ACA 1095 Reporting. DPI FBS Conference 7/21/16

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1 ACA 1095 Reporting DPI FBS Conference 7/21/16 Disclaimer: Presentation being provided to DPI participants, which include some non BEACON employing units. The presentation contains basic ACA rules which should apply to all employing units. However, please be aware that some information included in the presentation is specific to BEACON processes and may not apply to all employing units. 1

2 What is a 1095-C Tax Form? Form 1095 C is the new Form required by the Affordable Care Act. Employer Provided Health Insurance Offer & Coverage Gives information about offers of health insurance and who was covered by the State Health Plan for 2015 including spouses and dependents It reports the health insurance coverage for each covered individual by month. March 31, 2016 was the deadline for providing the form to employees for the 2015 tax year Employees were able to file their tax return prior to receiving the Form 1095-C Employees should keep this form with their 2015 federal income tax records All full-time employees (30+ hrs) should get a 1095-C form Includes temp employees that averaged 30+ hours per week and were offered the high deductible plan FAQs on the IRS web site: Care-Information-Forms-for-Individuals 2

3 1095-C Tax Forms Distribution Forms for the 2015 tax year were sent to the external vendor (Benefitfocus) to print and mail after the employing unit verified the benefits data. Employees were scheduled to receive them by early April After the initial mailing, 1095-C forms were made available on the employees enrollment platform in the eenroll/benefitfocus system 3

4 How to obtain a re-print of the 1095-C Reprints were available in e-enroll/benefitfocus AFTER March 31, 2016

5 1095-C Correction Period Data Errors After the initial coverage/benefits data was sent to the IRS, errors were identified & provided to Benefitfocus to forward to the employing unit for correction and resubmission. BEACON found that most errors included incorrect dependent SSN. BEACON is currently researching the errors and trying to obtain corrected data for resubmission.

6 Re-print of the 1095-C during correction period NOTE: Reprints are NOT available if employing unit is making corrections Once corrections are resubmitted, reprints will be available again

7 1095-C Tax Forms Content Part 1 Employee/Employer identifying information Part 2 Offer information numerical codes that indicate: Minimum value offered to employee Minimum value offered to employee, spouse & dependents Minimum value offered, but did not enroll Not a full time employee / Not eligible Part 3 Coverage information for employee & dependents (The most important part of the form for most employees) Indicates months of coverage 7

8 Reading the 1095-C Tax Form-Example 1 John Q Employee had health insurance all 12 months of He did not cover any dependents under his medical plan. The lowest cost employee only plan available is $0. Note: $0 appear as blanks on line 15. 8

10 Reading the 1095-C Tax Form-Example 2 Mary J Smith had health insurance all 12 months of For May 2015 she had to pay full cost so the lowest cost employee only plan is $ In April 2015, she added one dependent who remained on her insurance for the rest of the year. 10

12 Reading the 1095-C Tax Form-Example 3 Bill Williams began work in March 2015 and had health insurance effective April 2015 through the rest of the year. He did not cover any dependents under his medical plan. The lowest cost employee only plan available is $0. 12

14 Reading the 1095-C Tax Form-Example 4 Sally Herman was offered medical insurance for all of The lowest cost employee only plan available is $0. She had the State Health Plan medical coverage from January through September only. She then dropped the State Health Plan and was covered by her spouse s insurance for October through December. 14

16 1095-C Form Coverage Errors Employees were directed to call State Health Plan Eligibility and Enrollment System with form questions: purpose of the form Employees are directed back to their agency HBR (BEACON) for coverage questions or coverage errors: Covered dependent or spouse is not listed Dependent or spouse coverage months are incorrect Employee s own coverage months are incorrect Confirm coverage errors in BEACON and send tickets to BEST subject line 1095-C correction No time estimate yet on when corrected forms will be issued

17 Additional ACA Responsibilities Employer Shared Responsibility Payment Employing Units have begun to receive notices from the Health Insurance Marketplace that they may be subject to the Employer Shared Responsibility Payment. This is a shared cost paid to the IRS when an employee is deemed eligible for advance payments of the premium tax credit (APTC) or cost sharing reductions (CSRs). (federal subsidies) This is generated from an employee s application for health coverage thru the Health Insurance Marketplace, where the employee reported that the employer: Didn t provide an offer of health coverage, OR The employer did provide an offer, but it wasn t affordable or did not provide minimum value, OR The employee was in a waiting period & unable to enroll. Employers can file an appeal if it is believed that a mistake has occurred & an offer was made for affordable, minimum value 17 coverage.

