Is It Time to Review Your Medicare Plan?

| February 20, 2025
Old woman work at home using notebook computer.

Use this checklist to determine if your Medicare plan still meets your needs.

Navigating changes in your Medicare plan can be challenging. Regularly reviewing your plan is essential to ensure it still meets your health, financial, and lifestyle needs. Factors like health changes, rising costs, new prescription needs, plan dissatisfaction, lifestyle changes, and annual adjustments might prompt you to consider a new Medicare plan. Evaluating these aspects can help you make informed decisions about your coverage. Having a local agent to call or reference can also be crucial to your experience with and understanding of your Medicare options.

If you answer “Yes” to any of these questions, it might be time to consider reviewing your plan:

1. Changes in Your Health
  • Have you had any new health issues or started new treatments?
  • Are you taking new medications that your current plan doesn’t cover?
2. Rising Out-of-Pocket Costs
  • Have your monthly premiums increased significantly?
  • Are you paying more out-of-pocket for doctor visits, hospital stays, or prescriptions?
3. New Prescription Drug Needs
  • Are your current medications not covered or too expensive under your plan?
  • Is your preferred pharmacy no longer in-network?
4. Dissatisfaction with Your Current Plan
  • Have you experienced issues with claims being denied?
  • Are your preferred doctors or specialists no longer in-network?
  • Are you unhappy with the customer service provided by your plan?
5. Lifestyle Changes
  • Have you recently moved to a different state or region?
  • Are you traveling more frequently and need better out-of-network coverage?
6. Annual Plan Changes
  • Has your plan changed its coverage, costs, or benefits in a way that no longer suits your needs?

At OneGroup, we’re committed to providing you with the resources and support you need to navigate your Medicare options confidently. If you answered “Yes” to any of the above questions, start by reviewing your current plan’s coverage, costs, and benefits. OneGroup can support you in reviewing your plan and comparing your options.

For more information

Click here to get in touch OneGroup’s Medicare team for more information. 

We are not a government agency. We are licensed insurance agents who discuss insurance programs such as Medicare Advantage, Medigap, and Medicare Part D Prescription Drug Coverage. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-Medicare to get information on all of your options.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

OSHA’s Top 10 Safety Standard Citations in 2024

| February 18, 2025
Warehouse, tablet and people teamwork for storage, inventory and supply chain management for b2b distribution. Factory, Industry partner or worker on digital technology, software and logistics boxes

Every year, the Occupational Safety and Health Administration (OSHA) rank the 10 most frequently cited standards following worksite inspections.

Workers experience avoidable injuries, illnesses and fatalities associated with the hazards the standards cover.

OSHA publishes its ranking so employers can become aware of repeatedly flagged standards. The aim is to help employers identify and correct hazards before they become a problem. See how your safety programs stand against these citations.

Top 10 OSHA Citations

OSHA shared its preliminary data at the 2024 NSC Safety Congress & Expo. Fall protection maintained the top spot for the 14th straight year. It received twice the number of citations as the runner-up, hazard communication. Respiratory protection went from seventh to fourth place. Scaffolding dropped from fourth to eighth place. Machine guarding maintained its position.

The following are the top 10 OSHA standards cited from October 2023 to September 2024:

RankSafety & Health TopicOSHA StandardWhat it Covers
1Fall protection1926.501Fall protection. Requires employers to provide fall protection systems to employees working at heights.
2Hazard communication1910.1200Hazard communication. Requires employers to disclose and classify hazards of all chemicals produced or imported. Also requires employers to communicate information about the classified hazards to employees, and maintain a written hazard communication program and chemical inventory.
3Ladders1926.1053Ladders. Regulates the types of ladders employers must provide to employees for the jobs they’re doing.
4Respiratory protection1910.134Respiratory protection. Requires employers to control employees’ exposure to air contaminated with harmful dusts, fogs, fumes, mists, gases, smokes, sprays or vapors.
5Lockout / Tagout1910.147The control of hazardous energy (lockout/tagout). Sets minimum requirements for controlling hazardous energy when machines and equipment are being serviced or maintained. The lockout/tagout process prevents unexpected startups and releases of stored energy that could injure employees.
6Powered industrial trucks1910.178Powered industrial trucks. Requires safety measures relating to the design, maintenance and use of powered industrial trucks. These include fork trucks, tractors, platform lift trucks, motorized hand trucks, and other industrial trucks powered by electric motors or internal combustion engines.
7Fall protection1926.503Training requirements. Requires employers to provide fall protection training to employees exposed to fall hazards. Minimally, employees should be able to recognize fall hazards in the workplace and follow procedures for minimizing those hazards.
8Scaffolds1926.451General requirements. Regulates the types, materials, construction and uses of scaffolds, as well as fall protection and guards employers must provide for employees working on or around scaffolds.
9Personal protective equipment1926.102Eye and face protection. Requires employers to provide affected employees with proper eye and face protection. Personal protective equipment must protect against hazards like flying particles, molten metal, liquids, chemicals, acids or caustic liquids, chemical gases or vapors, and light radiation.
10Machine guarding1910.212General requirements for all machines. Requires employers to protect machine operators and other employees nearby from rotating parts, flying chips, sparks and other machine-related hazards.
Free on-site safety consultation

