ACA (Affordable Care Act) Compliance Checklist

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ACA (Affordable Care Act) Compliance Checklist

Company Name:

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Controlled Group / Common Ownership Details:

Applicable Large Employer (ALE) Determination

Calculate full-time equivalent (FTE) employees to determine ALE status

Add the number of full-time employees (averaging 30 or more hours per week or 130 hours per month) to the FTE count of part-time employees for each month of the prior calendar year, then average across 12 months to determine if the employer meets the 50 FTE threshold for ALE status.

Apply controlled group and affiliated service group aggregation rules

Identify all entities within the employer's controlled group, affiliated service group, or management company arrangement under IRC Sections 414(b), (c), (m), and (o), and aggregate their employees to determine ALE status, since all members of a controlled group are treated as a single employer.

Assess seasonal worker exception eligibility

Determine whether the employer can apply the seasonal worker exception, which allows exclusion of seasonal employees who work 120 or fewer days during the year, if the employer would not be an ALE but for the seasonal workforce.

Document ALE determination annually before the start of each plan year

Complete and retain the ALE determination calculation each year using prior-year data, including monthly headcounts, hours of service, and FTE calculations, to support the employer's filing position on Forms 1094-C and 1095-C.

Monitor monthly headcount for mid-year ALE status changes

Track full-time and FTE counts throughout the year to anticipate potential ALE status changes in the following year and prepare for employer shared responsibility obligations before they take effect.

Offer of Coverage & Affordability

Offer minimum essential coverage (MEC) to at least 95 percent of full-time employees

Ensure the employer offers minimum essential coverage to at least 95 percent of full-time employees (and their dependents) each month to avoid the IRC Section 4980H(a) penalty, which applies when any full-time employee obtains a premium tax credit on the Marketplace.

Ensure the plan provides minimum value (MV) covering at least 60 percent of costs

Verify that the employer-sponsored health plan provides minimum value by covering at least 60 percent of the total allowed costs of benefits expected to be incurred under the plan, using the HHS MV calculator, actuarial certification, or safe harbor checklists.

Test plan affordability using an IRS safe harbor method

Apply one of the three IRS affordability safe harbors (W-2 wages, rate of pay, or federal poverty level) to demonstrate that the employee's required contribution for self-only coverage does not exceed the applicable affordability percentage of the employee's household income.

Offer dependent coverage to all full-time employees' children up to age 26

Ensure the plan offers coverage to the dependent children of all full-time employees up to age 26, regardless of student status, marital status, or financial dependency, as required by ACA. Spousal coverage is not required but should be tracked for reporting.

Apply the correct measurement, administrative, and stability periods for variable-hour employees

For employees whose full-time status cannot be determined at the date of hire, use the look-back measurement method with a standard measurement period of 3 to 12 months, an administrative period of up to 90 days, and a stability period at least as long as the measurement period and no less than 6 months.

Ensure timely enrollment within the ACA waiting period limits

Confirm that eligible full-time employees are enrolled in coverage no later than the first day of the fourth full calendar month of employment, which is the maximum 90-day waiting period permitted under the ACA.

IRS Reporting: Forms 1094-C and 1095-C

Prepare Form 1095-C for each full-time employee

Complete IRS Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) for every individual who was a full-time employee for any month of the calendar year, including Part I (employee and employer information), Part II (offer and coverage codes), and Part III (if the employer is self-insured).

Apply the correct Line 14, 15, and 16 codes on Form 1095-C

Use the appropriate indicator codes on Lines 14 (offer of coverage), 15 (employee share of lowest-cost monthly premium for self-only MV coverage), and 16 (applicable safe harbor, Section 4980H relief, or other code) for each month of the calendar year.

Complete Form 1094-C as the transmittal form

Prepare the Form 1094-C transmittal form including employer identifying information, ALE member information, aggregated group indicator, the Section 4980H full-time employee count for each month, and certification of eligibility for relief provisions.

Furnish Form 1095-C to employees by the IRS deadline

Distribute Form 1095-C to all full-time employees by the annual furnishing deadline (typically January 31 of the following year, unless extended by IRS notice) either in paper or through electronic delivery if consent is obtained.

