Happy Thanksgiving, everyone!
As we head into the holiday, we want to say how truly thankful we are for those of you who’ve taken the time to read Benefits Weekly over the past few months. This has been a bit of a passion project for us, and the positive feedback we’ve received from brokers and employers alike has meant more than you know. We’re grateful for everyone who opens these emails, follows along, and uses this information to support their teams and their clients.
Since this is a busy week for everyone, we’re taking a break from our usual deep-dive topic. Instead, we thought we’d share something lighter but still really useful: quick answers to ten common questions we get from our readers. Each of these Q&As comes from our blog — so if you haven’t had a chance to explore it yet, be sure to take a look. We don’t post every week, but whenever we receive a question that’s likely to help more than just the person who asked it, we do our best to turn it into a short, practical post.
While these topics may not each warrant a full newsletter issue, they’re still important — and they might just help you answer questions a little faster, whether you’re advising a client or guiding your own employees. We hope you enjoy this quick roundup, and we encourage you to check back on the blog from time to time for new updates.
1. How do I know if my businesses are under “common ownership” — and why does it matter for ACA rules?
The IRS may treat multiple businesses as one employer if they share ownership, family relationships, or services — even with separate tax IDs. When aggregated, all employees across the entities count together, which can push a group over the 50-employee ALE threshold and trigger ACA reporting and penalties. Read the full blog post
2. Should small employers self-administer state continuation instead of using a TPA?
Usually no. State continuation rules — like those in Texas — often have multiple timelines, dependent-specific rules, and no model notices, making self-administration risky. A TPA can manage notices, deadlines, eligibility, and premiums for a low cost and significantly reduce compliance exposure. Read the full blog post
3. What is the Gag Clause Attestation, and who is responsible for filing it?
The annual Gag Clause Attestation confirms a group health plan has no prohibited restrictions on accessing cost, quality, or claims data. Fully insured carriers typically file automatically, while self-funded and level-funded employers must ensure the attestation is submitted — and failure to file can lead to federal penalties or audit issues. Read the full blog post
4. When does Medicare become secondary to a group health plan under the 20-employee rule?
Medicare is secondary when an employer has 20 or more employees on each working day in at least 20 weeks during the current or prior year (weeks don’t need to be consecutive). Once the threshold is met, the group plan is primary for the rest of that year and the entire following year, making accurate headcounts and MSP questionnaires essential. Read the full blog post
5. How long does COBRA last?
It depends on the qualifying event: most employee-triggered events allow 18 months, while dependent-triggered events (death, divorce, aging out) allow 36 months, with disability extensions reaching 29 months. Second qualifying events can also extend dependent coverage to 36 months, and small employers may instead follow state continuation rules. Read the full blog post
6. How long can an employer make new hires wait for health coverage?
Employers may use an orientation period of up to one month, a 90-day waiting period, and (if drafted correctly) a 1,200-hour eligibility rule, but Applicable Large Employers must still offer coverage by the first day of the fourth full calendar month to avoid ACA penalties. The key is using the right terminology and not stacking these rules in a way that delays coverage too long. Read the full blog post
7. Can a company offer health coverage to 1099 employees — and is it a good idea?
Many carriers allow 1099 workers to enroll if they consistently work full-time hours, but the group must qualify without them, and all eligible contractors must receive the same coverage, contributions, and participation rules as W-2 employees. However, offering employee-style benefits increases worker-classification risk, so many employers choose not to do it. Read the full blog post
8. Do employers have to keep paying their share of health insurance premiums during FMLA leave?
Yes — covered employers must continue paying their normal premium share and maintain the employee’s coverage as if they were actively working. The employee must still pay their portion (through pay-as-you-go, catch-up, or prepayment), and coverage can only be terminated for non-payment after proper notice and a 30-day grace period. Read the full blog post
9. What’s the difference between Section 125 nondiscrimination testing and Section 105(h) testing?
Section 125 testing applies to cafeteria plans and ensures pre-tax benefits don’t favor highly compensated or key employees; failures make certain pre-tax elections taxable. Section 105(h) applies only to self-insured medical plans (including HRAs) and uses a different definition of highly compensated individuals; failures make excess reimbursements taxable to those HCIs. Read the full blog post
10. What happens to Premium Tax Credits (PTCs) in 2026 if Congress doesn’t extend the enhanced subsidies?
Now that the government shutdown has ended and Congress has not yet extended the enhanced PTCs, the system will revert to the original ACA formula in 2026, capping what families pay for the benchmark Silver plan at a set percentage of income. Our Tools section includes a chart showing the maximum monthly contributions for different household sizes and income levels if the enhanced credits are not extended. Read the full blog post
Wrapping Up
We hope this quick roundup was helpful and gave you a fast, useful refresher on several issues that come up throughout the year. If even one of these helps you answer a client’s question a little more quickly, then this special Thanksgiving edition has done its job. And we’ll continue to add to the library in the weeks and months to come.
We’re grateful for each of you — and we look forward to continuing to support brokers, employers, and anyone who wants clear, practical benefits guidance.
Have a wonderful Thanksgiving!
-Eric and Kyle