ABD Office Hours. Health Care Reform Information Reporting

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1 ABD Office Hours Health Care Reform Information Reporting New Draft Forms and Instructions Show Employers What to Track in 2015 Click here for a recording of the Webinar Brian Gilmore Lead Benefits Counsel November 6, 2014

2 A Premier Partnership ACA ADVANTAGE Pay or Play Hours Tracking / 6056 Reporting Services ACA Advantage: Significant discount available for ABD clients Fee structures tailored to employer size and services performed Full service model for employers with up to 1,000 employees: ABD Client Annual Fee: $ 1,875 (Standard Non-Client Fee: $2,500) ABD Client PEPM Fee: $3.75 (Standard Non-Client Fee: $5.00) See the ACA Advantage Product Demo:

3 Background The ACA added two new tax code sections: 6055 & : Requires providers of health coverage to report to the IRS and covered individuals that the persons were covered by minimum essential coverage. This will demonstrate that each person has satisfied their individual mandate, and therefore will not be subject to the tax penalty. 6056: Applies to applicable large employers or ALEs subject to the employer mandate pay or play rules generally employers with at least 50 full-time employees, including full-time equivalent employees. This will be used to determine whether the employer is subject to any pay or play penalties under 4980H. It will also be used to determine whether the individual is eligible for the premium tax credit on the Exchange.

4 Which Employers Need to Report? Self-Insured Medical Plan All employers with a self-insured medical plan must report. Employers under 50 full-time employees (plus full-time equivalents) will be reporting only for 6055 (minimum essential coverage). Employers that are applicable large employers will report both for 6055 (minimum essential coverage) and 6056 (employer mandate). Insured Medical Plan Only applicable large employers those with 50 or more full-time employees (plus full-time equivalents). FOR INSURED PLANS, THE INSURANCE CARRIER REPORTS FOR 6055 (MINIMUM ESSENTIAL COVERAGE). However, the insurance carrier will not report for 6056 (employer mandate) that is always the employer s responsibility.

5 Which Employers Need to Report? Flow Chart Is the medical plan fully insured? NO YES ALE? ALE? YES NO YES NO 6055 & (MEC only) 6056 NONE! Form 1094-C Form 1094-B Form 1094-C N/A Form 1095-C Form 1095-B Form 1095-C N/A Part III (MEC): Yes N/A Part III (MEC): No N/A 2013 ABD Insurance & Financial Services. License #0H55918

6 What are the Forms? 1094-C Transmittal Form Think of this as the cover sheet for the Forms 1095-C. Each member company within the controlled group must file a separate Form 1094-C. Must be one Authoritative Transmittal, even if multiple Forms 1094-C filed. This will include aggregate information for all full-time employees of the entire controlled group. Information Reported Name, contact information, and EIN of the employer.

7 2013 ABD Insurance & Financial Services. License #0H55918

8 What are the Forms? 1094-C Transmittal Form Think of this as the cover sheet for the Forms 1095-C. Each member company within the controlled group must file a separate Form 1094-C. Must be one Authoritative Transmittal, even if multiple Forms 1094-C filed. This will include aggregate information for all full-time employees of the entire controlled group. Information Reported Name, contact information, and EIN of the employer. Whether any streamlined reporting or transitional relief applies: e.g., full-time employee delayed effective date to 2016 plan year. e.g., Non-calendar year plan delayed effective date until 2015 plan year begins.

9 2013 ABD Insurance & Financial Services. License #0H55918

10 What are the Forms? 1094-C Transmittal Form Think of this as the cover sheet for the Forms 1095-C. Each member company within the controlled group must file a separate Form 1094-C. Must be one Authoritative Transmittal, even if multiple Forms 1094-C filed. This will include aggregate information for all full-time employees of the entire controlled group. Information Reported Name, contact information, and EIN of the employer. Whether any streamlined reporting or transitional relief applies: e.g., full-time employee delayed effective date to 2016 plan year. e.g., Non-calendar year plan delayed effective date until 2015 plan year begins. Whether the employer offered MEC to at least 70% of full-time employees for each month in 2015 (95% for 2016 plan year).

11 2013 ABD Insurance & Financial Services. License #0H55918

12 What are the Forms? 1094-C Transmittal Form Think of this as the cover sheet for the Forms 1095-C. Each member company within the controlled group must file a separate Form 1094-C. Must be one Authoritative Transmittal, even if multiple Forms 1094-C filed. This will include aggregate information for all full-time employees of the entire controlled group. Information Reported Name, contact information, and EIN of the employer. Whether any streamlined reporting or transitional relief applies: e.g., full-time employee delayed effective date to 2016 plan year. e.g., Non-calendar year plan delayed effective date until 2015 plan year begins. Whether the employer offered MEC to at least 70% of full-time employees for each month in 2015 (95% for 2016 plan year). Total number of employees and full-time employees in each month.

