# Benefits Administration Glossary

> 50 terms from the Workforce book's Benefits Administration part, each defined in a line and linked to the chapter that explains it.

- **834:** the HIPAA benefit enrollment and maintenance transaction (ASC X12N 005010X220A1) a plan sponsor or its platform sends a carrier to add, change, terminate or verify members ([Carrier Connections & the 834](https://www.syntaqx.com/books/workforce/carrier-connections#the-834-in-one-page)).
- **999:** the implementation acknowledgment saying an X12 file was or wasn't syntactically valid ([Carrier Connections & the 834](https://www.syntaqx.com/books/workforce/carrier-connections#acknowledgments)).
- **Administrative period (ACA):** an optional gap of up to 90 days between a measurement period and its stability period, used to compute status and run enrollment ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#who-is-full-time)).
- **Affordability safe harbor:** a test of the employee's share of the lowest-cost self-only minimum value plan against W-2 box 1 wages, the rate of pay or the poverty line, which protects the employer from the 4980H(b) payment (9.96% for 2026) ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#affordability-and-minimum-value)).
- **Applicable large employer (ALE):** an employer, counted with its controlled group, that averaged at least 50 full-time employees including full-time equivalents in the prior calendar year, and so is subject to section 4980H and 1094-C and 1095-C reporting ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#who-is-covered-applicable-large-employer-status)).
- **Applicable premium (COBRA):** the plan's cost of coverage for similarly situated active participants, fixed before each 12-month determination period, on which the 102% (or 150%) COBRA premium is computed ([COBRA & State Continuation](https://www.syntaqx.com/books/workforce/cobra#elections-and-premiums)).
- **Average enrollee premium:** a small group composite rate computed from per-member ACA rates and fixed for the plan year ([Benefits Administration Platforms](https://www.syntaqx.com/books/workforce/benefits-platforms#the-data-model-plans-rates-and-eligibility)).
- **Broker of record:** the insurance agency that places and services an employer's coverage for a line, and often the channel through which the employer gets its benefits administration platform ([Benefits Administration Platforms](https://www.syntaqx.com/books/workforce/benefits-platforms#brokers-as-a-channel)).
- **Change file:** an 834 carrying only the members that changed, identified by BGN08 code 2 ([Carrier Connections & the 834](https://www.syntaqx.com/books/workforce/carrier-connections#change-files-and-full-files)).
- **Change in status:** an event (marriage, divorce, birth, a change in employment status, a dependent gaining or losing eligibility, a move) on which a cafeteria plan may permit a consistent mid-year election change under Treas. Reg. 1.125-4 ([Enrollment & Life Events](https://www.syntaqx.com/books/workforce/enrollment-and-life-events#the-three-windows)).
- **Companion guide:** a carrier's or exchange's document stating which parts and values of the 834 implementation guide it uses ([Carrier Connections & the 834](https://www.syntaqx.com/books/workforce/carrier-connections#the-834-in-one-page)).
- **Comparability (HSA):** the rule that employer HSA contributions made outside a cafeteria plan be the same amount or percentage of the deductible for comparable employees with the same category of coverage ([HSAs, FSAs & HRAs](https://www.syntaqx.com/books/workforce/hsa-fsa-and-hras#payroll-contributions-seed-money-and-comparability)).
- **Consistency rule:** the requirement that a mid-year cafeteria plan election change be on account of and correspond with the change in status that permitted it ([Enrollment & Life Events](https://www.syntaqx.com/books/workforce/enrollment-and-life-events#the-three-windows)).
- **Coverage tier:** the set of people an election covers (employee only, employee plus spouse, employee plus children, family), the unit most employer plans price by ([Enrollment & Life Events](https://www.syntaqx.com/books/workforce/enrollment-and-life-events#coverage-tiers-and-rates)).
- **Decision support:** tools that help employees compare plans and estimate total cost during enrollment, reading the same plan and rate data the election saves ([Benefits Administration Platforms](https://www.syntaqx.com/books/workforce/benefits-platforms#decision-support)).
- **Election notice (COBRA):** the notice offering continuation coverage, due 14 days after the administrator learns of the qualifying event, or 44 days after the event when the employer is the administrator ([COBRA & State Continuation](https://www.syntaqx.com/books/workforce/cobra#the-notices-and-their-clocks)).
- **Employer shared responsibility payment:** the section 4980H assessable payment an ALE owes when a full-time employee receives a premium tax credit; $3,340 a year per full-time employee (less 30) under 4980H(a) and $5,010 per credit recipient under 4980H(b) for 2026 ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#the-two-penalties-worked)).
