ACA's hidden health hazard for employers is that the law requires commonly or jointly owned businesses to count all employees together. An HR professional for one business may not know that their employer owns multiple businesses (since commonly owned businesses may not share resources like HR and benefits departments). So, asking about ALE status is an important question brokers and carriers can ask clients as a way to open the conversation about overall ACA compliance obligations.

Transparency in coverage

Signed into law in 2021, the No Surprises Act builds on ACA transparency rules by requiring group health plans to:

Post in-network negotiated rates, and out-of-network allowed amounts on a public-facing website.
Provide a web-based price comparison tool that allows individuals to estimate their cost-sharing responsibility for a specific item/service from a particular provider.
Annually report detailed information related to prescription drug costs, including most frequently dispersed brand-name drugs and most costly drugs.

Although fully insured plans will rely heavily on insurance carriers to make the information available, self-funded groups will bear the compliance obligations. It is critical for plan sponsors to work with carriers and third-party administrators to outline and clearly document who is responsible for each requirement.

Family and Medical Leave Act (FMLA)

FMLA, specifically designed to protect employees and their jobs when taking leave to care for themselves or a family member, exposes employers to compliance risk—especially as it pertains to maintaining employee health benefits.

Transparency in coverage

Family and Medical Leave Act (FMLA)

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Benefits check-up: 6 compliance issues affecting your clients' health

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