Everything Employers Need To Successfully Implement And Manage The Plan

Invoice Preferences

Two choices. Invoice format: a straightforward version broken down by employee, or a detailed version breaking out the fees that make up your health plan. Invoice recipient: the email address of whoever on your team should actually receive the invoice each month — name a person who will read it, not a general inbox.

Company Information

Six fields: your DBA name, company website, a short description of the company, business phone, business address, and your EIN. The EIN is worth a second look — it flows into your tax and compliance filings, and a transposed digit surfaces months later at filing time.

Then Verification Documents

Separately from these fields, the portal asks for two uploads — EIN paperwork and a government photo ID for your primary owner. That is what produces Business Verified, and until it clears, automatic payments stay off. It needs a second person, so read the next block before you start.

EIN Documentation

Upload one document showing your Employer Identification Number: an IRS Form SS-4 or an IRS 147C letter. If you can't find either, the 147C is the one to request — the IRS will reissue it, whereas the SS-4 is your original application.

Government-Issued Photo ID

For the primary owner of the organization, for identity verification. Accepted: a valid driver's license or state ID, or a passport. A license or state ID needs both the front and the back uploaded. This is a person-level requirement, not a company one — no company document substitutes for it.

Getting The Photo Accepted

Most rejections are photo quality, not eligibility. The portal requires:

• A clear color photo — black and white is rejected
• An actual photo, not a scan or photocopy
• All four edges of the card visible
• Text readable and the ID photo clear
• No glare or shadows across the card

Shoot it flat on a dark surface in indirect light. Overhead light is what causes the glare that gets uploads bounced.

What Has To Happen First

Your business has to be verified first, and that comes from the two verification document uploads — your EIN paperwork and the primary owner's photo ID. Once they clear, the Connect Bank Account screen shows Business Verified. Note what that box actually says: automatic payments turn on only after a bank account is connected. Verified but not connected means you are not done.

If The Screen Won't Load

The most common cause is a browser extension blocking Stripe's connection window — the portal itself flags this. Turn off ad blockers and privacy extensions for the page and try again. If you're on a locked-down work machine, a personal browser or asking IT to allow the page usually settles it.

If You Get Stuck

The portal has built-in guidance on that screen for what Stripe is, how your information is protected, why business verification is required, and what to do if your bank is not listed with Stripe — expand those questions before troubleshooting further. Still stuck, email Yuzu Account Management.

Employee Premium Contributions

For each plan, enter the monthly employee contribution toward premium. Enter $0 where there is none. Every plan in the group needs its own entry — even when the numbers are identical across plans. Where contributions vary by class, use your best estimate of the average monthly amount per individual subscriber. Any member of your team can fill the form in, but the Plan Sponsor confirms the figures. Required for the RxDC report under CAA Section 204, and the group cannot be finalized without it. Revise any time from the Compliance tab once active.

An HR Contact On The Group Team

Every group must designate a Human Resources contact. That role receives the onboarding reminder emails and the "Actively at Work" forms used to verify eligibility — so if the seat is empty, the requests have nowhere to land.

Human Resources  · required

Every group must have one. This role receives the onboarding reminder emails and the "Actively at Work" eligibility verification forms. Leave the seat empty and those requests have nowhere to land.

Privacy Officer  · optional

Available if you have someone holding that title — not required. It grants view-only access to sensitive data: coverage claims, coordination of benefits, individual claim detail and attachments. It is also the only role with access to the full report set.

Finance  · optional

No special portal permissions attach to the role itself. Useful for whoever reconciles the monthly invoice. Grant portal editing separately with the Is Admin toggle.

Legal  · optional

Available if you have in-house counsel or an equivalent. No special portal permissions attach to the role itself — grant portal editing separately with the Is Admin toggle.

Open Enrollment Toolkit

The full kit: announcement email, benefits-at-a-glance one-pager, plan comparison, election instructions and a meeting deck — branded to your organization.

• Announcement & reminder emails
• Employee-facing plan comparison
• Meeting presentation

Communication Templates

Pre-written, plain-language templates for the messages HR sends every year — new hire welcome, life event reminders, plan year reset, ID card instructions.

Employee Flyers

One-page handouts on the things members ask about most: $0 virtual care, using the Cigna network, prescription savings, and the wellbeing programs.