File Forms 1094-C and 1095-C with the IRS by the filing deadline

Submit the 1094-C transmittal and all 1095-C forms to the IRS by the annual filing deadline (typically February 28 for paper filing or March 31 for electronic filing), using the ACA Information Returns (AIR) system for electronic submission.

File electronically if submitting 250 or more Forms 1095-C

Comply with the IRS requirement to file electronically through the AIR system if the employer is submitting 250 or more information returns, and register with the IRS AIR program well in advance of the filing deadline.

Employer Shared Responsibility Penalties (4980H)

Monitor exposure to the Section 4980H(a) penalty for failure to offer coverage

Track whether the employer offers minimum essential coverage to at least 95 percent of full-time employees each month, since failing to meet this threshold while any full-time employee receives a Marketplace premium tax credit triggers the 4980H(a) penalty (approximately $2,900 per full-time employee annually, minus the first 30).

Monitor exposure to the Section 4980H(b) penalty for inadequate or unaffordable coverage

Assess whether the coverage offered meets minimum value and affordability requirements, since offering coverage that is unaffordable or does not provide minimum value while a full-time employee receives a Marketplace premium tax credit triggers the 4980H(b) penalty (approximately $4,350 per affected employee annually).

Respond to IRS Letter 226-J penalty assessments promptly

Upon receiving an IRS Letter 226-J proposing employer shared responsibility payments, review the enclosed Form 14764 and employee-level detail (ESRP Summary Table) within the 30-day response window, and submit corrections or contest the assessment with supporting documentation.

Maintain documentation to support penalty relief and safe harbor claims

Retain records supporting affordability safe harbor calculations, measurement period determinations, offers of coverage, and employee enrollment data for at least seven years to defend against potential ESRP assessments.

Plan Design, Compliance & Ongoing Monitoring

Comply with ACA preventive care coverage mandates at no cost-sharing

Ensure the health plan covers recommended preventive services (USPSTF A and B recommendations, ACIP immunizations, HRSA guidelines) without cost-sharing to participants when delivered by in-network providers.

Eliminate annual and lifetime dollar limits on essential health benefits

Verify that the group health plan does not impose annual or lifetime dollar limits on essential health benefits, as prohibited by the ACA, and that any limits on non-essential benefits are clearly documented.

Distribute the Summary of Benefits and Coverage (SBC) to participants

Provide the SBC in the DOL-prescribed format to plan participants and beneficiaries at enrollment, renewal, upon request, and when material modifications are made, within the required timeframes.

Report the cost of employer-sponsored coverage on Form W-2

Include the aggregate cost of employer-sponsored health coverage in Box 12 (Code DD) of each employee's Form W-2 for informational purposes, as required for employers that filed 250 or more W-2s in the prior year.

Review ACA compliance annually and adjust for regulatory updates

Conduct a comprehensive annual review of ACA compliance including ALE status, affordability testing, plan minimum value, reporting accuracy, and preventive care mandates, incorporating any new IRS or HHS guidance issued during the year.

What Is an ACA Compliance Checklist?

An ACA compliance checklist is a comprehensive guide that helps applicable large employers meet their obligations under the Affordable Care Act's employer shared responsibility provisions, also known as the employer mandate. It covers ALE determination, measurement and stability periods for variable-hour employees, minimum essential coverage and minimum value requirements, affordability safe harbors, and IRS reporting on Forms 1094-C and 1095-C. Following this checklist helps employers avoid substantial penalties under IRC Sections 4980H(a) and 4980H(b).

Why HR Teams Need This Checklist

ACA penalty assessments from the IRS have been increasing in both frequency and dollar amounts, with Section 4980H(a) penalties exceeding $2,000 per full-time employee per year and Section 4980H(b) penalties reaching over $3,000 per affected employee. The complexity of tracking variable-hour employees, calculating affordability, and accurately coding Forms 1095-C creates significant compliance risk for employers who lack a systematic process. This checklist provides a structured framework for meeting every ACA obligation on time and with accurate data.

Key Areas Covered in This Checklist

This checklist covers ALE determination using the 50 full-time equivalent employee threshold, full-time employee identification under the monthly measurement method and look-back measurement method, offers of minimum essential coverage to 95 percent of full-time employees, minimum value plan design requirements, affordability testing using the W-2, rate of pay, and federal poverty line safe harbors, Form 1094-C and 1095-C preparation and filing, employee statement distribution deadlines, and IRS Letter 226-J penalty response procedures.

