Affordable Care Act Reporting Requirements
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1 Affordable Care Act Reporting Requirements Holly Murphy Senior Attorney, TASB Legal Services April 27, 2015
2 Goals How reporting applies to your service center Form 1095 C Form 1094 C
3 Materials
4 Materials
5 Materials pdf/f1095b.pdf (form) pdf/f1094b.pdf (transmittal) pdf/i109495b.pdf (instructions)
6 HOW REPORTING APPLIES TO YOUR SERVICE CENTER Purpose of reporting Which entities must report Reporting period Deadlines
7 Purpose of Reporting Employer Full time status Offer of coverage Affordability Plan enrollment (selfinsured) Employee Eligibility for premium tax credits Coverage for self and dependents Page 1 of instructions: Purpose of Form
8 Separate But Related Shared Responsibility Requirements Reporting Requirements
9 Which Entities Must Report Employer size Fully insured Self insured < 50 full time Employer reporting does Form 1095 B on all persons employees* not apply who enrolled in coverage >/= 50 full time employees* Form 1095 Cfor each full time employee Form 1095 C for each fulltime employee AND Form 1095 C for each employee who was not fulltime but who enrolled in coverage Pages 1 2 of instructions: Who Must File * Including workforce extender (fulltime equivalents as defined by ACA)
10 TRS ActiveCare PPOs: self funded multiple employer plans HMOs: fully funded plans
11 Which Entities Must Report Employer size Fully insured (HMO) < 50 full time Employer reporting does employees* not apply >/= 50 fulltimtime Form 1095 Cfor each full employee employees* Self insured (PPO) Form 1095 B on all persons who enrolled in coverage Form 1095 C for each fulltime employee AND Form 1095 C for each employee who was not fulltime but who enrolled in coverage * Including workforce extender (fulltime equivalents as defined by ACA)
12 Which Entities Must Report Employer size Fully insured (HMO) < 50 full time Employer reporting does Includes employees* not apply COBRA >/= 50 fulltimtime employee Form 1095 Cfor each full participants employees* Self insured (PPO) Form 1095 B on all persons who enrolled in coverage Form 1095 C for each fulltime employee AND Form 1095 C for each employee who was not fulltime but who enrolled in coverage * Including workforce extender (fulltime equivalents as defined by ACA)
13 Which Entities Must Report Employer size Fully insured (HMO) < 50 full time Employer reporting does employees* not apply >/= 50 fulltimtime Form 1095 Cfor each full employee employees* Self insured (PPO) Form 1095 B on all persons who enrolled in coverage Form 1095 C for each fulltime employee AND Form 1095 C for each employee who was not fulltime but who enrolled in coverage * Including workforce extender (fulltime equivalents as defined by ACA)
14 Which Entities Must Report Employer size Fully insured < 50 full time Employer reporting does employees* not apply >/= 50 fulltimtime Form 1095 Cfor each full employee employees* Includes COBRA participants Self insured Form 1095 B on all persons who enrolled in coverage Form 1095 C for each fulltime employee AND Form 1095 C for each employee who was not fulltime but who enrolled in coverage * Including workforce extender (fulltime equivalents as defined by ACA)
15 Reporting Period Calendar Year
16 ActiveCare Plan Year Sept 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 July 2015 Aug Plan Year Sept 2015 Oct 2015 Nov 2015 Dec 2015 Jan 2016 Feb 2016 Mar 2016 Apr 2016 May 2016 Jun 2016 July 2016 Aug Plan Year
17 Calendar Year Reporting Sept 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 July 2015 Aug Plan Year Sept 2015 Oct 2015 Nov 2015 Dec 2015 Jan 2016 Feb 2016 Mar 2016 Apr 2016 May 2016 Jun 2016 July 2016 Aug Plan Year
18 Reporting Deadlines
19 Reporting Deadlines January 31: statements to employees (February 1 for 2016) ActiveCare: WellSystems will provide data on COBRA participants in January Page 3 of instructions: Furnishing Forms 1095 C to Employees
20 Reporting Deadlines February 28: reports to IRS if filing on paper (February 29 for 2016) 28 Page 2 of instructions: When to File