If you’re a smaller business looking for feedback about your safety programs, try OSHA’s free safety consultation program. It’s open to small businesses with 250 or fewer employees at a single location and fewer than 500 employees in the entire company.

An on-site consultation can help you identify and address hazards and establish or improve your safety and health programs. Consultants from state agencies or universities provide the services. The consultations are confidential and separate from OSHA enforcement.

Keeping up with OSHA standards can help you maintain a safe workplace and avoid regulatory mishaps. Employees are counting on you to help them make it through the workday safely!

Looking for more information

Looking for help with this topic? Please contact our Risk Management team.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Written content in blog post: Copyright © 2024 Applied Systems, Inc. All rights reserved.

Auto insurance rates are still rising. What can you do?

| February 18, 2025
Auto insurance prices continue to rise. Learn ways to steer the cost cycle without compromising your vehicle coverage.

Auto insurance prices continue to rise. Learn ways to steer the cost cycle without compromising your vehicle coverage.

According to Value Penguin’s State of Auto Insurance report, costs will grow by 7.5% in 2025, estimating the national average at $2,101 for full coverage. That’s a considerable slowdown from last year’s increase of 16.5% and 12% in 2023.

Nevada, Florida, and Michigan are the most expensive states, with rates exceeding $250 per month. Maine, New Hampshire, and Vermont were the cheapest states, with prices barely topping $100 monthly.

Even with the slowdown, insurance costs will remain higher than in the past.

Reasons auto insurance prices grow

Extreme weather, increased cost of vehicle repairs, along with increased frequency of all claims, has translated into higher premiums for all drivers.

From supply chain issues to get parts, to the expansion of technology now used in vehicles compared to just ten years ago, repairing your vehicle costs more and takes longer. In response to this, your insurance carrier has to adjust rates accordingly in order to be able to support the new claim frequency and cost that is involved.  Their priority is to make sure they have the funds to support, help, and make you whole in the event of a loss. As a consumer/insured, that is reflected in your increased rates.

Tips for lowering your auto insurance premiums

Contact your agent about discounts. Qualifying might be easier than you imagine. Ask about these potential savings moves:

  • Bundle your car and property insurance.
  • Pay the entire policy upfront instead of monthly.
  • Enroll in autopay.
  • Go paperless.
  • Try telematics. (Before you commit, ensure there are no penalties for driving errors or unenrolling from the program if you don’t like it.)
  • Get good student driver discounts.
  • Improve your credit score.
  • Raise your deductible. (You’ll pay a lower monthly premium but more out of pocket if you’re in an accident. Choose an out-of-pocket amount that works for your budget.)

Your independent agent can walk you through these options. Ask them to run multiple quotes with different discounts, deductibles and options. They can shop for better rates if they think you can get them. If you’ve had difficulty securing auto insurance, you might be better off staying with your current insurance carrier. Your agent can advise you on the best move for your situation.

Get an insurance quote before you buy your next car

If you’re in the market for another car, call your insurance agent before you sign the deal. Different makes and models come with different insurance price tags. Luxury or sporty models often cost more to insure because they cost more to repair or replace. Some electric cars also cost more to insure. Specific model years may cost more, too. It doesn’t mean you have to go with a car you don’t like, but you might change your mind about the kind of car you want once you know what the insurance will cost.

Why do your costs go up even though you’re a good driver?

