ACA REPORTING REQUIREMENTS AND SOLUTIONS FOR EMPLOYERS. Mark Combs, ProACA Solutions

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1 ACA REPORTING REQUIREMENTS AND SOLUTIONS FOR EMPLOYERS Mark Combs, ProACA Solutions

2 Affordable Care Act Reporting.. ONLY what you REALLY need to know! Pro-ACAReporting.com

3 Meeting Objectives... 1). Understanding ACA Reporting in 5 minutes or less 2). Is this more Payroll reporting? Or Benefits reporting? 3). How do the penalties work? 4). Reporting help options

4 ACA Reporting in 5 minutes or less What is ACA Reporting Trying to Accomplish? 1). Individual Health Insurance Mandate (IRC 6055) 2). Play or Pay Employer Requirements (IRC 6056)

5 Individual Mandate Reporting IRC 6055 How will the IRS know if each person is covered by a health insurance plan for all months of the year? A Forms: Issued by the Healthcare Exchanges (form 1095 A) B Forms: Issued by Health Insurance Carriers (form 1095B) Also used by self-insured employers with under 50 employees C Forms: Issued by Self Insured Employers (form 1095 C, part 3)

6 Individual Mandate Reporting IRC 6055 (A Form)

7 Individual Mandate Reporting IRC 6055 (forms B & C)

8 Individual Mandate Reporting IRC 6055 (forms B & C) The IRS Then Pulls All Of The Data Together. & Knows Who As Enrolled & When They Were Enrolled

9 How will this impact form 1040 Specifically, on the form 1040 of individuals, there is a line (shown below) and they will need to complete as part of filing their taxes.

10 How will the IRS know if each Large Employer offered qualifying coverage and affordable coverage. C Forms: Issued by all Large Employers & Aggregated Groups - Form 1094C is the transmittal - Form 1095C is specific for each employee Employer Play or Pay IRC 6056 Fully Insured Carriers Will NOT Do This For The Employer!

11 What s the difference between the B Forms and the C Forms?

12 Line 14: Codes 1A through 1I Line 15: Only entered in certain circumstances. Line 16: Codes 2A through 2I Part II of form 1095-C

13 Codes Vary Based Upon These factors for every month impact the associated codes used: full time, part time, part time benefit eligible, who was enrolled and when, plan costs, type of coverage offered, who it was offered to, transitional relief, various safe harbors, initial measurement periods, limited non-assessment periods, multi-employer rules, non-calendar year renewal plans, etc. Visit this page on our site for many resources to assist you with your form 1095-C codes.

14 What information is needed to the complete reporting? (Basic Info & Payroll Info) Basic information on the company whom both the Benefit Broker & Payroll provider have Company name, address, contact information and EIN Payroll Information / Payroll Provider Number of part time and full time employees Payroll employee names, SSN, address, hire and termination dates

15 Benefits Information Benefits Information / Benefits Provider Is this your first year offering medical coverage? Renewal dates Type of plan funding structure (fully insured, self insured, multi employer plans) Waiting periods and if there are multiple waiting periods for different employee classes Did your medical plans offer minimum essential coverage? When? Did your medical plans offer minimum value coverage? When? Full detailed understanding of 4980H Transitional Relief Medical plan start and end dates Medical plan offerings to various classes of employees, and costs of these plans Eligibility by employee class for Federal Poverty Line safe harbor Eligibility by employee class for Rate of Pay Safe Harbor Eligibility by employee class for W2 safe harbor Medical plan employee contributions by month and class Plan offering Criteria, Qualifying offer Method, Qualifying offer Method with Transitional Relief, 98% offer method

16 More Benefits Information Was an HRA offered? Was it integrated with medical plan enrollment? Certifications of unchanging workforce size for plan purposes as well as consistent employer contributions. Months Offering MEC coverage to 70% of FT Employees Full information on employees including name, SSN, DOB and address Full information on dependents of employees including name, SSN, DOB and address Medical plan coverage start and end dates for all persons on the medical plan Medical plan offering details including start and end dates by employee class Designated governmental entity information Aggregated group information, and full details on control groups

17 How the A Penalty Works Transmittal Form 1094-C

18 How the B Penalty Works Unfortunately this would take too long for our session today

19 1). Payroll companies Tend to be expensive Currently brokers are reporting major service issues Reporting Help Options 2). Online enrollment systems Offers the advantage of using a vendor you already work with Can be expensive at other times very inexpensive To date we have received many reports that this service is not being support with customer support 3). E-Filing Only Vendors You get what you pay for they are only transmitting to the IRS

20 Reporting Help Options 4). CPAs 99% are not even aware this reporting contains PHI, and they are not HIPAA compliant 5). Benefit Broker Can be difficult due to current workload Reporting truly requires that you do it every day to understand it in full 6). Full Service ACA Reporting Vendor Most flexible solution. An App that fits any payroll or medical plan Less Expensive Specific expertise in ACA reporting

21 Questions & Answers Visit the site below for Q&A ONLY Sessions ACA Reporting Code Assistance Form 1095-C Code Calculator Preferred Pricing & Cypress Integration