We help employers comply with the ACA

If you are one of the many employers who are still overwhelmed by ACA compliance, Lowery Benefits can help.
As benefit experts, we are required to stay updated on this complex law and have specifically designed our services to help clients in the following areas of the ACA they struggle most with.  

Annual Reporting

Accurately compile benefits data and timely IRS filings (1094-1095-C & others)


Plan design to meet ACA requirements, affordability threshold testing

ACA Eligibility

Eligibility tracking to ensure employees who are eligible for coverage are offered coverage

Marketplace Notices

Evaluate penalty potential for employees receiving subsidies from the Marketplace

Highlights of the Affordable Care Act

Avoid Tax Penalties

Employers: Businesses with 50+ full time equivalent employees must offer a Minimum Essential Coverage (MEC) plan otherwise they could incur a penalty of $2,700 (in 2021) times the number of full time employees (minus the first 30 employees). A $4,060 (in 2021) penalty can also occur if an employee goes to the exchange and gets a subsidy (tax premium credit). Penalties can increase each year by the growth in insurance premiums.

Individuals: Currently, most individuals are not subject to a tax penalty and are not required to purchase health insurance. The ACA “shared responsibility payment” and the individual mandate has been eliminated by the Trump Administration for 2019 and beyond. However, some states have established their own individual mandates, so you still may be subject to your specific state tax penalty, if any.  Check with a Lowery Benefit expert for more information.

Underwriting Rules of the ACA

Medical underwriting used to determine risk and insurance premiums, particularly in the individual insurance market prior to the ACA.   Under new rules of the ACA, most medical underwriting is no longer allowed, although some premiums may vary based on age and tobacco use.  

-Insurance companies can not increase rates or deny coverage because of a pre-existing condition.
-Your dependents can remain on you policy until they turn 26 years old.
-Insurance companies can not consider gender when setting rates.
-Employer renewals must be based on the same rates as new business.
-The waiting period for employer benefits should not exceed 90 days.

Essential Benefits of the ACA

Employer paid benefits must comply with the “Essential Benefits” of ACA. Specifically, employers must cover 60% of the costs of the following essential benefits. Individual policies from the marketplace also contain these benefits.

-Ambulatory patient services
-Emergency services
-Maternity and newborn care
-Prescription Drugs
-Mental health and Substance —Abuse disorder services
-Rehabilitative and habilitative services and devices
-Pediatric services, including oral and vision care
-Preventive and wellness services, and chronic disease management