18 18 Additional ACA Responsibilities Employer Shared Responsibility Payment

19 Employer Shared Responsibility Payment Appeal Process Appeals are submitted to the Health Insurance Marketplace. Appeals must be submitted within 90 days of the date of the Marketplace notice. Appeals forms can be found: Mail form to: Health Insurance Marketplace 465 Industrial Blvd. London KT The appeal will NOT determine if the employing unit has to pay the Employer Shared Responsibility Payment. The IRS will determine that. The appeal may determine if the employee was eligible for help with the costs of coverage thru the Marketplace at the same time that the employer may have offered affordable/minimum value coverage. 19

20 20 Questions

21 Frequently Asked Questions For 1095 C Statements In April 2016, State of North Carolina employees will receive a new tax form called the IRS 1095-C. This form will contain detailed information about your personal health care coverage. It is important to keep this form for your 2015 tax records. 1. What is a Form 1095-C? The Affordable Care Act requires nearly all Americans to have health insurance. The 1095-C statements that will be generated by the State of North Carolina serve as documentation to the IRS about coverage offered to you. The form includes information about offers of health insurance along with information about covered dependents. It is important to keep this form with your tax records. The information from the form will be used to determine whether you will pay a penalty for failing to have health care coverage as required by the ACA. Think of the form as your proof of insurance for the IRS. 2. When will I get my Form 1095-C? Statements will be mailed to employee s mailing address by March 31, 2016, so employees should expect them in early April, If you believe you should have received a 1095-C but did not, please contact the State Health Plan Eligibility and Enrollment Center at Do I need to wait until I receive my Form 1095-C before I file my 2015 tax return? No. You do not have to wait to receive Form 1095-C to file your individual income tax return. You can use other forms of documentation, instead of the Form 1095 to prepare your tax return. Other forms of documentation that would provide proof of your insurance coverage include: insurance cards, explanation of benefits statements from your insurer, W-2 or payroll statements reflecting health insurance deductions, records of advance payments of the premium tax credit, and other statements indicating that you, or a member of your family, had health care coverage. 4. What should I do with my Form 1095-C? When you receive your 1095-C, keep it with your 2015 tax records. 5. Where will the 1095-C form be mailed? Forms will be mailed to the last known address in the State Health Plan eenroll system as of February 1, 2016.

22 6. Who receives a Form 1095-C? The State of North Carolina is required to send a 1095-C to any employee who was fulltime (worked an average of 30 or more hours per week) or who was enrolled in the State Health Plan medical benefits in This includes retirees, COBRA participants, and RIF employees enrolled in the State Health Plan. 7. Why did I get a Form 1095-C? If you were full-time (worked an average of 30 or more hours per week) or were enrolled in health insurance through the State Health Plan at any time during 2015, you should receive a 1095-C. 8. Why did I get more than one Form 1095-C? If you worked at more than one company or employer, you may receive a 1095-C from each. For example, if you worked at a state university and a BEACON agency during 2015, you may receive two separate statements. 9. Why didn t I get a Form 1095-C? If you were not full-time (worked less than 30 hours per week) and were not enrolled in health care coverage through your employer at any time during 2015, you should not receive a 1095-C. You may also not receive a 1095-C if you were not the primary insured. 10. How will the Form 1095-C impact my taxes? If you do not have health care coverage and do not qualify for an exemption, you may have to make a shared responsibility payment when you file your 2015 tax return. 11. What information is on the Form 1095-C? There are three parts to the form: Part 1 reports information about you and State of North Carolina. Part 2 reports information about the coverage offered to you by State of North Carolina, the affordability of the coverage offered, and the reason why you were or were not offered coverage. Part 3 reports information about the individuals covered under your plan, including dependents. 12. What do the codes on line 14 in Part II mean? These codes indicate whether an offer of health insurance was made to you. The most common codes are 1A You were offered health insurance coverage for this month. 1E You were offered health insurance coverage and had to pay full cost (employee plus employer share). 1H You were not offered health insurance coverage for this month. 13. What do the codes on line 16 in Part II mean? These codes indicate whether you accepted the offer of health insurance made to you. The most common codes are