21 Reporting Deadlines March 31: reports to IRS if filing electronically 250+ (1095 Cs): must file electronically <250 (1095 Cs): may file electronically ( encouraged ) 79 Fed. Reg (Mar. 10, 2014)
22 How Reporting Applies to Your Service Center Recap Large employers file full time employee reports All employers large and small file enrollment reports on employees who enroll in a self insured plan ActiveCare: PPOs Calendar year reporting, beginning with 2015 Reports are due early 2016
23 FORM 1095 C Overview Copy to employee Which employees Part I Part II Part III
24 1095 C: Employee Information Voluntary for 2014! pdf/f1095c.pdf (form) pdf/i109495c.pdf (instructions) Page 1 of instructions: Reminders
25 1095 C Instructions These instructions are for the employee, not the employer
26 Copy to Employee Paper Mail Last known address OK to mail with W 2 Electronic Consent Specific to 1095 C Delivery Page 3 of instructions: Furnishing Form 1095 C to Employees 79 Fed. Reg (Mar. 10, 2014)
27 Which Employees Large employer: every full time employee Self insured: every enrollee Full time Employees Employees who enroll
28 Full Time Employee Full time even one calendar month that reporting year Every full time, regular employee Every substitute, temporary, or part time employee who works 130 or more hours in even one month Page 1 of instructions: Who Must File (first paragraph)
29 Recap 1095 C reports information on individual employee Copy to employee by January C is used to report on full time employees and on enrollees in selfinsured plans Small employers that are self insured use 1095 B for enrollment reporting
30 Three Parts Part I Part II Part III
31 Part I Employee and employer information Page 6 of instructions: Part I
32 Part II Offer of coverage and cost Pages 6 7 of instructions: Part II Employee O0ffer of Coverage
33 Part II: Three lines Line 14 Line 15 Line 16
34 Line 14 Whether employee and/or family was offered coverage Series 1 codes
35 Line 14 generally meaning the employee was eligible for coverage under the plan Page 7 of instructions: second full paragraph
36 A Series 1 code must be entered for each calendar month, even if the employee was not a full-time employee for one or more months. Page 7 of instructions
37 Series 1 Codes 1A: Qualifying Offer 1B: Offer to employee only 1C: Offer to employee and dependents 1D: Offer to employee and spouse 1E: Offer to employee, spouse, and dependents 1F: Offer of coverage not providing minimum value 1G: Employee not full time and enrolled in selfinsured coverage 1H: No offer 1I: Qualifying Offer Transition Relief Page 7 of instructions
38 Series 1 Codes 1A: Qualifying Offer 1B: Offer to employee only 1C: Offer to employee and dependents 1D: Offer to employee and spouse 1E: Offer to employee, spouse, and dependents 1F: Offer of coverage not providing minimum value 1G: Employee not full time and enrolled in selfinsured coverage 1H: No offer 1I: Qualifying Offer Transition Relief
39 Series 1 Codes 1A: Qualifying Offer 1B: Offer to employee only 1C: Offer to employee and dependents 1D: Offer to employee and spouse 1E: Offer to employee, spouse, and dependents 1F: Offer of coverage not providing minimum value 1G: Employee not full time and enrolled in selfinsured coverage 1H: No offer 1I: Qualifying Offer Transition Relief
40 Series 1 Codes 1A: Qualifying Offer 1B: Offer to employee only 1C: Offer to employee and dependents 1D: Offer to employee and spouse 1E: Offer to employee, spouse, and dependents 1F: Offer of coverage not providing minimum value 1G: Employee not full time and enrolled in selfinsured coverage 1H: No offer 1I: Qualifying Offer Transition Relief
41 Series 1 Codes 1E: Offer to employee, spouse, and dependents 1G: Employee not full time and enrolled in selfinsured coverage 1H: No offer
42 Series 1 Codes 1E: Offer to employee, spouse, and dependents 1G: Employee not full time and enrolled in selfinsured coverage 1H: No offer Enrollee reporting All 12 months Page 1 of instructions
