Part 7: Group Health
Requirements
Mandated Coverage
 QMCSO
 Dependents
 Mental Health
 Financial Accounting
Standards Board (FASB)
Requirement
 Statement 106
 Statement 112
 Statement 158
Other Federal Laws
 Medicare Part D etc.
 8 others
 Employment Law Affecting
Group Health Plans
 7 items
 Key State Regulations
Employer Express
Notice Delivery Email
 Monthly notices are
delivered directly to
employer email
inbox
 Employer is
responsible for
delivering to
employees
Employee Express
Notice Delivery Email
 Notices are delivered
directly to employee
email inboxes from
HCRToolbox
 Simple “click thru”
process to show email
receipt begins by
clicking the link at the
bottom of the email
Employee Express
Verification Record
1.
2.
Once employees click the
link in the email they are
taken to a verification
screen
Employees are asked to
“confirm” receipt of listed
notices
–
–
There are no logins or
passwords to remember
New links are generated
monthly
Employee Express
Monthly Report
On a monthly basis employers are given a report on
notices sent and employee verification of notices
SPD
What is an SPD?
 Summary Plan Description
 SPD is the basic ERISA disclosure document
 Different then a plan document
 Goes hand-in-hand with certificate booklets and evidence of coverage
 Must be written to be understood by the “average plan participant”
 Must be a complete and accurate summary of the plan
 Including benefits
 Rights and obligations under the plan
 Timing Requirement
• Automatically given within 90 days of being covered by a group health plan
• Within 30 days of request
• Every 5 years
SPD
Getting Compliant
 Template that needs to be filled out
completely
 NavigateHCR will do the input for you on
our software system
 NavigateHCR can send out existing SPD to
employees through Employee Express
 Clients can come to NavigateHCR for
questions on SPD
 Works well with Employer Direct and
Employee Direct
•
•
42 Notices in 2014
52 Notices in 2015, based on IRS and DOL
recommendations
Two types of SPD
 Wrap
 Evergreen
Tracker
Look Back Analysis







Analysis using 12 months
Analysis using 6 consecutive months
Start of Tracker
FTE Calculation included
Affordability Calculation included
Shows with our ACA Alerts
Color Coded Report




Red - Employees working 130+ hours
Yellow - Employees 129 -120 hours
Green - Enrolled on benefits
Blue - Ineligible
Tracker
Look Back Example
Tracker
Tracking Variable Hour Employees
 Tracker gives the following data monthly







Name
Description
Monthly Period Hours
Average Hours
Rate Type
Pay Rate
Affordability
 ACA Alerts




Red - Employees working 130+ hours “STOP”
Yellow - Employees 129-120 hours “CAUTION”
Green - Enrolled on benefits “GO”
Blue - Ineligible “ON ICE”
Tracker
Dashboard
Example of Tracker
Tracker Reporting
6055 and 6056
 Data gathered quarterly for IRS filings
 Need data by the following dates




January- March: April 15
April - June: July 15
July - September: October 15
October - December: January 5
 Description: IRS DRAFT!
 Signature ready for companies
 Payroll agnostic
 In Excel format
NavigateHCR ACA Hotline
Call For Help
 Available for questions regarding ACA compliance
 Expert advice and guidance
ACA Compliance Solutions
NavigateHCR
 Employer Express
– Pushes all notices to employer for distribution to employees
 Employee Express
– Pushes all notices direct to employees and verifies receipt
– Monthly reports sent to employer (notices sent/verification of notices)
 SPD/Wrap
– Create and maintain proper SPDs (to accompany certificates of
coverage)
– Can send SPD to employees through Employee Express
 Tracker – Monthly variable hour tracking
 Tracker Reporting - 6055 and 6056
 ACA Hotline
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NavigateHCR Packages
Package
Employee
Direct
1
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2
3
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4
5
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6
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7
8
Employer
Direct
l
Tracker
IRS
Reporting
SPD/Wrap
ACA
Hotline
Tracker
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Pricing and Implementation
Benefits Network
is the exclusive
distributor of
navigateHCR in
Western PA
 Varies by small group (2-49) and
large group (50+)
 Minimum one-time set up fee and
monthly flat price depending upon
the package selected
 Preferred pricing for Benefits
Network clients
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NavigateHCR Packages and Pricing
73
Questions
Followed by a 5 minute break…
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Payroll and HR Technology:
A Partner in Compliance
A Preferable Alternative to Payroll
Giants like ADP, Paychex and Ceridian
 CTR
– Strategic Partner to Benefits Network
– National reach, local headquarters
 State of the art technology
– Leading edge HR system solutions
 Mike Patterson, CTR
– Expert in his field
– 30+ years in payroll, time & attendance and HRIS business
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HUMAN CAPITAL MANAGEMENT
Family Owned and Operated Since 1964
Independent Advisory
Board
President & CEO
Sales & Marketing
Vice-President & COO
Business Development
& Product Management
Service Bureau
Software Engineering
Administration
Tax
Finance
Implementations
Human Resources
Support
Legal
Your Own Dedicated Team of Experts and Specialists
Single Core Platform with Integrated Ancillary Services
Streamline and Automate Tasks and Administration
ACA Affordable Care Act
INDIVIDUAL AND EMPLOYER PENALTIES
BUDGETED TO COVER COST OF SUBSIDIES
Individual Penalties
$46 Billion
Employer Penalties
$130 Billion
EMPLOYEE STATEMENT
EMPLOYER STATEMENT
BUILDING BLOCK 1: SETTING UP ACA STATUS
BUILDING BLOCK 2: BUILDING BENEFIT PLAN
BUILDING BLOCK 3: IDENTIFY PLANS WHICH PROVIDE
MINIMUM ESSENTIAL COVERAGE FOR ACA
• Enforces 90 day
waiting period
• Include the plan
on the Affordability
Report (if there are
multiple plans it will
pick the lowest
cost EE Only
option)
• Include this plan
information on
1095 and 1094
reports
• Will alert an
employee if they
waive coverage
BUILDING BLOCK 4: ATTACH ELIGIBILITY RULES TO BENEFIT PLAN
ONLINE OPEN ENROLLMENT
Employees who are eligible for benefits may enroll through
our online open enrollment tool. If an employee waives an
ACA Minimum Essential Coverage plan, the system will track
the waiver for reporting purposes and will also provide the
employee a warning message.
Self-Service and Workflow for Employees & Managers
PRODUCT FEATURES
DASHBOARD