23 2A You were not an employee for any day of this month. 2B You were a part-time employee (<30 hrs/wk) and did not enroll in State Health Plan. 2C You were enrolled in the State Health Plan for this month. 2D You were a full-time employee (30+ hrs/wk) but were not eligible for health insurance coverage for this month. 2G You were a full-time employee (30+ hrs/wk) and did not enroll in the State Health Plan for this month. 14. Will dependents that are covered on my medical plan also get 1095-C forms? No. The 1095-C statements are only sent to the person who is the primary individual insured, the policyholder. If your dependents are filing their own personal tax returns, you will need to provide them with a copy of the 1095-C statement for their tax records. 15. How do I receive additional copies of the 1095-C statement? After March 31, you may re-print a copy of the form from the State Health Plan eenroll system. Contact State Health Plan Eligibility and Enrollment Center at for assistance. 16. What if the coverage data (Part 3) for me or my dependents is incorrect? If the information on the form does not agree with your records, please contact your agency health benefits representative. 17. My dependent s Social Security Number (SSN) is blank or incorrect. Do I need a corrected form? No, an SSN for a dependent is not required on the 1095 form by the IRS for Please update your dependent s record in the State Health Plan e-enroll system to avoid issues in future years. 18. How do I determine if I am eligible for Premium Tax Credit or need to make a shared responsibility payment? Individuals should consult with a tax adviser to determine eligibility and requirements. 19. What if I have questions? If you have additional questions about your 1095-C, please contact State Health Plan Eligibility and Enrollment Center at Any tax related questions should be directed to your personal tax adviser. NOTE: These frequently asked questions (FAQ s) and corresponding answers are not intended to be tax advice. If you have any tax questions, you should contact your tax adviser.

25 4/2016 Instructions to help you complete the Employer Appeal Request Form Form Approved OMB No Using this form If you received a Marketplace notice stating that you may be subject to the Employer Shared Responsibility Payment, you can request an appeal by submitting this form or mailing in a letter that includes the information requested on this form. Use this form if you re appealing a notice you received from: The federally-facilitated Health Insurance Marketplace A state-based Marketplace operating in: California Colorado District of Columbia Kentucky Maryland Massachusetts New York Vermont This appeal may determine if an employee was eligible for help with the costs of coverage through the Marketplace at the same time that you may have offered them affordable health coverage that met the minimum value standard. This appeal will NOT determine if your organization has to pay the Employer Shared Responsibility Payment. Only the Internal Revenue Service (IRS), not the Health Insurance Marketplace or the Marketplace Appeals Center, can determine which employers are subject to the Employer Shared Responsibility Payment as stated under section 4980H of the Internal Revenue Code. IMPORTANT: For 2015, the Employer Shared Responsibility Payment will generally apply to employers with 100 or more full-time equivalent (FTE) employees, and may apply to certain employers with 50 or more FTE employees. Starting in 2016, the Employer Shared Responsibility Payment will apply to employers with 50 or more FTE employees. If you want to appeal a Small Business Health Options Program (SHOP) eligibility decision, visit HealthCare.gov/small-businesses/provide-shopcoverage/appeal-a-shop-decision/ for more information. Timeframe to request an appeal You must submit your appeal request form within 90 days of the date of your Marketplace notice. Designating a secondary contact How to submit this form You may authorize a secondary contact to help with your appeal. The secondary contact may act on your behalf, talk with the Marketplace Appeals Center, view your case file, and receive all correspondence regarding your appeal. To authorize a secondary contact complete Section 2: Designate a secondary contact. Complete and sign this form, and mail it with copies of any supporting documents to the address shown below. Health Insurance Marketplace Dept. of Health and Human Services 465 Industrial Blvd. London, KY You may also fax the form to a secure fax line: You ll receive all future correspondence about this appeal from the Marketplace Appeals Center. The Marketplace Appeals Center is different from the Health Insurance Marketplace.