43 Line 15 Net cost to employee for lowest-cost, employeeonly coverage.
44 Line 15 Only if code 1B, 1C, 1D, or 1E was entered on Line 14 Page 7 of instructions
45 Line 16 Safe Harbors and other relief series 2 codes Pages 7 8 of instructions
46 Series 2 Codes 2A: Employee not employed on any day of the month 2B: Employee not a full time employee for the month and did not enroll in coverage 2C: Employee enrolled in coverage offered 2D: Employee was in a Limited Non Assessment Period 2E: Multiemployer interim rule relief 2F: W 2 safe harbor 2G: Federal poverty line safe harbor 2H. Rate of pay safe harbor 2I. Non calendar year transition relief Page 8 of instructions
47 Series 2 Codes 2A: Employee not employed on any day of the month 2B: Employee not a full time employee for the month and did not enroll in coverage 2C: Employee enrolled in coverage offered 2D: Employee was in a Limited Non Assessment Period 2E: Multiemployer interim rule relief 2F: W 2 safe harbor 2G: Federal poverty line safe harbor 2H. Rate of pay safe harbor 2I. Non calendar year transition relief
48 Series 2 Codes 2A: Employee not employed on any day of the month 2B: Employee not a full time employee for the month and did not enroll in coverage 2C: Employee enrolled in coverage offered 2D: Employee was in a Limited Non Assessment Period 2G: Federal poverty line safe harbor 2H. Rate of pay safe harbor 2I. Non calendar year transition relief
49 Series 2 Codes: 2C 2C is the King of the Series 2A: Employee not employed on any day 2 of the codes month 2B: Employee not a full time employee for the month and did not enroll in coverage 2C: Employee enrolled in coverage offered 2D: Employee was in a Limited Non Assessment Period 2G: Federal poverty line safe harbor 2H. Rate of -Even pay safe harbor if employee was 2I. Non calendar not full-time year transition that relief month -Even if a safe harbor applies Page 8 of instructions
50 Series 2 Codes: 2A 2A: Employee not employed on any day of the month 2B: Employee not a full time employee for the month and did not enroll in coverage 2C: Employee enrolled in coverage offered 2D: Employee was in a Limited Non Assessment Period 2G: Federal poverty line safe harbor 2H. Rate of pay safe harbor 2I. Non calendar year transition relief
51 Series 2 Codes: 2B 2A: Employee not employed on any day of the month 2B: Employee not a full time employee for the month and did not enroll in coverage 2C: Employee enrolled in coverage offered 2D: Employee was in a Limited Non Assessment Period 2G: Federal poverty line safe harbor 2H. Rate of pay safe harbor 2I. Non calendar year transition relief
52 Series 2 Codes: 2D 2A: Employee not employed on any day of the month 2B: Employee not a full time employee for the month and did not enroll in coverage 2C: Employee enrolled in coverage offered 2D: Employee was in a Limited Non Assessment Period 2G: Federal poverty line safe harbor 2H. Rate of pay safe harbor 2I. Non calendar year transition relief Pages of instructions
53 Series 2 Codes: 2G and 2H 2A: Employee not employed on any day of the month 2B: Employee not a full time employee for the month and did not enroll in coverage 2C: Employee enrolled in coverage offered 2D: Employee was in a Limited Non Assessment Period 2G: Federal poverty line safe harbor 2H. Rate of pay safe harbor 2I. Non calendar year transition relief
54 Series 2 Codes: 2I 2A: Employee not employed on any day of the month 2B: Employee not a full time employee for the month and did not enroll in coverage 2C: Employee enrolled in coverage offered 2D: Employee was in a Limited Non Assessment Period 2G: Federal poverty line safe harbor 2H. Rate of pay safe harbor 2I. Non calendar year transition relief
55 2I: Non Calendar Year Transition Relief Employee was not offered affordable coverage for the plan year; AND Employee was offered affordable coverage as of the first day of the plan year Use 2I for the months of the plan year that fall in 2015 Page 8 of instructions
56 Non Calendar Year Transition Relief: Example Sept 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 July 2015 Aug I 2I 2I 2I 2I 2I 2I 2I Plan Year Employee not offered affordable coverage Sept 2015 Oct 2015 Nov 2015 Dec C 2C 2C 2C Jan 2016 Feb 2016 Mar 2016 Apr 2016 May 2016 Jun 2016 July 2016 Aug Plan Year Employee offered affordable coverage
57 Recap Part II: Whether employee was offered coverage Cost of coverage Safe harbors and other relief from penalties Enrollee reporting only: Line 14, 1G
58 Part III Only if employee enrolled in PPO Pages 8 9 of instructions
59 Column a Name of each covered individual
60 Column b SSN s of all covered individuals
61 Column c If dependent SSNs are not available
62 Column d Individual was covered for at least one day in each month of the calendar year
63 Column d (cont.) Check the box(es) for the months in which the individual was covered for at least one day
