Larger employers [those with 50 or more full-time equivalents (FTEs)] and sponsors of self-insured plans are required to file information returns to share with IRS and employees. The reports must be given to employees by January 31, 2016 for the 2015 coverage year and must be filed with the IRS by February 28 (March 31 if filed electronically). The forms (1095-B, 1095-C) will be used to determine compliance with the ACA’s individual and employer mandates. The final versions of the forms with instructions were released earlier this month.
Reporting is based on a calendar year, even if the employer has a non-calendar year plan. For a complete overview of the reporting requirements, see this matrix: 6055-6056 Reporting Matrix
Fully Insured Plans Employees who are offered coverage through a fully insured employer plan will receive two forms annually (by January 31):
- “Applicable Large Employers” (employers with 50 or more full-time equivalents) with fully insured plans will provide Form 1095-C to all full-time employees, whether or not they enrolled in the employer’s health plan. The forms are required to be mailed; however, a recipient may consent to receive the statement electronically. Fully insured employers will complete Parts I & II of Form 1095-C. This information will be used by the IRS to determine if the employer satisfies the employer mandate required for each calendar month of 2015. Form 1095-C is also used to determine employee eligibility for premium tax credits. A transmittal form (1094-C) must be attached to any Forms 1095-C filed by an employer.
- Thankfully, health insurers will provide Form 1095-B to all employees enrolled in fully insured group coverage. The information on this form confirms if an employee (and his or her dependents) on the group plan has satisfied the individual mandate for each calendar month in the reporting year.
Self Funded Plans Employees who are offered coverage through a self funded plan will generally receive one form annually (by January 31).
- Employers with fewer than 50 FTEs (full time equivalents) complete Forms 1094-B and 1095-B.
- Employers with 50 or more FTEs are considered “Applicable Large Employers” and are subject to the employer mandate. Those which offer a self funded health plan must complete Form 1095-C, Parts I, II and III, for any employee who enrolls in the health coverage–whether or not the employee is a full-time employee for any calendar-year month. Part III requires self funded employers to provide Social Security Numbers (SSNs) of employees and family members enrolled in coverage. As this may be a challenge to collect, we advise you to take steps to collect that data early in the year.
The Insurance Group is prepared to assist you in navigating the complex landscape of Reform and its reporting requirements. Please contact a member of our benefits practice for additional assistance.