Manage Benefits Administration ACA Medical Offers and Self-Insured Enrollee Data

Manage Benefits Administration ACA Medical Offers and Self-Insured Enrollee Data

Benefits Administration PPACA Overview

Generally, employers with 50 or more full-time employees must report Forms 1095-C and 1094-C to the IRS.

Form 1095-C reports offers of coverage made to full-time employees and individuals who are enrolled in the employer’s self-insured medical or Health Reimbursement Account (HRA) coverage. Form 1094-C provides information about the employer, such as the number of employees, the number of Forms 1095-C, and employer contact information.

For employers using Benefits Administration, all ACA reporting for IRS Forms 1095-C and 1094-C is completed through UKG Pro. UKG Pro’s ACA Manager enables you to generate Forms 1095-C and 1094-C using:
  • Medical Offer records calculated in Benefits Administration
  • Self-insured enrollee data calculated in Benefits Administration
  • UKG Pro ACA Manager configuration
  • ACA Payroll hours processed in UKG Pro
  • UKG Pro Health Care Measurement Group data (for customers measuring ACA full-time status using a look-back period)
Note UKG Pro’s ACA tools and processes are generally used in the same way by all customers. This guide covers only the ACA product areas and processes that are unique to Benefits Administration customers. Refer to the PPACA Process and Tasks Guide in the Learning Center for a complete set of PPACA learning materials.

Benefits Administration ACA Data Storage

For Benefits Administration customers, ACA-relevant data is stored in two separate areas, UKG Pro and Benefits Administration.

Data Type In UKG Pro In Benefits Administration
Configuration Data
  • PPACA Reporting Settings
  • ALE Members
  • ALE Groups
  • Earnings
  • Health Care Measurement Groups
  • Role and security configuration for employees and administrators
  • Business processes for changes to Form 1095-C eConsent and Health Care Measurement Group data
  • Define Benefits (Medical, Medical 2, HRA)
  • Define Benefit Plans (Minimum Essential Coverage, Minimum Value, Spousal Conditional Offer, and Self-insured)
  • Populations for Plan and Cost eligibility
  • Define Costs (employee monthly premiums for Employee Only coverage)
  • New Hire Rules (waiting periods)
  • ACA API integration settings
Employee-Level Data
  • Employee demographics
  • ACA monthly payroll hours
  • ACA look-back measurements and eligibility statuses (Health Care Measurement Group data)
  • Employee eConsent designations to receive Form 1095-C electronically
  • Medical Offers (date ranges showing employee eligibility for coverage, details on coverage offered, if employee enrolled)
  • Self-insured Enrollees (date ranges showing each employee and dependent enrolled in self-insured coverage)
  • Dependent demographics

Benefits Administration ACA Data Reporting

ACA-relevant data stored separately in UKG Pro and Benefits Administration is combined automatically each night:

  • Benefits Administration ACA calculation calculates two employee-level data sets, Medical Offers and Self-Insured Enrollees (if applicable)
  • Benefits Administration ACA API transmission sends data sets for Medical Offers and Self-Insured Enrollees (including dependent demographics) to UKG Pro’s ACA tables
  • UKG Pro stored procedure for Benefits Administration ACA reformats Benefits Administration’s API data to integrate with the rest of UKG Pro’s ACA data
  • UKG Pro stored procedure for monthly hours calculates monthly ACA service hours and ACA eligibility statuses for each employee
  • UKG Pro stored procedure for Health Care Measurement Groups calculates average hours and eligibility statuses for customers who use a look-back period to measure ACA full-time status
When employers using Benefits Administration generate their Form 1095-C in UKG Pro, each part of the form is calculated using data from UKG Pro, Benefits Administration, or both:
  • Part I
    • UKG Pro data is used for employee demographic information and the customer ALE Member configuration
  • Part II
    • UKG Pro data is used for employment statuses and full-time status determinations
    • Benefits Administration data is used for Medical Offers
  • Part III (if applicable)
    • UKG Pro data is used for employee demographics
    • Benefits Administration data is used for dependent demographics, self-insured coverage months for employees and dependents

Medical Offers Data in Benefits Administration

Benefits Administration’s Medical Offers data includes the date range for when coverage was offered to each employee, details about the offered coverage, and how long the employee was enrolled in the offered coverage (if applicable).

