‘ACA’ and Transparency in Coverage

Affordable Care Act Employer Shared Responsibility:

Proposed Rules on Large Employer Reporting Requirements under ACA (IRC Section 6056)

The 6056 reporting requirement will be effective on Jan. 1, 2015, with the first returns due by the end of May 2016 (end of June if filed electronically).

What Employers are Subject to these Reporting Requirements?

The section 6056 reporting requirements apply to “applicable large employers” (known as “ALEs”). An ALE is an employer that employed, on average, at least 50 full-time employees in the prior calendar year. “Full-time” employees are those employed on average at least 30 hours per week or 130 hours per month.

IRC section 6056 requires “applicable large employers” to:

  1. File annual information returns with the IRS on the terms and conditions of their health care coverage for full-time employees during the prior year (by Feb. 28, or March 31 if filed electronically), and
  2. Furnish written statements by March 31 to each full-time employee whose information was reported to the IRS.

Transparency in Coverage:

On June 24, 2019, President Trump issued the “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.

Beginning July 1, 2022 all insurance companies and self insured groups must supply 'Machine Readable Files' (MRF's) on their websites.The MRF's provide in-network reimbursement rates and out of network allowed amounts between health plans and health care providersThe consumer will now have the opportunity to know, prior to accessing any type of health care, what the actual cost will be. These files must be accessible to the general public without a user name, password or other credentials, be free of charge, updated monthly and provide a 'place of service code' and provider tax ID number. Here are the public links for health insurance companies Machine Readable Files:

Aetna: Aetna.com

Anthem: https://www.anthem.com/machine-readable-file/search

Cigna: https://www.cigna.com/legal/compliance/machine-readable-files

CT-Care: Connecticare.com

Harvard: https://www.harvardpilgrim.org/public/machine-readable-files

United: transparency-in-coverage.uhc.com