64 Fully Insured v. Self Insured Employer size Fully insured < 50 full time Employer employees reporting does not apply >/= 50 fulltime employees Form 1095 C for each fulltime employee Parts I and II only Self insured Form 1095 B on all persons who enrolled in coverage Form 1095 C for each full time employee Parts Iand II Part III if employee enrolled in a PPO AND Form 1095 C for each employee who was not full time but who enrolled in a PPO Parts I and III (and enter code 1G at line 14 of Part II)
65 Recap Part III is used for enrollment reporting Every employee who enrolled in selfinsured coverage Regardless of whether full time ActiveCare employers will not do enrollment reporting on employees who enrolled in HMOs
66 Designated Governmental Entity Enrollment reporting only Written agreement DGE becomes plan sponsor Form 1095 B Copies to employees DGE becomes responsible for penalties for failure to timely file reports
67 Employer TRS
68 Likely conditions for TRS to be DGE Deadline to designate TRS Employer retains responsibilities: Tax id numbers on enrollees Current addresses Full time employee reporting Cost of delivering statements to employees Employer retains liability for shared responsibility penalties
69 Fully Insured v. Self Insured Employer size Fully insured < 50 full time Employer reporting employees does not apply >/= 50 fulltime employees Form 1095 Cfor each full time employee Parts I and II only Self insured Form 1095 B on all persons who enrolled in coverage Form 1095 C for each full time employee Parts Iand II Part III if employee enrolled in a PPO AND Form 1095 C for each employee who was not full time but who enrolled in a PPO Parts I and III (and enter code 1G at line 14 of Part II)
70 FORM 1094 C Overview Transmittal for 1095 C Authoritative transmittal Part II Part III
71 1094 C Page 1 of instructions: Reminders Voluntary for 2014! pdf/f1094c.pdf (form) pdf/i109495c.pdf (instructions)
72 Four Parts Part I Part II
73 Four Parts Part III
74 Four Parts Part Part III IV Part I
75 Transmittal for 1095 C 1095 C 1095 C 1095 C
76 Authoritative Transmittal Aggregate employerlevel data 1095 C 1095 C 1095 C
77 Part I Employer information
78 Part II ALE Member Information ALE = Large employer One or more entities that are treated as a single employer under the ACA. 26 C.F.R H 1(a)(5)
79 Line 19: Authoritative Transmittal Indicator AT: check box and complete parts II, III, and IV to the extent applicable Non-AT: leave Part II, lines 20-22, Part III, and Part IV blank Page 4 of instructions: Part II ALE Member Information, Line 19
80 Line 22: Certifications of Eligibility Check each applicable box
81 Certifications of Eligibility Qualifying Offer Method Qualifying Offer Method Transition Relief Section 4980H Transition Relief 98% Offer Method
82 Recap Certifications of Eligibility Qualifying Offer Method Qualifying Offer Method Transition Relief Section 4980H Transition Relief 98% Offer Method
83 Section 4980H Transition Relief full time employees* in 2014 One year delay of shared responsibility penalties 100+ full time employees* in 2014 Reduced penalty for failure to offer to at least 70% of full time employees * Including workforce extender (full time equivalents as defined by ACA) Page 5 of instructions: Section 4980H Transition Relief; page 13
84 Part III Only on Authoritative Transmittal
85 Column a: Substantial Compliance Pages 5 and 12 of instructions
86 Column b: Full Time Employee Count Page 6 of instructions
87 Column c: Total Employee Count Page 6 of instructions
88 Total Employee Count (Monthly) Pick one First day of the month Last day of the month First day of the first payroll period Use the same day for every month of the year Last day of the first payroll period Last day of payroll period must fall within calendar month in which payroll period starts
89 Column d: Aggregate Group Indicator Page 7 of instructions
90 Column e: Section 4980H Relief Code A or Code B Page 6 of instructions
91 Section 4980H Transition Relief full time employees* in 2014 One year delay of shared responsibility penalties Code A 100+ full time employees* in 2014 Reduced penalty for failure to offer to at least 70% of full time employees Code B * Including workforce extender (full time equivalents as defined by ACA) Page 5 of instructions: Section 4980H Transition Relief; page 13
92 Evaluate Data Systems Which elements do you already track? Which ones do you need to track? What needs to change? Can you automate tracking and reporting?
93 Affordable Care Act Reporting Requirements Thank you! This information is provided for educational purposes only to facilitate a general understanding of the law or other regulatory matter. This information is neither an exhaustive treatment on the subject nor is this intended to substitute for the advice of an attorney or other professional advisor. Consult with your attorney or professional advisor to apply these principles to specific fact situations.
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