Insurance rates go up for several reasons, and they don’t always have to do with your driving record. Usually, they go up during a hard market when insurance companies raise their standards and rates to compensate for the losses they incurred in previous years. It may seem unfair, but insurance carriers can go bankrupt if they don’t raise rates to reflect the current conditions.

Here are some reasons auto rates increase:

An increase in accident rates

High congestion in urban areas and increased distracted and impaired driving contribute to more accidents.

Higher medical costs from accidents involving injuries

The medical expenses associated with these claims have also been growing.

An increase in car prices and technology

Modern cars have features like backup cameras and collision warning systems, making them more expensive to repair or replace.

A rise in uninsured or underinsured drivers

When more drivers are uninsured, insurance companies pay more for accidents, especially when the payment would have come from the other uninsured driver’s insurance carrier.

Fraud

Scammers often stage accidents or exaggerate claims, increasing the overall cost. Policyholders absorb these costs.he policy limit, but it could be higher.

Call for an auto coverage review

Our team can help you understand your current coverages, deductibles and more. We’re happy to help you stay updated about ways to save.  Reach out to our Personal Insurance team for a free, no-obligation review.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Written content in blog post: Copyright © 2024 Applied Systems, Inc. All rights reserved.

ACA Pay-or-Play Provision: Determining your ALE Status

| February 18, 2025
Businesswoman examining documents at desk

Under the Affordable Care Act, applicable large employers (ALEs) must offer minimum affordable health coverage to their full-time employees, or pay a penalty. Find out if you qualify as an ALE and what you must do to comply.

The Affordable Care Act’s (ACA’s) employer mandate requires businesses with 50 or more full-time equivalent (FTE) employees to either:

  • Offer minimum affordable health coverage to their full-time employees or
  • Pay a penalty if any full-time employee receives a premium tax credit for purchasing individual coverage on the health insurance marketplace

The employer mandate is also known as the “pay-or-play” provision because it requires you to comply or pay a penalty. Whether you are subject to the pay-or-play provision depends on your status as an applicable large employer (ALE).

In this article, we’ll explain who qualifies as an ALE and what you must do to avoid ACA penalties.

Determining your ALE status

You are considered an ALE if you averaged 50 or more full-time (FT) and FTE employees during the prior calendar year.

  1. For each month in the prior calendar year, count the number of employees who had 120 hours of service or more for that month or who are classified as FT employees.
  2. Count the hours of service of all other employees for the month and divide by 120.
  3. Add up the FT and FTE employees.
  4. Do the same for all 12 months and divide by 12.
  5. Round down to determine ALE status.

(Sample numbers have been inserted into the table below for clarity; delete these before doing your own calculations.)

Row #FTE FormulaJanFebMarAprMayJunJulAugSepOctNovDecTOTAL
1EEs ≥ 120 hrs383439374343444645485354 
2EEs < 120 hrs 700 878 788 976 685 814 860 640 812 710 574 671 
3Divide Row 2 by 1205.8337.3176.5678.1335.7086.7837.16675.336.7675.91674.7825.592 
4Add Rows 1 & 3 together for FTE Count 43.833 41.317 45.567 45.133 48.708 49.783 51.167 51.33 51.767 53.917 57.782 59.592 599.9

In the example above, 599.9 divided by 12 is 49.99, which rounds down to 49. The employer is not an ALE. 

If you fall just below the 50 FTE threshold, you must watch your growth. A small increase in just one employee’s hours can tip you into ALE status. This can significantly increase your compliance burden under the pay-or-play mandate.

Special rules for ALE determinations

Controlled and affiliated groups. Employers under common ownership or control are combined when determining ALE status. Examples include controlled groups and affiliated service groups under IRC Sections 414(b), (c), (m) or (o).

  • If one entity within the group qualifies as an ALE, all entities are treated as ALE members. Each is subject to the pay-or-play provision.
  • Employers must aggregate employees across all group entities when performing the ALE calculation.

Seasonal workers. If your workforce exceeds 50 employees for 120 days or fewer in the prior calendar year, you may not be considered an ALE, as long as the employees exceeding the threshold were all seasonal workers.

A four-year preview for ALEs

Year 1: Determine ALE status. Calculate your prior year’s average of FT and FTE employees using the IRS’ ALE calculation above. If the average is 50 or more, you are an ALE (unless you qualify for an exemption). As an ALE, your compliance obligations under the pay-or-play mandate continue on a four-year cycle.