FAQ Documents

The member FAQ in printable form, plus an HR-facing version covering eligibility rules, waiting periods, proration and termination timing.

Compliance Materials

Required notices, the annual filing calendar, and the documentation you'll want on hand if you're ever audited.

ACA & COBRA Resources

ACA 1095 reporting requirements and timing, plus COBRA administration guidance for terminations and qualifying events.

PCORI Fee

Lumelight prepares. You sign and pay. Self-funded employers owe this as part of second-quarter taxes on IRS Form 720 (Box 133). Lumelight builds the form from plan data and emails it to your group contact for signature and payment — the same pattern as Form 5500. The fee is a per-member-per-year rate that adjusts annually and is based on covered lives, not employees, so every spouse and child counts. The portal's PCORI Fee Calculator shows the same math by the snapshot method: average covered lives × the IRS rate.

Forms 1094 & 1095

You file. Form 1095 reports each covered individual's minimum essential coverage; Form 1094 is the cover sheet that transmits them with group summary data. Under 50 full-time employees files the B versions, 50 or more files the C versions. The portal generates a 1095 per employee and one 1094 for the group. Due electronically by March 31.

Form 5500

Lumelight prepares. You sign. The annual return/report required under ERISA sections 104 and 4065 and Code sections 6057(b) and 6058(a). The portal produces a Form 5500 Data Summary Table from eligibility data collected across the plan year; Lumelight uses it to prepare the filing and emails it to your group contact for signature. You remain the plan sponsor and responsible party. Due the last day of the seventh month after your plan year ends.

Form MA 1099-HC

The subscriber files; you distribute. Massachusetts' state version of the 1095, used by residents to confirm coverage on their state return. Generated automatically for every Massachusetts resident who was a subscriber during any part of the prior calendar year. Due January 31. Dependents filing their own returns may need figures off the subscriber's form; it may be photocopied. If your group has no Massachusetts residents, it won't appear.

RxDC Report

Yuzu submits — but only if you complete one form. Prescription drug and health care spending data required under CAA Section 204. The PBM supplies most fields; Yuzu may submit P2, D1 and D2. Yuzu can only generate and submit on your behalf once Employee Premium Contributions are entered in the portal. Leave it blank and the obligation lands on you. Either way the Plan Sponsor remains responsible for meeting the requirement.

Creditable Coverage

Informational. Tells Medicare-eligible members whether the plan's drug coverage is at least as good as Part D — which lets them stay on the plan without a late-enrollment penalty later. The plans administered here generally offer creditable coverage; confirm against your Proof of Insurance letter. Members download it themselves from the Documents tab of the member portal.

Gag Clause Attestation

The plan attests, annually. CAA 2021 Division BB Section 201 bars agreements that restrict the plan from accessing provider-specific cost and quality information or de-identified claims data, or from sharing it with a business associate. Attestation goes directly to the Department through the Health Insurance Oversight System. Yuzu has prepared an attestation letter — a copy sits in the Compliance tab.

New York HCRA Surcharge

Your election. A surcharge on claims at HCRA-designated New York facilities. Electing to pay the state Public Goods Pool directly carries a 9.63% surcharge; non-electing payers who pay providers instead carry an additional 28.27%. Electing means filing monthly electronic reports — every month, payment due or not — dropping to annual filing after a year if liability stays under $25,000. Yuzu does not elect groups. Ask your Benefit Consultant whether your plan designer elects on your behalf.

Which Set Applies To You

Three thresholds decide your paperwork. Full-time headcount — under 50 files 1094-B/1095-B, 50 or more files 1094-C/1095-C. Massachusetts residents — any subscriber triggers Form MA 1099-HC. New York services — claims at HCRA facilities raise the Public Goods Pool election. Count all three before filing season, not during it.

Where To Find Everything

The Compliance tab in the left sidebar of the employer portal holds all of it: 1095s for every subscriber, Forms MA 1099-HC, the Form 5500 Data Summary, the PCORI Fee Calculator, the Gag Clause Attestation letter and the Employee Premium Contributions form. A dropdown pulls prior years' tax forms.