The homepage is tailored to the security role, whether
Administrator, Manager, or Employee
The Administrators determines what information is shared, and
by who or what role
EMPLOYEE MESSAGES
Send out messages
to employees and
staff and post
important notices
Set start and end
dates for each
message
Great for use with
required
communications,
like ACA and ERISA
EMPLOYEE DATA AND SELF-SERVICE



Allow employees to view or update their own
data, controlled by your security set-up
View Pay History, W-2’s, Skills &
Certifications, Accruals, Benefits, and more
Performance and Compensation
Management
EMPLOYEE BENEFITS ENROLLMENT

Guide employees
through the benefit
enrollment process with
a self-service web-based
application.

Makes Enrollment Easy
for Everyone with
added custom content
such as video.

Engages Employees in
Reducing HR costs with
plan comparisons
features.

Open Enrollment, New
Hire, and Life Event
Employees choose their elections, coverage tiers,
costs, and contribution amounts using drop
down menus
CARRIER CONNECTIONS FOR BENEFITS


Automate benefit enrollment and updates through pre-built,
secure, and fully managed integration between your HR system
and your benefit insurance carriers and providers
Electronic file transfers eliminate manual updates on multiple
provider sites, reducing errors
PAYROLL SERVICES AND ENTRY







Full Tax Filing Services and W2 Processing
Process in all 50 States
Garnishment Services
GL Interfaces
401k Interface
Workers Compensation Payment Remittance
New Hire Reporting
APPLICANT TRACKING

Post jobs externally
and collect all
applicants in one
system

Track your applicants
by job and stage

Do real time analysis
and comparisons

Perfect for high
turnover, compliance
reporting
requirements, and
creating talent pools
ONBOARDING


Get ALL Onboarding paperwork complete in ONE intuitive, simple to use
process.
Configure your Employee Onboarding request to meet your needs. It includes
employee demographics, tax withholdings, employment eligibility verification,
payroll information, and Company/Location policies.
TIME & ATTENDANCE DASHBOARD

Administrators, Managers, and Employees find their day
to day required data all in one screen
TIMECARD

Our powerful time and attendance system manages
punches, absences, and schedules
REPORTING





Standard Reports
Powerful Ad-Hoc
Report Writer
Check Print Back
Quarterly and Year
End report writing
Security allows
Managers and
Employees to run
reports
TIME COLLECTION

Traditional Hardware
Connection Options
 Ethernet
 Serial/USB
 Wireless Ethernet
 Modem
 Cellular Modem
TIME COLLECTION

Traditional Hardware

Mobile Entry

Web Based Entry
IMPLEMENTATION PROCESS
IMPLEMENTATION METHODOLOGY
25%
75%
BLUEPRINT
ONBOARDING ACTIVITES
Phase Approval
Phase Approval
Phase Approval
Phase Approval
2.
Planning
3.
Data Gathering
4.
Configuration
1.1 Internal Planning
Meeting
2.1 Project Plan
3.1 Client business
policies
4.1 Establish Client
Shell
1.2 Introductory Client
Call
2.2 Data Extract Plan
3.2 EE level data
4.2 Configure Client
Business Rules
1.
Onboarding Initiation
1.3 Client Planning
Meeting(s)
2.3 Communication Plan
1.4 Internal
Requirements Review &
Approval
5.
Client Training and
Approval
5.1 Client Admin Training
5.2 Validate the data and
process
5.3 Client Approval to Go
Live
4.3 Add Employee data
3.3 Gather Check
History
Project Approval
4.4 Load Current Year
Check History and
Balance*
3.4 Prior Quarter Tax
Reports
6.
Go Live & Post
Implementation
6.1 Execute Transition
Plan
6.2 Post
Implementation
Review
6.3 Future Needs
Assessment
1.5 Client Requirements
Review &Approval
10%
15%
15%
35%
20%
5%
Summary of Phase Deliverables
•Intro call to Customer
•Project resources assigned
•High-level timelines
•Signed agreements
contract
•Data extract signoff
•Tax Reports received
•Project Plan
•Data extract plan
•Status Meetings
established
•Status Reporting
Milestone
•
Client Shell created
•
Employee
Demographic data
Loaded
Estimated Time
Commitment Per Project
Phase
•
•
•
PR Admin Training
HR Admin Training
Time Admin Training
•
Benefits Admin
Training
Estimated Time Commitment
Per Project Stage
•Transition Client to Support
•Client evaluation
•Future needs assessment
SAMPLE IMPLEMENTATION PROJECT PLAN
CUSTOMIZED TRAINING PPT’S
Questions and Wrap Up
Thank you!
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