If you are not an ALE, then the pay-or-play provision does not apply. However, if you sponsor a self-insured plan, you should familiarize yourself with the ACA’s employer mandate reporting obligations for non-ALEs.

Year 2: Make an offer of coverage. You must offer minimum affordable coverage to all benefit-eligible FT and FTE employees by April 1 of year two to avoid offer-of-coverage penalties. This gives you three full months after determining you are an ALE to shop for coverage, perform a risk analysis and conduct your open enrollment.

Year 3: Report on your offer of coverage. Regardless of whether you offer coverage in year two, you must file Forms 1094-C and 1095-C with the IRS on time. You must also furnish copies to employees based on your offer of coverage in year two.

Year 4 (or later): Defend against penalties. You may need to respond to IRS-proposed penalty assessments if an employee triggers a penalty by going to the health insurance marketplace and getting subsidized coverage.

Seek help as needed

ALE calculations can quickly become complicated, and the penalties for getting it wrong can be steep. Reach out to our Employee Benefits team and we’ll be happy to help.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem.

Copyright © 2024 Applied Systems, Inc. All rights reserved.

Contracts: A Guide to Managing Risks

| February 18, 2025
Business crisis manager stopping falling dominos from collapsing

A contract is a formal agreement between two or more parties that creates binding obligations to perform or refrain from certain actions.

By Kirsten Shepard, CIC, CISR Elite

While contracts establish these obligations, they also introduce potential risks to your organization. Therefore, each time your organization enters into a contract, it should:

  • Evaluate the risks the agreement may pose
  • Decide whether to accept or transfer those risks
  • Determine the method of financing those risks, be it through your organization or the contractor

It’s crucial to scrutinize the terms of any contract thoroughly. While some contracts may appear to contain standardized language, they could include commitments your organization should avoid. We recommend a detailed review to anticipate potential scenarios affected by the contract, such as:

  • Scope of Work: What will the contractor be responsible for?
  • Potential Losses: What types of losses might occur?
  • Financial Impact: What’s the “worst-case scenario” in terms of financial loss?
  • Protection Measures: How can you safeguard your organization?

Particular attention should be paid to clauses like Limitation of Liability, Hold Harmless, Indemnity, and Insurance. These clauses can obligate you to indemnify another party for property or liability losses. Should you find a contract’s provisions unfavorable, we advise seeking legal counsel.

Transferring risk to other entities helps manage and reduce losses. When feasible, your organization should endeavor to transfer risk through contractual agreements. For example, you might require a vendor to assume all liability for a product they sell to your organization, a term typically embedded in the contract. Your ability to transfer risk often depends on your bargaining power and the nature of the business involved.

Hold Harmless and Indemnity Agreements

Hold harmless and indemnity agreements are essential tools for risk transfer. These may be labeled as hold harmless, waiver and release, save harmless, or indemnity agreements within a contract. Always read contracts meticulously, as these terms can be included without explicit labeling.

In a hold harmless agreement, one party agrees to assume the liability of another. Although often used interchangeably, hold harmless and indemnity agreements differ in the scope and manner of risk transfer. Hold harmless agreements typically pertain to claims between the contracting parties, such as property damage or consequential losses like lost income. These agreements often accompany indemnity agreements because third parties may still file negligence claims against any involved party.

Indemnity agreements shift the responsibility to cover third-party claims. They ensure one party (the indemnitee) can seek reimbursement from another (the indemnitor) for losses, claims, and expenses related to third-party damage claims. A well-crafted indemnity agreement should clearly outline the allocation of responsibilities.

Insurance as a Risk Financing Method

Requiring contractors or service providers to purchase insurance is a practical way to finance loss payments. However, insurance has its limitations and exclusions. For instance, professional liability policies may only cover the insured’s negligence.

When transferring risk, ensure the other party understands the transfer and has the financial resources or suitable insurance to cover potential losses. An indemnity agreement does not absolve your organization from liability; rather, it mandates that the other party covers related costs. If the indemnitor lacks financial stability or insurance, your organization may still be liable.

Including your organization as an additional insured on the contractor’s liability policy offers several advantages:

  • Defense and Costs: The insurer must defend and cover your organization’s defense costs if sued.
  • Obligations: The insurer remains obligated regardless of the named insured’s financial status.
  • Personal Injury Coverage: Typically included under general liability.

