Self-Insured Coverage
For self-insured health plans - or self-funded, as they’re sometimes called - the employer assumes financial risk for providing health care benefits to employees. In other words, a self-insured employer would pay claims, usually from an earmarked fund, as they’re incurred instead of a fixed premium to an insurance carrier.
Fully Insured Coverage
Fully-insured health plans, which are the more traditional options for employers, have the employer paying a fixed premium to the insurance carrier each year based on the number of employees enrolled. In this case, the insurance carrier pays any health care claims based on the coverage terms.
Minimum Essential Coverage (MEC)
To put it plainly, MEC is the least amount of health care coverage you need to offer (and what you need to have, if you’re an individual reading this) your employees to remain ACA compliant. You can visit the IRS’s site here for more information on what types of coverage meet MEC requirements.
Minimum Value (MV)
Your employer-sponsored plan must provide the minimum value (MV) of coverage as dictated by the Affordable Care Act. The IRS states that a plan meets MV requirements if “it covers at least 60% of the total allowed cost of benefits that are expected to be incurred under the plan.”
Spouse & Dependent(s) Coverage
Under new Affordable Care Act regulations, offers of coverage to employees by ALEs must now include offers to the employee’s spouse and dependent(s), if applicable. Under ACA guidelines, a dependent is an employee’s child (including legally adopted children) who has not reached the age of 26.
Need to get started on your ACA e-filing? You can do so now at ExpressIRSForms! We’ve also created ExpressACAForms, a full-service e-filing option for Forms 1094 and 1095.
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