- **Evidence of insurability (EOI):** individual underwriting a group life or disability carrier requires for coverage above the guaranteed issue amount, for late entrants or for increases; the excess is pending until approved ([Enrollment & Life Events](https://www.syntaqx.com/books/workforce/enrollment-and-life-events#evidence-of-insurability)).
- **Form 1094-C:** an ALE member's transmittal to the IRS with monthly offer indicators and full-time and total employee counts ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#forms-1094-c-and-1095-c)).
- **Form 1095-C:** the statement an ALE files and furnishes for each full-time employee, with monthly offer (line 14), lowest-cost contribution (line 15) and safe harbor (line 16) codes ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#forms-1094-c-and-1095-c)).
- **Full file (Verify):** an 834 listing all current members, identified by BGN08 code 4, used periodically to confirm the sender's and carrier's records agree ([Carrier Connections & the 834](https://www.syntaqx.com/books/workforce/carrier-connections#change-files-and-full-files)).
- **Full-time employee (ACA):** an employee with at least 30 hours of service a week on average, or 130 hours in a calendar month ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#who-is-full-time)).
- **Full-time equivalent (FTE):** the hours of employees who aren't full-time, capped at 120 each per month and divided by 120, counted only to determine ALE status ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#who-is-covered-applicable-large-employer-status)).
- **Grace period (health FSA):** up to two and a half months after the plan year during which new expenses can be paid from the prior year's balance; a plan can't also have a carryover ([HSAs, FSAs & HRAs](https://www.syntaqx.com/books/workforce/hsa-fsa-and-hras#health-fsas-uniform-coverage-carryover-and-grace)).
- **Guaranteed issue:** the amount of group life or disability coverage an eligible employee gets without evidence of insurability ([Enrollment & Life Events](https://www.syntaqx.com/books/workforce/enrollment-and-life-events#evidence-of-insurability)).
- **Health FSA carryover:** a cafeteria plan feature letting up to $680 of unused 2026 health FSA money carry into the next plan year ([HSAs, FSAs & HRAs](https://www.syntaqx.com/books/workforce/hsa-fsa-and-hras#health-fsas-uniform-coverage-carryover-and-grace)).
- **High deductible health plan (HDHP):** a health plan meeting the year's minimum deductible and out-of-pocket maximum ($1,700 and $8,500 self-only for 2026), required for HSA eligibility; bronze and catastrophic exchange plans qualify from 2026 ([HSAs, FSAs & HRAs](https://www.syntaqx.com/books/workforce/hsa-fsa-and-hras#hsa-eligibility-and-the-hdhp)).
- **HIPAA special enrollment:** a group health plan's required opportunity, of at least 30 days (60 for Medicaid and CHIP), to enroll after loss of other coverage, marriage, birth, adoption or placement, with coverage from the birth or adoption date or the first of the month after the request ([Enrollment & Life Events](https://www.syntaqx.com/books/workforce/enrollment-and-life-events#hipaa-special-enrollment)).
- **Hour of service:** each hour an employee is paid, or entitled to payment, for work, plus paid leave hours, the unit of ACA full-time and ALE counts ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#who-is-covered-applicable-large-employer-status)).
- **Individual coverage HRA (ICHRA):** an employer-funded HRA that reimburses individual market or Medicare coverage, offered by employee class with minimum class sizes, a 3:1 age ratio and a 90-day notice ([HSAs, FSAs & HRAs](https://www.syntaqx.com/books/workforce/hsa-fsa-and-hras#ichra)).
- **Initial measurement period:** a 3- to 12-month look-back period for a new variable hour, seasonal or part-time employee, which with its administrative period must end by the last day of the first calendar month after the first anniversary ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#who-is-full-time)).
- **Last-month rule:** the HSA rule treating someone eligible on December 1 as eligible all year, subject to a testing period through the next year ([HSAs, FSAs & HRAs](https://www.syntaqx.com/books/workforce/hsa-fsa-and-hras#the-hsa-limit-month-by-month)).
- **Letter 226-J:** the IRS's initial letter proposing an employer shared responsibility payment, answered on Form 14764 with corrections on Form 14765 within at least 90 days ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#letter-226-j)).
- **List bill:** a carrier's periodic invoice computed from its census, with a line per covered employee or a total by tier, which the employer reconciles to enrollment and deductions ([Carrier Connections & the 834](https://www.syntaqx.com/books/workforce/carrier-connections#reconciling-carrier-invoices)).
- **Look-back measurement method:** determining ACA full-time status from hours over a past measurement period of up to 12 months, held for a stability period of at least six months ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#who-is-full-time)).