However, additional insured status is not a replacement for a hold harmless and indemnity agreement, as insurance policies have limitations and may not cover all claims.

Combining hold harmless and indemnity agreements with insurance provides comprehensive financial security for your organization, with state regulations. Proper handling of claims not only helps in reducing costs but also supports a safer workplace environment.

If you have any questions or need further assistance, please do not hesitate to reach out to OneGroup’s team for guidance and support.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Winterize Against Workers’ Compensation Claims

| February 14, 2025
Civil Engineers At Construction Site In Winter Season

Cold weather leads to an increase in employee injuries. With a few steps, you can improve your workers’ chances of coming through the chill unscathed.

In many parts of the United States, the onset of winter weather means an increase in workers’ compensation claims. Blizzards, winter storms, snow, sleet, ice and freezing temperatures can lead to various occupational and workplace injuries and illnesses. According to the Bureau of Labor Statistics, there were 20,460 occupational injuries related to snow, ice and sleet in 2017, the most recent year for which statistics are available.

While winter weather hazards can affect any worker, those who work outdoors are most at risk. They include construction workers, first responders, recreation workers and utility workers.

Most common winter workers’ compensation claims

Many of the common winter workers’ comp claims fall into one of these categories:

  • Slips, trips and falls: These incidents are a leading cause of death for workers, according to the National Safety Council. The likelihood of these injuries increases when there is ice or snow on the ground. Some common hazards associated with workplace slips and falls include snow and ice on parking lots, stairs, walkways, floors, roadways and sidewalks.
  • Cold-stress injuries: According to the Occupational Safety and Health Administration (OSHA), cold stress occurs when a person’s skin temperature is driven down and their internal body temperature drops too low. Serious cold-related illnesses and injuries may occur when the body is unable to warm itself. Some can even be permanent or fatal. Cold temperatures, high winds, dampness and cold water all contribute to cold stress. Common cold-stress illnesses and injuries include trench foot, frostbite and hypothermia.
  • Winter driving: Winter weather can cause hazardous driving conditions. This can increase in workers’ comp claims related to auto and vehicle accidents.
  • Snow shoveling and snow removal: Injuries and illnesses include strains and sprains, harm from using equipment, dehydration and even heart attacks, according to OSHA.

Winter workplace injuries don’t just have detrimental effects on the health and safety of employees. They can also increase workers’ comp claims and costs, increase general liability insurance costs, increase employee absences due to work injuries and lower productivity.

Prevention strategies are key

Fortunately, employers can implement risk management and safety strategies to minimize risk and prevent injuries from snow, ice, storms and other winter weather hazards. These solutions and prevention tools include employee communication and education, safety campaigns, and plans and procedures to be followed during cold weather, snows and storms.

Here are some tips to develop a complete winter workplace safety strategy:

Communication and education

  1. Implement a winter weather communications strategy to advise employees of hazardous weather events.
  2. Create a winter weather safety manual and distribute it to all workers.
  3. Educate employees on the risks of slips and falls during winter.
  4. Consider creating winter storm contingency plans to minimize travel in hazardous conditions. One option is remote work.
  5. Make sure outdoor workers know how to recognize the signs of cold stress.

Safe snow and ice removal

  1. Hire a snow removal company to clear parking lots, sidewalks, stairs and walkways.
  2. Use safe ice and snow melting techniques.
  3. Be aware of the hazards of shoveling snow.

Safety campaigns

  1. Develop a winter safety awareness campaign to communicate procedures and plans.
  2. Use highly visible signage such as caution and warning signs in hazardous areas, indoors and outdoors.
  3. Promote safe operations of all winter equipment, including plows and snowblowers.

Winter weather safety gear and clothing

  • Make sure outdoor employees wear appropriate clothing and other protective equipment during cold weather.
  • Be aware of OSHA requirements for providing personal protective equipment for workers. Protective winter gear may fall into this category.

Equipment and vehicles

  • Make sure drivers are properly trained to operate vehicles in winter weather conditions.
  • Ensure that workplace vehicles and heavy equipment are inspected and properly working for winter weather conditions.
  • Equip vehicles with emergency safety and weather kits.

Remember that the common cold, influenza and other communicable illnesses associated with the winter are not covered under workers’ comp. Train your employees to practice excellent hygiene during winter to avoid lost work time due to preventable communicable disease. Vaccinations are also important. You may wish to provide flu shots on site.