How to Use This Free ACA Compliance Checklist

Use Hyring's free checklist generator to build an ACA compliance calendar customized to your organization's measurement periods, plan year, and workforce composition. The Brief view is suitable for employers with a straightforward full-time workforce, while the Detailed view addresses the complexities of variable-hour, seasonal, and part-time employee tracking. Download the checklist to coordinate with payroll, benefits, and your ACA reporting vendor throughout the year.

Frequently  Asked  Questions

What is an applicable large employer under the ACA?

An applicable large employer is an employer that employed an average of at least 50 full-time employees, including full-time equivalent employees, during the preceding calendar year. Full-time employees are those who work an average of 30 or more hours per week or 130 or more hours per month. Part-time employee hours are combined to calculate full-time equivalents by dividing total part-time hours by 120 per month. All members of a controlled group or affiliated service group are treated as a single employer for ALE determination.

What are the ACA employer mandate penalties?

The Section 4980H(a) penalty applies when an ALE fails to offer minimum essential coverage to at least 95 percent of its full-time employees and any full-time employee receives a premium tax credit. This penalty is calculated as a monthly amount per full-time employee minus the first 30. The Section 4980H(b) penalty applies when an ALE offers coverage that is either not affordable or does not provide minimum value, and a full-time employee receives a premium tax credit. Both penalties are adjusted annually for inflation.

What is the look-back measurement method?

The look-back measurement method allows employers to determine full-time employee status based on hours worked during a designated measurement period of 3 to 12 months, rather than month-by-month. Employees who average 30 or more hours per week during the measurement period are treated as full-time during the subsequent stability period, which must be at least as long as the measurement period and no shorter than six months. This method is particularly useful for tracking variable-hour, seasonal, and part-time employees.

What are the ACA affordability safe harbors?

The ACA provides three safe harbors for determining whether an offer of coverage is affordable: the W-2 safe harbor, the rate of pay safe harbor, and the federal poverty line safe harbor. Under each safe harbor, the employee's required contribution for self-only coverage cannot exceed a specified percentage of the applicable measure. Employers may use different safe harbors for different categories of employees. The affordability percentage is adjusted annually and is currently set at approximately 9.5 percent as adjusted for inflation.

What are Forms 1094-C and 1095-C?

Form 1094-C is the transmittal form that accompanies Forms 1095-C and provides aggregate employer-level information to the IRS, including ALE member status, total employee count, and coverage offer information by month. Form 1095-C is an individual employee statement that reports offers of health coverage, employee share of the lowest-cost self-only premium, and enrollment information for each month of the year. ALEs must furnish Form 1095-C to employees and file both forms with the IRS annually.

When are ACA reporting forms due?

Forms 1095-C must be furnished to employees by March 2 of the year following the reporting year, though the IRS has historically granted automatic extensions. Forms 1094-C and 1095-C must be filed with the IRS by February 28 if filing on paper or March 31 if filing electronically. Employers filing 250 or more forms must file electronically. The IRS has progressively lowered the electronic filing threshold, so employers should verify current requirements each year.

What should I do if I receive an IRS Letter 226-J?

Letter 226-J is the initial notice proposing employer shared responsibility penalties. Employers have 30 days from the date of the letter to respond using Form 14764. Review the attached Form 14765 listing each employee for whom a penalty is proposed, and identify any errors in the employee's reported information, coverage offers, or affordability. Respond with supporting documentation such as corrected 1095-C forms, plan documents, or employee enrollment records. Many proposed penalties are reduced or eliminated when employers provide accurate data.

How does the ACA define minimum essential coverage and minimum value?

Minimum essential coverage is any group health plan coverage, including self-insured and fully insured plans, that provides more than excepted benefits such as stand-alone dental or vision. Minimum value means the plan pays at least 60 percent of the total allowed costs for a standard population, as determined by the HHS Minimum Value Calculator or an actuarial analysis. A plan can meet minimum value even with relatively high deductibles, as long as the overall plan design covers at least 60 percent of expected costs.
Adithyan RKWritten by Adithyan RK
Surya N
Fact Checked by Surya N
Published on: 3 Mar 2026Last updated:
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