ACA Compliance Survey
RequiredRequired Question(s)
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Name:

 

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Email:

 

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Phone Number:

 

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Client Name:

 

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Plan start date: (if applicable)

 

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Is your client's benefits plan fully insured?
Yes
No
Self Insured
Both
  • Comment:

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When does your client's standard measurements period begin and end?
 

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How long is your client's initial measurement period?
 

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When does your client's standard administrative period begin and end?

 

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How long is your client's initial stability period?

 

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When does your client's standard stability period begin and end?

 

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Please indicate any Affordability Safe Harbor in use

W2
Rate of Pay
FPL
Unknown
Other  
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Your client's current ACA reporting provider.
 

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What specific issues do you and/or your clients need assistance with?

 

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What would your ideal ACA compliance solution provide?

 

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