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ACA Compliance
Applicable large employer status, full-time equivalents, affordability and the safe harbors, § 4980H penalties and reporting. The rules that decide whether an offer of coverage actually protects you.
Benefits answers organized by the decision in front of you
This is the informational side of 4J’s employee benefits practice. Everything here exists to answer one of four employer questions: does this rule apply to us, how do we calculate it, what are our options, and what do we do next?
The content is written for the people who actually carry the obligation — HR directors, controllers, CFOs, benefits administrators, superintendents and business owners — not for a search engine. Where a page states a penalty amount, an affordability percentage or a filing deadline, it links to the controlling IRS, DOL or CMS source and records the date we reviewed it.
Three clusters are live below: ACA compliance, health plan funding, and tools. A fourth cluster covering benefits compliance outside the ACA — ERISA plan documents and Form 5500, Section 125 cafeteria plans, COBRA, PCORI, RxDC, gag clause attestation, Medicare Part D creditable coverage and the annual compliance calendar — is being built and will appear here as each resource is published.
Definitions for the terms used across these clusters are collected in the group health and employee benefits glossary, which supports the ACA, funding and tools material alike.
4J Insurance is an independent commercial insurance brokerage, powered by PGI, based in Frisco, Texas. We are not attorneys, accountants, actuaries or a third-party administrator, and nothing on these pages is legal, tax or actuarial advice.
Where employers start
Health Plan Funding
Fully insured, level-funded and self-funded structures compared, stop-loss contract terms, and what has to be true before changing funding model is justified.
Tools and Decision Support
Screen your ALE status, aggregate commonly owned businesses, and test whether your current employee contribution is likely to clear the affordability threshold — plus the counting rules behind the result.
An employer rarely gets into trouble because it chose the wrong plan. It gets into trouble because nobody checked whether the rule applied to them this year.
Guides employers use most
What is an ICHRA?
Individual coverage HRAs let an employer fund individual-market premiums instead of sponsoring a group plan. Where that works, where it does not, and what it does to ACA affordability.
Lowering health plan costs
Seven levers Texas employers actually have on plan cost, ordered by how much control the employer holds over each one, and what each requires in data or administration.
Choosing a benefits consultant
Written for Texas school districts and public entities, where procurement rules, TRS-ActiveCare and board oversight change how a benefits consultant should be evaluated.
Want someone to read your plan the way a claim will read it?
A benefits program review covers the plan documents, the contribution structure, the compliance filings and the funding model, and produces a written list of the gaps between what you are obligated to do and what your program currently does.