Medical Offer records are created when an employee:
  • Is a new hire
  • Is eligible for an open enrollment period
  • Completes a Life Event election or has their election modified by a Work Status Event
  • Is enrolled in medical coverage
Note Medical Offers for new hires do not finish calculating until the end of the employee’s full new hire enrollment window, regardless of when the employee makes new hire coverage elections. Medical Offers for new hires who are still within their enrollment window will initially show with incomplete data, which automatically finishes calculating after the last day of the employee’s new hire enrollment window.

You can manage Medical Offers data in Benefits Administration for individual or multiple employees. Medical Offers data is calculated nightly in Benefits Administration and transmitted via the Benefits API into UKG Pro’s ACA tables. Medical Offers data is used to calculate Form 1095-C Part II Lines 14, 15, and 16.

Medical Offers Best Practices

Review the following best practices to manage Medical Offers data in Benefits Administration:

  • Update Not Accepted Eligible Medical Offers Status
    • Employees who are eligible for coverage but have not enrolled in or waived coverage have an Eligible Medical Offers status of Not Accepted. Periodically review your Medical Offers data in Benefits Administration and update the status of these Not Accepted Eligible Medical Offers to Manually Accepted.
Note Generated Forms 1095-C for full-time employees with Not Accepted Eligible Medical Offers will have a 1H in Line 14 (indicating no coverage was offered) and no Safe Harbor code in Line 16 (indicating a potential penalty risk). To update the codes, update the status of the offers from Not Accepted to Manually Accepted. Then, allow the next nightly processes to run and regenerate Form 1095-C data. 
  • Manage configuration changes in Benefits Administration
    • Configuration changes, such as changes to medical plans, costs, populations, or new hire rules, do not automatically prompt existing Medical Offers to recalculate. Medical Offers only recalculate if an employee-level change occurs, such as a change in enrollment or termination of employment. Manage configuration changes by completing one of the following:
      • Manually update the existing Medical Offers either individually or in bulk
      • Delete the existing Medical Offers and wait for the next nightly calculation process to recreate them using the updated configuration rules
  • Form 1095-C Line 15 Costs Configuration Amounts
    • You may want the dollar amount for Form 1095-C Line 15 to be different than the amount that the employee is eligible for based on the Benefits Administration Costs Configuration. For example, Form 1095-C Line 15 may show that smokers are charged higher medical premiums than non-smokers based on the Costs Configuration amounts. You can partner with your ACA Services team each year to configure the ACA Affordability Cost setting in the Benefits Administration solution to ensure the different costs are reported on employees' Forms 1095-C. This setting is often used for wellness credits and tobacco surcharges as it is easier to report Form 1095-C Line 15 rates that are lower or higher than the amount for which the employee was eligible.
    • For example:

      • ACA regulations permit reporting non-tobacco rates, even if the employee was charged a higher rate as a smoker.

      • If you have wellness credits apart from tobacco usage, such as biometric, blood pressure, cholesterol, you must report the higher rate for 1095-C calculations.

  • Medical Offers for Company Transfers
    • Company Transfers may have incorrect Medical Offers data because employees have an updated Last Hire Date. To correct Medical Offers data for Company Transfers, go to the employee’s ACA Employee Data page in Benefits Administration and manually update the employee’s ACA Employment Period to show continuous employment from the employee’s original start date. Delete the incorrect Medical Offers and allow the nightly processes to run and recalculate the employee’s Medical Offers with corrected dates. Regenerate your Form 1095-C data in UKG Pro.