The PCORI Calculator's Window

The PCORI Fee Calculator appears when the filing window opens and stays available for one year after your plan year ends. It records the covered-lives count, the total fee, the applicable IRS deadline and the methodology. Pull it before the window closes. Note that Yuzu cannot file Form 720 for you — the form also carries unrelated excise taxes only you can report.

What You Hand To Employees

You must distribute Forms MA 1099-HC to your subscribers. You may distribute 1095s, but members can pull their own from the member portal, as they can their Proof of Insurance letter — point them there rather than fielding requests one at a time.

Effective Dates & Term

Your requested effective date is a non-binding request. The actual Effective Date is always the first day of a month. The initial contract runs twelve months from that date, and renewal contracts run in subsequent twelve-month periods. The employer may terminate only upon renewal.

Your Plan Year Is An Election

Section 10 of the contract has you elect either a plan year running from your effective date or a calendar year. You also elect whether COBRA is administered by the TPA or an outside vendor, and whether your contribution is a percentage or flat rate for each of the four tiers.

Billing, ACH & The 30th

Invoices arrive by email and are billed on the census of record as of the date the invoice generates — so census changes move your fees. Payment is due the 1st and drafted by ACH on or about the first business day. It is late after the 30th, at which point the group is subject to termination if not paid in full.

Termination Notice: 15 Days

Member and dependent terminations go to the MGA or TPA on the appropriate form at least fifteen days before the requested date. Miss that window and the termination is delayed no less than thirty days, with fees still owed for the delay. Terminating before the end of a term also requires the equivalent of ninety days of healthcare fees.

Underwriting Accuracy

The employer must report health changes to the Program before the approved effective date, even after rates are approved. Intentionally inaccurate health information during underwriting allows the Program to rescind back to the original effective date — meaning coverage was never in effect, and the employer accepts liability for claims incurred but not paid.

Eligibility & Good Standing

Coverage requires being an eligible member of Triad Benefits, LLC in good standing. Full time means 30 or more hours per week and under age 65; the Program may request wage and tax records as verification. Fees may be modified based on experience, utilization or demographic change, and the Program may decline to renew at its sole discretion.

Triad Benefits

The program. Managed by Health Cooperative Strategies. Triad Benefits, LLC is the entity named on your Group Contract, and membership in good standing is a condition of coverage. The program sets underwriting guidelines, healthcare fees, renewal terms and participation requirements.

Yuzu Health

The technology and TPA. Runs the employer and member portals, banking and claims funding, invoicing, and the RxDC submission. This is the name you'll see on billing. Yuzu also negotiates and defends out-of-network payment disputes on the plan's behalf.

Securus Benefits

The member-facing brand. The same Yuzu platform, presented to your employees as Securus Benefits. This is the name on ID cards, EOBs and member materials, and the care team members call for claims, eligibility, ID cards and help finding a provider.

Lumelight

The compliance firm. Prepares IRS Form 720 for the PCORI fee and Form 5500 from plan data, then emails them to your group contact for signature and payment. Watch your inbox at filing time — the signature and the accuracy are yours.

DisclosedRx

The pharmacy benefit manager. Formulary and tier placement, prior authorizations, mail order, specialty medications and copay assistance. Also supplies most of the fields in the annual RxDC report.

Your Benefit Consultant

Your advocate. Plan design, renewal strategy, claims review, budgeting, and escalation when an answer you got isn't the right one. Everything on this page can be routed through them if you'd rather not manage it directly.

Account Management

Plan configuration, compliance, group eligibility, and the contracts your group signs. All onboarding questions run through here, up through your first invoice. Vendor integration questions too.

Support

Future claims. Whether something will be covered, and eligibility questions looking forward. If the care hasn't happened yet, this is your inbox.

Claims

Claims already processed. Appeals, payment status, and eligibility as it affected how a claim was handled. If the care already happened, start here rather than with Support.

Accounting & Finance

Payments and payment status, reporting questions, and flexible funding policy — the arrangement where a group funds less than its maximum liability.

NSA Disputes

Open Negotiation initiations and Independent Dispute Resolution on out-of-network claims. Also where an outside vendor handling your disputes gets registered.

HRIS Configurations

HRIS and eligibility feed questions, and HRIS onboarding. If your employee data flows in from a payroll or HR system, configuration questions go here.