Your human resources department or safety manager can consult with various resources to create and implement winter safety plans and programs. These may include the National Safety Council, OSHA or your insurance provider. By taking a proactive approach to winter safety and risk management, you can protect your workers and create a safe work environment regardless of the weather.

This list is not exhaustive. In fact, the list of combustible dust-related materials and industries keeps expanding as incidents are investigated.

Contact Us

Looking for help with this topic? Please contact our Risk Management team.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Written content in blog post: Copyright © 2024 Applied Systems, Inc. All rights reserved.

Prepare for Your 2024 ACA Reporting Deadlines

| February 12, 2025
DEADLINE AHEAD Road Sign 3D Rendering

It’s time to start planning for IRS reporting deadlines under the Affordable Care Act. Use this information to get ready.

With health plan requirements on the horizon, now is a good time to note your 2024 reporting deadlines under the Affordable Care Act (ACA).

You must file Forms 1094-C and 1095-C or Forms 1094-B and 1095-B with the IRS by:

  • Feb. 28, 2025 (paper filing)
  • March 31, 2025 (electronic filing)

Note: Virtually every employer will need to file electronically. Prior to last year, you could file by paper if you had less than 250 forms. Now, you must file electronically if you have 10 or more aggregate forms. This aggregate number includes W-2 and 1099 forms, in addition to Forms 1094-C, 1095-C, 1094-B or 1095-B.

The recently enacted Paperwork Burden Reduction Act relieves employers from the requirement to provide Form 1095-C or Form 1095-B to covered individuals as long as they have the ability to request Form 1095. The law firm Seyfarth Shaw LLP notes that you must inform covered individuals of their right to request Form 1095-B or 1095-C. If a covered individual requests Form 1095, you must provide it to them by the later of Jan. 31 or 30 days after they make their request.

Which forms apply


You qualify as an applicable large employer (ALE) for the current calendar year if you had an average of 50 or more full-time employees, including full-time equivalent employees, during the prior calendar year. You are considered a small employer if you averaged fewer than 50 full-time employees.

Forms 1094-C and 1095-C

If you are an ALE, you will file Forms 1094-C and 1095-C to provide information on offers of health coverage and enrollment for employees and their dependents. The IRS uses these forms to determine premium tax credit eligibility and employer shared responsibility provisions.

  • Form 1095-C is a form you provide to every individual who qualified as a full-time employee during any month of the calendar year and who requests this form.
  • Form 1094-C is a transmittal form you send to the IRS. It includes your identification and the number of 1095-C forms you are submitting.

Forms 1094-B and 1095-B

If you are a small employer offering a self-insured health plan that meets the requirements for minimum essential coverage, you will file Forms 1094-B and 1095-B. For fully insured plans, insurance issuers and carriers must also file Forms 1094-B and 1095-B.

  • Form 1095-B includes information on minimum essential coverage. It is reported to the IRS and any qualifying employees who request this form.
  • Form 1094-B is a transmittal form you send to the IRS. It includes your identification and the number of 1095-B forms you are submitting.
For more filing information

Before you file, check the IRS instructions:

For more information about ACA requirements and filing deadlines, talk to your insurance broker or benefits advisor

Contact Us

At OneGroup, we prioritize keeping you informed of legislation and compliance updates through our comprehensive service model. We work as an extension of your HR team throughout the year, allowing you to focus on your core responsibilities. Reach out to our Employee Benefits team and we’ll be happy to help.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem.

Copyright © 2024 Applied Systems, Inc. All rights reserved.

Legal Alert: RxDC Reporting Due June 1st

| February 7, 2025
US Capitol Building - IRS Adjustments

With the 2024 reference year RxDC reporting deadline approaching in June, plan sponsors should re-familiarize themselves with the reporting requirements.

The 2024 reference year RxDC Reporting Instructions have been released, though there were no changes to the reporting requirements or data elements from last year. 

As a reminder, the Consolidated Appropriations Act, 2021 includes a provision that requires group health plans and health insurance issuers (collectively “plans and issuers”) to report certain specified data related to prescription drug and other health care spending. The first RxDC report (for 2020 and 2021) was due on January 31, 2023, with the reports for 2022 and 2023 due on June 1, 2023 and June 1, 2024, respectively. The deadline to submit reporting for calendar year 2024 is June 1, 2025 (and continues each June 1st thereafter).

