In early 2016, reporting under the Affordable Care Act will be required from all employers offering qualified health plans. Only employers with fewer than 50 full-time equivalents (FTE) who do not offer a qualified health plan are not required to file.
The type of reporting and who is responsible for the filing depends on the size of the employer and whether their health insurance benefits plans are self-insured or fully insured. Many employers still have questions about their responsibilities, and we want to make our members aware of the forms they will be responsible for filing at the beginning of the year.
Under IRC Section 6055, employers must report all covered individuals enrolled in plans that meet minimum essential coverage (MEC) requirements of the ACA. This information is to be used by the IRS to audit individuals’ compliance with the individual mandate.
- Employers with fewer than 50 FTE and who are fully insured should check with their carrier to make sure Forms 1095-B are completed and sent to covered individuals and the IRS along with transmittal Form 1094-B. Carriers are expressly responsible for taking care of this reporting.
- If self-insured, employers with fewer than 50 FTE must complete Form 1095-B and send to covered individuals and the IRS along with a completed transmittal Form 1094-B.
- Employers with 50 or more FTE, including employers with between 50 and 99 FTEs and who are fully insured should check with their carrier to make sure Forms 1095-B are completed and sent to individuals and the IRS along with transmittal Form 1094-B.
- Employers with 50 or more FTE, including employers with between 50 and 99 FTEs and who are self-insured must complete Form 1095-C and send to each covered individual and to the IRS along with a completed transmittal Form 1094-C.
Under IRC Section 6056 Applicable Large Employers with 50 or more full-time equivalents must report whether they offered substantially all full-time employees and dependents MEC and the months MEC was available. This reporting is based on the employer shared responsibility provision of the ACA. While employers with between 50 and 99 employees were not required to offer MEC in 2015, they must still meet reporting requirements.
- Employers who are self-insured will meet this reporting obligation when they complete the 1094-C transmittal form and 1095-C individual statement for the IRC Section 6055 requirements.
- Employers who offer fully insured health care plans use the 1094-C transmittal form and 1095-C individual statement (except Part III).
- Employers who do not provide health coverage must report that fact under this requirement by completing the Form 1095-C (except Part III) individual statement for all full-time employees, and sending a copy to the IRS with the 1094-C transmittal form.
Reporting must include COBRA recipients and retirees covered under the employer’s health plan as well.
Penalties for non-compliance are $250 for each missed return ($500 for intentionally disregarding the reporting requirements), up to a maximum penalty of $3,000,000 (no cap if intentionally disregarding requirements).
This reporting is quite complicated, and forms can be difficult to fill out. MSEC has called on accountants to help members with these forms, but many do not have the bandwidth to assist new clients. Employers should contact their benefits brokers, payroll service, and tax advisors now to determine the type of reporting help they can expect to receive. On a positive note, for the 2015 filing, the IRS has said it will accept a good-faith effort and will overlook some mistakes in filling out the form.
MSEC is working on developing resources to help members prepare to meet these reporting requirements.
Beginning November 2, MSEC’s weekly Hot Topics will include a column devoted to frequently asked reporting requirement questions.