What are the main ACA compliance requirements for employers?

Applicable Large Employers (ALEs) with 50+ full-time equivalent employees must: (1) offer minimum essential coverage to full-time employees and their dependents; (2) ensure coverage meets minimum value (pays at least 60% of covered costs) and affordability standards; (3) file annual IRS Forms 1094-C and 1095-C; and (4) provide employees with 1095-C forms by January 31 each year. Failure to comply can result in employer shared responsibility payments (ESRP) of $3,340–$5,010 per employee per year.

What is ERISA fiduciary duty for employer health plans?

Under ERISA, employers who sponsor health plans are plan fiduciaries and must act solely in the interest of plan participants and beneficiaries. This includes prudently selecting and monitoring service providers (carriers, TPAs, PBMs), ensuring plan fees are reasonable, maintaining proper plan documents (SPD, wrap plan), and filing Form 5500 annually for plans with 100+ participants. The Consolidated Appropriations Act (CAA) of 2021 strengthened fiduciary duties around PBM transparency.

What is the Mental Health Parity and Addiction Equity Act (MHPAEA) and what does it require?

MHPAEA requires that mental health and substance use disorder (MH/SUD) benefits be no more restrictive than medical/surgical benefits. Employers must conduct and document a Comparative Analysis of Non-Quantitative Treatment Limitations (NQTLs) — a written analysis showing that the processes, strategies, and factors used to apply limitations to MH/SUD benefits are comparable to those used for medical/surgical benefits. The CAA 2021 strengthened enforcement and requires employers to make this analysis available upon request.

Employer Benefits Compliance Checklist

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Employer Benefits Compliance Checklist

Track your compliance status across ACA, ERISA, HIPAA, COBRA, Mental Health Parity, Transparency in Coverage, and required annual notices.

Data reviewed: August 2026

Total Items

compliance requirements

Completed

0% complete

Critical Open

require immediate attention

High Priority Open

should be addressed soon

Overall Compliance Progress0%

File Forms 1094-C and 1095-CCritical

Applicable Large Employers must file annual ACA reporting with the IRS and furnish 1095-C to employees.

Deadline: March 31 (electronic)

Employer Shared Responsibility (ESR) complianceCritical

Verify that minimum essential coverage is offered to at least 95% of full-time employees and dependents.

Deadline: Ongoing

Minimum Value and Affordability testCritical

Confirm plan meets 60% minimum value threshold and affordability safe harbor for 2026.

Deadline: Annual renewal

Summary of Benefits and Coverage (SBC)High

Distribute SBC to all enrollees and applicants at open enrollment and upon request.

Deadline: Open enrollment

Summary Plan Description (SPD) currentCritical

Ensure SPD is up-to-date and distributed to all plan participants within 90 days of enrollment.

Deadline: Within 90 days of enrollment

Form 5500 filingCritical

File Form 5500 for plans with 100+ participants. Plans with fewer than 100 may qualify for simplified filing.

Deadline: July 31 (or Oct 15 with extension)

Wrap plan document in placeHigh

Maintain a wrap plan document that incorporates all welfare benefit plans into a single ERISA plan.

Deadline: Ongoing

Fiduciary duty documentationHigh

Document prudent process for plan decisions, vendor selection, and fee review.

Deadline: Ongoing

PHI firewall between plan and employerCritical

Ensure proper separation between health plan PHI and general HR functions. Business Associate Agreements in place.

Deadline: Ongoing

Notice of Privacy Practices distributedHigh

Distribute NPP to all plan participants at enrollment and upon material revision.

Deadline: Annual / at enrollment

HIPAA workforce training completedHigh

All employees with access to PHI must complete HIPAA privacy and security training.

Deadline: Annual

COBRA general notice within 90 daysCritical

Provide general COBRA notice to new enrollees within 90 days of coverage start.

Deadline: Within 90 days of enrollment

COBRA election notice within 14 days of qualifying eventCritical

Administer timely COBRA election notices following qualifying events.

Deadline: 14 days of qualifying event

MHPAEA comparative analysis documentedCritical

Document that mental health/substance use disorder benefits are not more restrictive than medical/surgical benefits.

Deadline: Available upon request

Non-Quantitative Treatment Limitation (NQTL) analysisCritical

Perform and document NQTL analysis for prior authorization, step therapy, and network adequacy.

Deadline: Ongoing

Machine-Readable Files (MRF) publishedCritical

Ensure in-network rates and out-of-network allowed amounts are published in required MRF format.

Deadline: Ongoing

Price comparison tool availableHigh

Provide internet-based price comparison tool for 500 shoppable services.

Deadline: Ongoing

Wellness program HIPAA/ADA complianceHigh

Ensure wellness incentives comply with HIPAA nondiscrimination rules and ADA reasonable accommodation requirements.

Deadline: Annual review

GINA compliance for wellness programsMedium

Confirm wellness program does not request genetic information or family medical history in exchange for incentives.

Deadline: Annual review

Women's Health and Cancer Rights Act noticeMedium

Provide annual WHCRA notice to plan participants.

Deadline: Annual

Newborns' and Mothers' Health Protection Act noticeMedium

Include NMHPA disclosure in plan documents and SPD.

Deadline: At enrollment

Medicare Part D creditable coverage noticeHigh

Provide annual notice to Medicare-eligible participants regarding prescription drug coverage credibility.

Deadline: Before Oct 15 annually

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Employer Benefits Compliance Checklist — ACA, ERISA, HIPAA & COBRA

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