Next Steps for Employers

In anticipation of the June 1, 2025 deadline, plan sponsors may receive communications from their carriers, TPAs, PBMs and other vendors regarding their expectations for completing the reporting. In our experience, carriers, TPAs, PBMs, and other vendors have varying requirements and expectations of what they need from plan sponsors to successfully complete the reporting, and some may delegate some of the reporting responsibility to the plan sponsor. For example, if your insurance company, TPA, or PBM sent you a survey or questionnaire to collect information about plan numbers, premium, or funding types, it is likely that they are reporting the P2 and D1 files on your behalf. Therefore, we recommend the following:

  • Respond to any requests for information you may receive and coordinate with your vendors to understand their expectations to ensure all reporting is completed in full on behalf of the plan. Note: Some carriers require responses by early March.
  • If your vendor sent you an email or letter asking you to create a HIOS account or stating that they will not submit P2 and D1 on your behalf, that means you must submit P2 and D1 directly to CMS (or engage a third-party to submit them for you). Thus, you and/or a third party submitting P2 or D1 on your behalf will need to follow the RxDC Reporting Instructions and timely complete the submission.
More Information

For additional information, contact our Employee Benefits team.

This alert was prepared for OneGroup by Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act. Contact Stacy Barrow or Nicole Quinn-Gato at [email protected] or [email protected].

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers, or our clients. This is not legal advice. No client-lawyer relationship between you and our lawyers is or may be created by your use of this information. Rather, the content is intended as a general overview of the subject matter covered. This agency and Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein. Those reading this alert are encouraged to seek direct counsel on legal questions.

© 2024 Barrow Weatherhead Lent LLP. All Rights Reserved.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

ACA Affordability Threshold Increases for 2025

| February 7, 2025
Stethoscope on the dollars.

This change in percentage could impact your plan’s employee contribution rates. Discover how to maintain compliance and avoid penalties under the Affordable Care Act. 

As you look ahead to the new plan year, it’s critical to note the new affordability threshold under the Affordable Care Act (ACA). In 2025, the threshold will be 9.02%. That’s up from the 2024 level of 8.39% and reverses a trend of three straight years with decreases. The percentage is indexed each year.

It’s important to note how any change in percentage will affect the premiums you can charge employees while meeting the ACA’s affordability safe harbor. Failure to do so could result in ACA employer shared responsibility payments.

The requirements

The ACA requires applicable large employers to offer full-time employees a chance to enroll in an affordable health care plan that provides minimum essential coverage. The ACA defines “affordable” as a percentage of an employee’s household income. Applicable large employers are those with 50 or more full-time equivalent employees in the previous year.

The percentage applies to the lowest-priced, self-only coverage under your health plan. As noted, that percentage will rise to 9.02% for 2025.

Here’s how this could impact your organization if you use the federal poverty level safe harbor to meet ACA affordability requirements.

This safe harbor requires an employee’s share of health care premiums to be equal to or less than the affordability threshold of a certain percentage of the federal poverty limit in effect six months prior to the beginning of the plan year. 

The federal poverty limit for 2024 is $15,060 for individuals in the mainland U.S. With the 9.02% limit for 2025, employers cannot charge employees more than $113.20 a month for health care premiums. This is up from $101.94 in 2024.

In addition to the federal poverty level safe harbor, you can select the Form W-2 safe harbor or the rate-of-pay safe harbor. These are based on an employee’s Form W-2 compensation and hourly or monthly pay, respectively. Talk to your benefits adviser for more information on which safe harbor works best for your plan.

The penalties

Suppose you use the exact amount under the federal poverty level safe harbor to set what you charge for employee contributions. In that case, you must amend the 2025 amount for your lowest-priced, self-only option providing minimum value.

If you fail to adjust this amount for employee contributions, your plan coverage will be considered unaffordable. You will then be subject to penalties for every employee who obtains subsidized public health coverage in the individual marketplace. In 2025, the penalty is $4,350 per employee..

Maintain compliance

To ensure plan compliance, contact your insurance broker or benefits adviser. They can provide guidance on coverage options, safe harbors and ACA affordability requirements.