- **Maintenance type code:** the 834 INS03 value saying what a member record does: 021 addition, 001 change, 024 cancellation or termination, 025 reinstatement, 030 audit or compare ([Carrier Connections & the 834](https://www.syntaqx.com/books/workforce/carrier-connections#the-834-in-one-page)).
- **Match true-up:** a year-end employer contribution that pays the difference between a plan's annual match formula and the per-payroll matches actually made ([401(k) Deferrals & Remittance](https://www.syntaqx.com/books/workforce/retirement-plan-deferrals#matches-and-true-ups)).
- **Mini-COBRA (state continuation):** a state law giving continuation rights under insured plans, usually for employers below COBRA's 20-employee threshold or as an extension of it, with its own duration, premium cap and administrator ([COBRA & State Continuation](https://www.syntaqx.com/books/workforce/cobra#state-continuation)).
- **Plan compensation:** the plan document's definition of pay on which deferral percentages and matches are computed, capped at $360,000 for 2026 ([401(k) Deferrals & Remittance](https://www.syntaqx.com/books/workforce/retirement-plan-deferrals#plan-compensation)).
- **Qualified beneficiary:** a covered employee, spouse or dependent child who loses group health coverage because of a qualifying event and has an independent right to elect COBRA ([COBRA & State Continuation](https://www.syntaqx.com/books/workforce/cobra#qualifying-events-and-beneficiaries)).
- **Qualified small employer HRA (QSEHRA):** an HRA for employers that aren't ALEs and offer no group health plan, limited to $6,450 self-only and $13,100 family for 2026, with a 90-day notice and W-2 code FF ([HSAs, FSAs & HRAs](https://www.syntaqx.com/books/workforce/hsa-fsa-and-hras#qsehra)).
- **Qualifying event (COBRA):** an event that causes loss of group health coverage: termination other than for gross misconduct, reduced hours, Medicare entitlement, divorce or legal separation, death, or a child's loss of dependent status ([COBRA & State Continuation](https://www.syntaqx.com/books/workforce/cobra#qualifying-events-and-beneficiaries)).
- **Recordkeeper file:** the per-payroll record of contributions by source, loans and census data payroll sends a 401(k) recordkeeper with the deposit, totaling to the remittance ([401(k) Deferrals & Remittance](https://www.syntaqx.com/books/workforce/retirement-plan-deferrals#the-payroll-to-recordkeeper-file)).
- **Roth catch-up rule:** SECURE 2.0 section 603 as implemented by TD 10033: catch-up contributions of a participant whose prior-year FICA wages from the employer exceeded the threshold ($150,000 of 2025 wages for 2026) must be Roth ([401(k) Deferrals & Remittance](https://www.syntaqx.com/books/workforce/retirement-plan-deferrals#the-roth-catch-up-rule)).
- **Self-Correction Component (SCC):** the 2025 VFCP option to self-correct late participant contributions with lost earnings of $1,000 or less, remitted within 180 days, by online notice ([401(k) Deferrals & Remittance](https://www.syntaqx.com/books/workforce/retirement-plan-deferrals#late-deposits-and-vfcp)).
- **Small plan safe harbor (deposits):** the DOL rule that participant contributions to a plan with fewer than 100 participants are timely if deposited by the 7th business day after withholding ([401(k) Deferrals & Remittance](https://www.syntaqx.com/books/workforce/retirement-plan-deferrals#remittance-timing)).
- **Stability period:** the period during which an employee's ACA status from a look-back measurement holds regardless of current hours, at least six months and no shorter than the measurement period ([The ACA Employer Mandate & 1095-C](https://www.syntaqx.com/books/workforce/aca-employer-mandate#who-is-full-time)).
- **Uniform coverage:** the health FSA rule that the full annual election is available from the start of the coverage period, regardless of contributions so far ([HSAs, FSAs & HRAs](https://www.syntaqx.com/books/workforce/hsa-fsa-and-hras#health-fsas-uniform-coverage-carryover-and-grace)).
- **Voluntary Fiduciary Correction Program (VFCP):** the DOL program for correcting fiduciary breaches such as late deposits of participant contributions, with excise tax relief under PTE 2002-51 ([401(k) Deferrals & Remittance](https://www.syntaqx.com/books/workforce/retirement-plan-deferrals#late-deposits-and-vfcp)).
- **Waiting period:** the time before a new employee's group health coverage starts, which may not exceed 90 calendar days ([Enrollment & Life Events](https://www.syntaqx.com/books/workforce/enrollment-and-life-events#the-three-windows)).

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