13 2013 ABD Insurance & Financial Services. License #0H55918

14 2013 ABD Insurance & Financial Services. License #0H55918

15 What are the Forms? 1095-C Employer Offer Details and Coverage Form This form will be completed for every full-time employee Self-insured plans will also need to report all individuals covered Instructions are clear that employer can file only one 1095-C for each employee in the employer s controlled group Employees who work for more than one division of a company will have only one combined 1095-C reported for that work even though each division files a separate C Two main topics being reported: 1) 6055: Individuals covered by MEC for individual mandate compliance Self-insured plans only Employers with fully insured plans leave Part III blank. For insured plans, the insurance carrier uses the Form 1095-B to report MEC. Requires Social Security Number for all covered individuals 2) 6056: Employer mandate pay or play compliance for 4980H penalties All ALEs must report on this both self-insured and fully insured Requires detail as to plan s offer of coverage to all full-time employees

16 What are the Forms? 1095-C Employer Offer Details and Coverage Form Information Reported Employee name, address, and Social Security Number

17 2013 ABD Insurance & Financial Services. License #0H55918

18 What are the Forms? 1095-C Employer Offer Details and Coverage Form Information Reported Employee name, address, and Social Security Number Employer name, address, contact phone number, EIN

19 2013 ABD Insurance & Financial Services. License #0H55918

20 What are the Forms? 1095-C Employer Offer Details and Coverage Form Information Reported Employee name, address, and Social Security Number Employer name, address, contact phone number, EIN Offer of coverage details for each month of coverage: Was the employee offered coverage for each month? Was the offer affordable and did it provide minimum value? Did the offer include an offer of coverage for dependents?

21 2013 ABD Insurance & Financial Services. License #0H55918

22 What are the Forms? 1095-C Employer Offer Details and Coverage Form Information Reported Employee name, address, and Social Security Number Employer name, address, contact phone number, EIN Offer of coverage details for each month of coverage: Was the employee offered coverage for each month? Was the offer affordable and did it provide minimum value? Did the offer include an offer of coverage for dependents? Employee share of the monthly employee-only premium for the lowest cost plan option that provides minimum value

23 2013 ABD Insurance & Financial Services. License #0H55918

24 What are the Forms? 1095-C Employer Offer Details and Coverage Form Information Reported Employee name, address, and Social Security Number Employer name, address, contact phone number, EIN Offer of coverage details for each month of coverage: Was the employee offered coverage for each month? Was the offer affordable and did it provide minimum value? Did the offer include an offer of coverage for dependents? Employee share of the monthly employee-only premium for the lowest cost plan option that provides minimum value What affordability or other 4980H safe harbor applies: Form W-2 affordability safe harbor Federal poverty line affordability safe harbor Rate of pay affordability safe harbor Non-calendar year transition relief applies for any month

25 2013 ABD Insurance & Financial Services. License #0H55918

26 What are the Forms? 1095-C Employer Offer Details and Coverage Form Information Reported SELF-INSURED PLANS ONLY Self-insured plans only will include MEC coverage information in Part III of the Form 1095-C: Names of all covered individuals

27 2013 ABD Insurance & Financial Services. License #0H55918

28 What are the Forms? 1095-C Employer Offer Details and Coverage Form Information Reported SELF-INSURED PLANS ONLY Self-insured plans only will include MEC coverage information in Part III of the Form 1095-C: Names of all covered individuals SSNs of all covered individuals Must make reasonable efforts to obtain the SSN for all covered individuals Requires three attempts to solicit the SSN: 1) Initial solicitation at the time the relationship is established 2) If not received, second solicitation by December 31 of that year (by January 31 of the following year if the relationship begins in December) 3) If not received, third solicitation by December 31 of the following year Enter date of birth for any covered individuals who don t provide the SSN

29 2013 ABD Insurance & Financial Services. License #0H55918

30 What are the Forms? 1095-C Employer Offer Details and Coverage Form Information Reported SELF-INSURED PLANS ONLY Self-insured plans only will include MEC coverage information in Part III of the Form 1095-C: Names of all covered individuals SSNs of all covered individuals Must make reasonable efforts to obtain the SSN for all covered individuals Requires three attempts to solicit the SSN: 1) Initial solicitation at the time the relationship is established 2) If not received, second solicitation by December 31 of that year (by January 31 of the following year if the relationship begins in December) 3) If not received, third solicitation by December 31 of the following year Enter date of birth for any covered individuals who don t provide the SSN Months of coverage (not just offered coverage, but actually enrolled) for all covered individuals in the plan

31 2013 ABD Insurance & Financial Services. License #0H55918

32 What Are the Due Dates? Form 1095-C: To Employees Must be furnished by January 31 of the following year February 1, 2016 first due date because 1/31/16 is a Sunday Forms 1094-C and 1095-C to the IRS Due date depends on whether the employer files electronically Paper: Must be furnished by February 28 of the following year February 29, 2016 first due date because 2/28/16 is a Sunday Electronic: Must be furnished by March 31 of the following year Employers that file 250 or more returns must file with the IRS electronically

33 What Happens If We Make a Mistake? Same Penalties as Apply for Forms W-2 General penalty is $100 for each incorrect return Total fine not to exceed $1,500,000 Penalty reduced to $30 if the corrected return is filed within 30 days after the required filing date total fine max reduced to $250,000 Penalty reduced to $60 if corrected by August 1 of the year in which the filing due total fine max reduced to $500,000 Special Good Faith Efforts Rule for 2016 For the Forms 1094-C and 1095-C filed at the beginning of 2016, a good faith efforts standard applies The IRS will not impose the penalties described above if the employer can show that is has made good faith efforts to comply with the information reporting requirements Applies to incorrect or incomplete information (including SSNs)

34 A Premier Partnership ACA ADVANTAGE Pay or Play Hours Tracking / 6056 Reporting Services ACA Advantage: Significant discount available for ABD clients Fee structures tailored to employer size and services performed Full service model for employers with up to 1,000 employees: ABD Client Annual Fee: $ 1,875 (Standard Non-Client Fee: $2,500) ABD Client PEPM Fee: $3.75 (Standard Non-Client Fee: $5.00) See the ACA Advantage Product Demo:

35 Thank You Brian Gilmore Lead Benefits Counsel For more information, please contact your ABD Team Member November 6, 2014