Review and Update Multiple Employees’ Medical Offers

The ACA Medical Offers page in Benefits Administration displays all the Medical Offers for the organization. From this page, you can search for Medical Offers that meet your selected criteria, download data to Excel, or update the data in bulk.  

Navigation:Data & Tools > ACA Medical Offers

  1. Use filters, or search, to change the Medical Offers that are displayed on the Medical Offers page.
    Medical Offers Page Filters
  2. Review the Medical Offers data. From the Medical Offers page, you can review Medical Offers data, including:
    • The names of the best plans offered to each employee
    • The offer date ranges
    • The enrollment date ranges, if applicable
    • The offer approval statuses
    • The employee’s eligibility status for each offer
    • Whether the offers meet minimum value and minimum essential coverage (MEC) requirements
    • The lowest employee monthly premium cost for self-only coverage
    • The highest tier of coverage included in the offers, identified by the following codes:
      • SUB indicates that coverage was offered only to the employee
      • SUB_COND_SPO indicates that coverage was conditionally offered to the employee and their spouse, but not to their children
      • SUB+SPOUSE or SUB_SPO (equivalent) indicates that coverage was offered to the employee and their spouse, but not to their children
      • SUB+DEP or SUB_DEP (equivalent) indicates that coverage was offered to the employee and their children, but not to their spouse
      • ALL indicates that coverage was offered to the employee, their children, and their spouse with no conditions
      • ALL_COND_SPO indicates that coverage was conditionally offered to the employee, their children, and their spouse
  3. Optionally, you can export the data to Excel if you want to review and filter all Medical Offers data in one spreadsheet:
    1. Select the Export Offer Data to Excel button.
    2. Select an export option:
      • Export Selected Offers in Background generates a ticket for the data to be exported (a notification is sent once the file is generated).
      • Export All Offers in Background generates a ticket for the data to be exported (a notification is sent once the file is generated).
      • Export Selected Offers exports data immediately.
    3. Optionally, select the UnMask SSN check box to display full Social Security Numbers in the file.
    4. Select the Generate File button.
      Export Offer Data
      Note UKG continues to deliver new and update existing People Analytics reports. Subscribe to Newswires to receive the latest news on updates and releases.
  4. To update all Medical Offers, select the check box for Apply Actions to All Records Found.
  5. Select an action:
    • Accept includes the Medical Offers in the calculation of Form 1095-C (if the employee is eligible for the offer).
    • Reject excludes the Medical Offers from the calculation of Form 1095-C.
    • Delete removes the Medical Offers and includes them in the next nightly processing cycle. You may choose to do this when:
      • You want to recalculate the Medical Offer. For example, if you need to make configuration changes after your original Medical Offers were calculated, you can delete those offers and then let the nightly process recalculate them based on your updated configuration
      • You want to remove manually created Medical Offers. For example, you may have mistakenly imported a new Medical Offer that was not part of the original system-calculated Medical Offers. 
        Note Do not select Delete option to exclude a system-calculated Medical Offer from Form 1095-C calculation. Deleting a system-calculated medical offer will result in the medical offer getting recalculated during the next nightly process run.
      Apply Action to All Medical Offers

Review and Update an Employee’s Medical Offer

You can review and update Medical Offers data for individual employees. You can update the attributes of the Medical Offer and the status. The default status for Medical Offers is system calculated and can be either:

  • Auto-Accepted
    • This status displays when an employee makes an active election for the offer (including when the employee declines the offer)
  • Not Accepted
    • This status displays when an employee does not make an election to either enroll in or decline coverage

Navigation:Employees > Find an Employee > Actions > ACA Employee Data > Medical Offers

  1. Review the Medical Offers details.
  2. If applicable, update attributes of the Medical Offer.
    Update Medical Offer Attributes
  3. To update the approval status, select one of the following from the Status drop-down list:
    • Manually Accepted
      • This status includes the Medical Offer in the calculation of Form 1095-C (if the employee is eligible for the offer)
    • Rejected
      • This status excludes the Medical Offer from the calculation of Form 1095-C
    Note Only Medical Offers with a status of Auto Accepted or Manually Accepted are included in the calculation of Form 1095-C (if the employee is eligible for the offer).
    Update Medical Offer Approval Status

Review and Update Self-Insured Enrollees Data

For customers with self-insured medical plans, employee and dependent data for self-insured enrollments can be viewed on the employee’s ACA Employee Data page.

