ACA Update for Plan Advisors

Transcription

1 ACA Update for Plan Advisors 4/28/15 Webinar Jason Cogdill Benefits Attorney

2 This Session Quick update on recent developments Overview of big 3 items for 2015 Discussion of new IRS reporting requirements & what you need to know Your questions

3 ACA Update: Major Items #1: Health Insurance Marketplace New SEP ends Thurs 4/30; 2016 OE 11/1/15 1/31/16 #2: New Coverage Requirements for Group Plans No new items for 2015 #3: Individual Mandate In effect again for 2015; penalties increased #4: Employer Mandate (Play-or-Pay & Reporting) In effect for 2015 #5: Nondiscrimination Rule for Fully Insured Plans Still delayed; will apply likely

4 Recent Developments Very few! Relative calm since February April 16: EEOC released proposed regs on wellness programs, specifically relating to compliance with the ADA and the voluntary requirement No major changes for wellness plan compliance, but clarifications on key considerations to avoid liability Today: No news on King v. Burwell; expected that the Supreme Court will announce decision in June

5 Employer Mandate Refresher Two parts: (1) penalties ( Play-or-Pay ) (2) new reporting requirements Potential Penalties under 4980H(a) or 4980H(b) Effective beginning 1/1/15 for employers with 100 or more FT + FTE (determined during 2014*) Effective beginning 1/1/16 for employers with 50 or more FT + FTE (determined during 2015) Reporting Requirements Apply for 2015 calendar year for employers with 50 or more FT + FTE (determined during 2014*) 5

6 Overview of Reporting Requirements IRS Code 6055/6056 reporting Required for all Applicable Large Employers Including FT + FTE groups exempt from penalties in 2015 First reports due in early 2016 for 2015 calendar year Timelines & submission methods track W-2/W-3 rules 6055: Insurer or self-funded plan sponsor reporting 6056*: Plan sponsor reporting, including Form 1095-C to full-time employees & 1094-C to IRS Employer data items: list of 9 categories Forms & instructions finalized for 2014 (informational only) but not More guidance to come. Employer keys: (1) assess data tracking requirements; (2) examine need or options for outsourcing 6

7 3 Quick Points: What You Need To Know Requirement applies to all employers that had 50 or more FT + FTE during 2014 (any consecutive 6+ month period) Reporting data covers 2015 calendar year, regardless of plan year or plan status Nearly all employers will utilize two forms: Form 1095-C & Form 1094-C. Employers with self-funded plans will provide additional data but can use same forms C is the employee statement that, similar to annual W-2, must be provided to all employees by 1/31/16. Recipients are EEs that had full-time (eligible) status for at least one month in C is the IRS submittal, to be provided to IRS by 2/29/16 (or 3/31/16 if electronic), along with copies of all 1095-Cs 7

8 Under 50 groups What Must Be Filed? Small employer with fully insured plan No reporting required as long as prior year employee count remains under 50 FT + FTE Small employer with self-funded plan Employer must submit Form 1095-B to all covered individuals by 3/31/16 Employer must submit Form 1094-B to IRS by 2/29/16 (or by 3/31/16 if submitted electronically) Note: the small employer is still exempt from the employer mandate penalties this is simply a legal requirement due to self-funded status 8

9 50+ fully insured plan What Must Be Filed? Carrier is required to submit Form 1095-B to all covered individuals by 1/31/16, & Form 1094-B to IRS by 2/29/16 Employer must submit: Form 1095-C to each employee that was full-time for at least one month during 2015 (due by 1/31/16) Form 1094-C to IRS by 2/29/16, or 3/31/16if filed electronically 1094-C is transmittal form sent to IRS with copies of all Cs sent to full-time employees 9

10 50+ self-funded plans Employer must submit: What Must Be Filed? Form 1095-C to each employee that was full-time for at least one month during 2015 (due by 1/31/16) This single form will cover requirements of both 1095-B & 1095-C. Employer will be required to complete Part III info for all covered individuals (spouses & dependents included) Form 1094-C to IRS by 2/29/16, or 3/31/16if filed electronically 1094-C is a transmittal forms sent to IRS with copies of all 1095-Cs sent to employees. Note: Rules allow a 3rd party (TPA or carrier) to submit forms on behalf of employer. However, legal responsibility is the employer s as self-funded plan sponsor. 10

11 The Forms Form 1094-C Form 1095-C Instructions for 1094-C/1095-C Forms & instructions available at Employer FAQ also available 11

12 How We Will Assist You More details available soon from your sales rep One-page summary of key reporting details Additional training for your agency (via webinar) Option for agency-branded workshop to provide detailed training for your employer clients Continuing updates throughout

13 Overview By Employer Size & Plan Type <50 fully insured plan No reporting required 50+ fully insured plan Carrier: Form 1094-B; 1095-B Employer: Form 1094-C to IRS Form 1095-C to F/T EEs <50 self-funded plan Employer: Form 1094-B to IRS Form 1095-B to F/T EEs 50+ self-funded plan Employer: Form 1094-C to IRS Form 1095-C to F/T EEs Current (2014) forms are available with instructions Rules allow 3 rd party to handle, but even if outsourced, data from employer will be required in process Examples: Month-by-month EE counts for 1094-C; monthly coverage & enrollment codes for employee 1095-Cs 13

14 The Cason Group Additional Resources Health Care Reform Update page on website Ongoing updates & info posted on LinkedIn site Contact your rep for more details on any topic Option for agency-branded employer workshop to educate your clients on reporting (and/or Play-or-Pay) 1-page 2015 or 2016 Play-or-pay summary available 2015 Benefits Compliance Checklist available Jason Cogdill: Partner benefits attorney Benefits, ERISA, & ACA advising ProBenefits: Plan administration & compliance 14