Employee and Employer Health Benefits Glossary

Coverage start date is the day your health plan becomes active. Learn how it works for group and Marketplace plans, plus CHOICE (ICHRA) reimbursement timing.

A copay is a fixed amount you pay for care (like $25 for a visit). Learn how copays work, what they apply to, and copay vs deductible/coinsurance.

A controlled group treats related businesses as one employer for ACA size, COBRA, and benefit rules. Learn types, tests, and common pitfalls.

Understand IRS Form 1095-A (Marketplace Statement), how it supports Form 8962 premium tax credit reconciliation, and why it matters for CHOICE (ICHRA) users.

COBRA continuation coverage: eligibility, qualifying events, notice and election deadlines, cost rules, and alternatives like Marketplace or CHOICE (ICHRA).

COBRA lets employees keep group health coverage after qualifying events. Learn eligibility, costs (up to 102%), timelines, notices, and duration rules.

Claims processing explained: how medical claims are reviewed, approved, denied, and paid—plus how reimbursement claims work with HRAs like CHOICE (ICHRA).

CHIP offers low-cost health coverage for kids in families who earn too much for Medicaid. Learn eligibility basics, what it covers, and how to apply.

Catastrophic plans have low premiums and very high deductibles. Learn who qualifies (under 30 or hardship), pros/cons, and how it works with CHOICE (ICHRA).

Carryover explained: how unused FSA funds roll into the next year, grace period vs carryover, IRS limits, and what SMBs and employees should know.

Cafeteria (Section 125) plans explained: pre-tax premiums, FSAs/DCFSA, key rules, nondiscrimination testing, and setup tips for SMBs.

Learn benefits administration basics—enrollment, eligibility, compliance, payroll, and reimbursements—and how SimplyHRA streamlines HRA administration.

Learn what makes an employer an ALE (50+ FTEs), how to count employees, ACA coverage duties, IRS penalties, and 1094-C/1095-C reporting.

Learn what IRS Form 1094-C is, who must file (50+ FTE ALEs), deadlines, penalties, and how it works with Form 1095-C under ACA reporting.

Learn the 3 IRS affordability safe harbors—W-2 wages, Rate of Pay, and Federal Poverty Line—and how they affect ACA compliance and tax credits.

Learn the IRS affordability percentage, how it’s calculated using safe harbors, and how CHOICE (ICHRA) affordability affects Marketplace premium tax credits.

Learn what a 1099 contractor is, how contractor vs. employee classification affects benefits, and why CHOICE (ICHRA)/HRAs generally apply only to W-2 employees.

Learn ACA affordability rules, safe harbors, and how CHOICE (ICHRA) affordability affects premium tax credits—plus strategies to stay compliant with SimplyHRA.

Understand APTC, the Marketplace premium subsidy, and how an affordable CHOICE (ICHRA) can end eligibility. Rules, examples, and tips from SimplyHRA.