26 What happens next? 1. We ll send you a notice letting you know that that we received your appeal request. If there s a problem with the appeal request, we ll tell you how to correct the issue. We ll also send a notice to the employee listed on the notice you received from the Marketplace. 2. We ll review your appeal including any additional documentation provided by you and/or the associated employee. We may request additional information. 3. We ll send appeal decision notices explaining the outcome of our review to you and to the associated employee. Additional help Language assistance services If you need language assistance in a language other than English, you have the right to get help and information in your language at no cost. Call the Marketplace Call Center at Accessibility To request an auxiliary aid or service, you can: Call ALT-FORM ( ). TTY users should call Send a fax to Send an to: AltFormatRequest@cms.hhs.gov Use this address only to send a letter requesting an auxiliary aid or service: Centers for Medicare and Medicaid Services Offce of Equal Employment Opportunity & Civil Rights (OEOCR) 7500 Security Boulevard, Room N Baltimore, MD Attn: CMS Alternate Format Team To submit your appeal request, see How to submit this form on page 1 of these instructions. Don t use Accessibility contact information to submit an appeal request. Questions Contact the Marketplace Appeals Center at TTY users should call Hours of operation are Monday through Friday, 7:30 a.m. to 8:30 p.m. Eastern Time (ET); and Saturday, 10:00 a.m. to 5:30 p.m. ET. Privacy and Use of Your Information The Marketplace protects the privacy and security of information about you that you ve provided. To view the Privacy Act Statement, go to HealthCare.gov/ individual-privacy-act-statement/. We re authorized to collect the information on this form and any supporting documentation, including Social Security numbers, under the Patient Protection and Affordable Care Act (Public Law No ), as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law No ), implementing regulations in 45 CFR part 155, subpart F, and the Social Security Act. For more information about the privacy and security of your information, visit HealthCare.gov/privacy/. Paperwork Reduction Act Disclosure Statement According to the Paperwork Reduction Act of 1995 (PRA), no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is The time required to complete this information collection is estimated to average 1 hour per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C , Baltimore, Maryland

27 Page 1 of 2 Employer Appeal Request Form Form Approved OMB No Appeal Request Form Employer Use this form to appeal a Marketplace determination that an employee was eligible for advance payments of the premium tax credit and cost-sharing reductions (if applicable) in part because your business didn t offer health coverage that met minimum value requirements and was affordable with respect to this employee. Please print in capital letters using black or dark blue ink only. SECTION 1: Tell us about the employer who s requesting this appeal. 1. Business Name Federal Employer ID Number (EIN) Primary business mailing address Suite # - City State ZIP code Name of the primary contact (First name, Middle initial, Last name) Title of primary contact Phone number - - Primary business mailing address Suite # City State ZIP code Phone number - - SECTION 2: Designate a secondary contact. (optional) This is someone who may act on your organization s behalf regarding this appeal request. Name of the secondary contact (First name, Middle initial, Last name) Organization name (if applicable) Phone number Title - - Secondary contact mailing address Suite # City State ZIP code Phone number - -

28 Page 2 of 2 SECTION 3: Tell us why you re appealing the Marketplace determination of this employee s eligibility for help with the costs of Marketplace coverage. What s the date on the Marketplace notice? (mm/dd/yyyy) / / What s the employee s first and last name? What s the employee s date of birth (if available)? / / What s the employee s Application ID # (if available on your notice)? An individual may qualify for help with the costs of Marketplace coverage if the coverage that s offered by an employer doesn t meet minimum value requirements or isn t affordable with respect to the employee. Use the space below to explain why this employee shouldn t have been eligible for advance payments of the premium tax credit and cost-sharing reductions (if applicable). Use extra paper, if necessary. If you re including documents to support your request, send us copies. Keep all original documents. SECTION 4: Signature By completing, signing, and dating below, I authorize the Marketplace Appeals Center to perform a review of whether the employer named on this form offered minimum essential coverage through an employer-sponsored plan that s considered affordable with respect to the relevant employee, and meets the minimum value standard. I understand I may request a copy of my Marketplace appeal record and that certain information about the relevant employee s eligibility determination may or may not be made available to me as described in 45 CFR (g)(2) and 45 CFR (h). By signing this form under penalty of perjury, I declare that I ve provided true answers to all the questions that I ve answered to the best of my knowledge. I know that I may be subject to penalties under federal law if I provide false information. Signature 1. Printed name of primary contact (First name, Middle name, Last name) Title Signature Date (mm/dd/yyyy) / /

Instructions to help you complete the Marketplace Eligibility Appeal Request Form

07/2015 Instructions to help you complete the Marketplace Eligibility Appeal Request Form Form Approved OMB No. 0938-1213 Use the right form to request an appeal Complete and mail the correct request form