Contact Us

At OneGroup, we prioritize keeping you informed of legislation and compliance updates through our comprehensive service model. We work as an extension of your HR team throughout the year, allowing you to focus on your core responsibilities. Reach out to our Employee Benefits team and we’ll be happy to help.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem.

Copyright © 2024 Applied Systems, Inc. All rights reserved.

How To Steer Clear of Unlawful Interview Questions

| February 5, 2025
Business, career and placement concept young asian woman smili

Train your employees to avoid illegal and inappropriate questions when talking to job candidates.

The right interview questions can help increase employee engagement, productivity and retention through good hires. It’s equally critical to understand and avoid the wrong questions.

This issue goes beyond legal claims and costs. Even if job candidates don’t bring discrimination charges, inappropriate questions can damage your reputation and ability to recruit and retain talent.

Train employees on proper interview questions

The human resources association SHRM recommends training your employees on the interview process. Highlight illegal, unethical and inappropriate questions that could give rise to lawsuits.

Off-limits questions apply to anyone involved in the interview process. Training should include recruiters, hiring managers, executives, potential colleagues and any employee who might formally contact a candidate.

It’s easy to stray into risky territory when moving from scripted questions into casual conversations. But anything asked and documented could appear in a discrimination lawsuit.

The U.S. Equal Employment Opportunity Commission (EEOC) advises against any questions related to protected characteristics. Protected characteristics may include race, gender, religion, nationality, age, sexual orientation, disability, marital status, pregnancy and genetic information.

The EEOC notes an exception for disabilities. You can ask a candidate with a disclosed or obvious disability if they need a reasonable accommodation during the application process or for the job position.

A good rule is to ensure each interview question relates to the job and the candidate’s ability to perform the assigned duties. Interviewers should be able to ask all candidates the same questions. For example, if you wouldn’t ask a man about marital status, pregnancy or family planning, the same should apply to women.

Interview questions to avoid

The following is a list of questions to avoid in job interviews. The list is not exhaustive, but it can serve as a training guide by highlighting off-limits topics when speaking with job candidates.

Many of the questions come from the EEOC, HR Dive, SHRM and LinkedIn. Some questions include an introductory comment demonstrating how casual conversations can create legal issues.

  • You look like you’re at a fun time in life. Are you single or married?
  • You look so youthful. How old are you?
  • It looks like you’re pregnant. When are you due?
  • We are very family-friendly. Do you have any children or want to have any?
  • You have such a unique look. Are you biracial? What gender do you identify with?
  • I’ve never known anyone with your name. Are you originally from here?
  • These are divisive times. Who are you voting for in this election?
  • We’re open to all faiths. Do you attend church?
  • I love your accent. Are you a U.S. citizen?
  • You speak well. Is English your first language? What language do you use at home?
  • It’s incredible how technology can pinpoint cancer and heart attack risks. Have you done any genetic testing or searched your family’s medical history?
  • I used to love having a good time after work. Have you ever had any problems with alcohol use?
  • My doctor has me trying all these different pills. Do you take medications?
  • Have you taken medical leave before?
  • Have you ever filed a workers’ compensation claim?
  • We value veterans in our organization. Why were you discharged from the military?
Additional considerations

Many employers choose to be inclusive about gender pronouns. HR Dive cautions against asking about preferred pronouns during an interview. That information most likely does not relate to immediate business or job needs.

HR expert Lauraine Bifulco noted during a presentation at the SHRM Annual Conference that indirect questions about protected characteristics are also off-limits. For example, asking a candidate when they graduated from high school could be an indirect way of figuring out their age.

Candidates sometimes provide information unrelated to a question. If a job candidate brings up their protected characteristics or improper personal details, don’t ask follow-up questions or add your own thoughts. Instead, be clear that you don’t choose candidates based on these factors. Note that it won’t affect their job candidacy, then redirect the interview to appropriate topics. EPLI policies exclude liabilities covered by other insurance policies, such as workers’ compensation.

Consult with your team

State regulations may also impact interview questions by increasing the number of unlawful topics, including height, weight and criminal records.

Work with your benefits adviser and legal counsel to remain compliant. They can also provide more interview best practices to enhance the process for your candidates and organization.

Need more information?

For support on this topic contact OneGroup HR Consulting at HR Consulting at [email protected]. They can provide best practices on the interview process.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Written content in blog post: Copyright © 2025 Applied Systems, Inc. All rights reserved.