Navigation:Employees > Find an Employee > Actions > ACA Employee Data

  1. Review self-insured enrollees data. The Enrollees (1095-C Part III Covered Individuals) section on the ACA Employee Data page lists the employee and dependents enrolled in a self-insured medical or HRA plan with date ranges of enrollment. This data is calculated and transmitted via API nightly into UKG Pro’s ACA tables so that these individuals can be included  in Part III of Form 1095-C.
  2. If applicable, update self-insured enrollee data:
    1. To delete, select the check box for the Medical Offers you want to delete and select Delete selected button.
    2. To add, select the Add Enrollee button.
    3. To edit, select the Edit link from the Action column. The edit link in the Action column enables administrators to edit the information related to each of the enrollees listed for the respective employee. 
      Note UKG continues to deliver new and update existing People Analytics reports. Subscribe to Newswires to receive the latest news on updates and releases.

Update Medical Offers or Enrollees via the Data Import

From the Data Import page, you can import or update ACA employment periods, Medical Offers, and self-insured enrollees. Once imported, updated offer of coverage and self-insured enrollee records are stored as Manual and will not be recalculated by the system.

Navigation:Data & Tools > Data

  1. Download the applicable worksheet:
    • To update existing Medical Offers, download the ACA Offer of Coverage Update worksheet
    • To update existing enrollees, download the ACA Enrollee Update worksheet
    • To update new Medical Offers, download the download the ACA Offer of Coverage New (empty) worksheet
    • To update new enrollees, download the ACA Enrollee New (empty) worksheet
  2. Follow the instructions on the Instructions tab and update the existing records that require changes.
  3. Save the worksheet to your computer.
  4. On the Data page, Select the Choose File button in either the ACA Offer of Coverage Import section or the ACA Enrollee Import section to select the worksheet from your computer.
  5. Select the Upload button.
  6. To view the status of the import, go to Data & Tools > Tickets.
  7. To view information about any errors, select Details >Attached Files
  8. To correct errors, reimport data.

View API Transactions Statuses and Correct Errors

You can use the API Transactions page in Benefits Administration to view the Medical Offers and Self-insured Enrollees data that is being transmitted nightly to Core UKG Pro’s ACA tables. This page allows you to see all the details for your API transmissions and any errors encountered.

Navigation:Data & Tools > Data > API Transactions

  1. From the API Transactions page, select Offers or Enrollees to view the status of API transmitted offer and enrollee data:
    • Completed indicates that the data was successfully transmitted
    • Pending indicates that  the data has not been transmitted
    • Errors indicates the data could not be transmitted
  2. If applicable, correct errors on the Errors tab. Use the filters at the top of the page to narrow down the displayed results. Correct errors by updating a record’s status:
    • Under Review indicates that a record has been acknowledged and is being reviewed before taking further action
    • Resolved removes the record from the Error tab (the record is not sent again in the next API transmission)
    • Retry moves the record to Pending (the record is sent again in the next API transmission)
      Note The default status for a newly added record is New.
  3. To change the status of a single record, select the Status drop-down menu. Select the applicable status for the record.
  4. To change the status of multiple records, select the check box for each record. At the bottom of the page, the number or select records appears with a status drop-down menu. Select the status drop-down menu and select the applicable status. Select Apply to Selected. A confirmation window appears.