The Employee Retirement Income Security Act (ERISA) and the Affordable Care Act (ACA): What Business Owners Should Know

ERISA and ACA Compliance

Navigating the complex landscape of employee benefits and health insurance mandates is a critical task for business owners. Two pivotal pieces of legislation in this domain are the Employee Retirement Income Security Act (ERISA) of 1974 and the Affordable Care Act (ACA) of 2010. Understanding the implications of these laws is essential for ensuring compliance, optimizing benefits offerings, and safeguarding against potential legal and financial penalties. This article explores the key aspects of ERISA and the ACA that business owners should be aware of.

The Employee Retirement Income Security Act (ERISA) of 1974

ERISA is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. ERISA mandates the provision of plan information to participants, establishes fiduciary responsibilities for those who manage and control plan assets, requires plans to establish a grievance and appeals process for participants, and gives participants the right to sue for benefits and breaches of fiduciary duty.

For business owners, compliance with ERISA involves several key considerations:

  • Plan Administration: ERISA requires the creation of a written plan that details the benefits and how they are financed, eligibility requirements, and how claims should be filed and processed.

  • Fiduciary Responsibility: Those who manage plan assets must do so with the utmost care and loyalty to the participants, including minimizing the risk of large losses and following the terms of the plan documents.

  • Reporting and Disclosure: Employers must provide participants with detailed information about plan features and funding, and regularly furnish information to the government.

The Affordable Care Act (ACA) of 2010

The ACA, often referred to as Obamacare, significantly expanded healthcare coverage and introduced numerous health insurance reforms with the goal of reducing healthcare costs and improving health insurance coverage. For employers, the ACA introduced several important requirements:

  • Employer Mandate: Employers with 50 or more full-time equivalent employees are required to offer health insurance that is affordable and provides minimum value to their full-time employees and their children up to age 26, or face penalties.
  • Reporting Requirements: Employers must report information about the coverage they offer to their employees and to the Internal Revenue Service (IRS).
  • Marketplace Notices: Employers must provide employees with a notice about the Health Insurance Marketplace and the possibilities of obtaining health insurance through it.
  • Navigating ERISA and the ACA

For business owners, navigating the requirements of ERISA and the ACA involves several steps:

  • Understanding Your Obligations: Familiarize yourself with the specifics of each law and how they apply to your business and employee benefits offerings.
  • Compliance: Ensure your benefit plans comply with ERISA standards and that you are meeting the ACA’s employer mandate and reporting requirements.
  • Consultation: Consider consulting with legal and financial advisors specializing in employee benefits to ensure compliance and to optimize your benefits strategy.

Next Steps

ERISA and the ACA represent significant federal efforts to regulate employee benefits and health insurance. For business owners, understanding these laws is crucial for compliance, for offering competitive benefits packages, and for avoiding penalties.

However, many of these laws can seem confusing which is why working with a benefits provider can help cut through compliance confusion.

Have questions or don’t know where to start? Just give me a call at 239-682-8567; it doesn’t cost you a thing to speak with me and get answers!

I’m also offering a FREE Employer Health/Benefits policy review to assist you in understanding what you currently have and if it meets your current needs.

I look forward to speaking with you soon!

Michele Sanchez
Michele Sanchez Insurance Agency

(239) 682-8567