Affordable Care Act Reporting Requirements Holly Murphy Senior Attorney, TASB Legal Services April 27, 2015
Goals How reporting applies to your service center Form 1095 C Form 1094 C
Materials
Materials
Materials www.irs.gov/pub/irs pdf/f1095b.pdf (form) www.irs.gov/pub/irs pdf/f1094b.pdf (transmittal) www.irs.gov/pub/irs pdf/i109495b.pdf (instructions)
HOW REPORTING APPLIES TO YOUR SERVICE CENTER Purpose of reporting Which entities must report Reporting period Deadlines
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
Separate But Related Shared Responsibility Requirements Reporting Requirements
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)
TRS ActiveCare PPOs: self funded multiple employer plans HMOs: fully funded plans
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)
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)
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)
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)
Reporting Period Calendar Year
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 2015 2014 15 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 2016 2015 16 Plan Year
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 2015 2014 15 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 2016 2015 16 Plan Year
Reporting Deadlines
Reporting Deadlines January 31: statements to employees (February 1 for 2016) ActiveCare: WellSystems will provide data on COBRA participants in January 2016. Page 3 of instructions: Furnishing Forms 1095 C to Employees
Reporting Deadlines February 28: reports to IRS if filing on paper (February 29 for 2016) 28 Page 2 of instructions: When to File
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. 13239 (Mar. 10, 2014)
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
FORM 1095 C Overview Copy to employee Which employees Part I Part II Part III
1095 C: Employee Information Voluntary for 2014! www.irs.gov/pub/irs pdf/f1095c.pdf (form) www.irs.gov/pub/irs pdf/i109495c.pdf (instructions) Page 1 of instructions: Reminders
1095 C Instructions These instructions are for the employee, not the employer
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. 13239 40 (Mar. 10, 2014)
Which Employees Large employer: every full time employee Self insured: every enrollee Full time Employees Employees who enroll
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)
Recap 1095 C reports information on individual employee Copy to employee by January 31 1095 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
Three Parts Part I Part II Part III
Part I Employee and employer information Page 6 of instructions: Part I
Part II Offer of coverage and cost Pages 6 7 of instructions: Part II Employee O0ffer of Coverage
Part II: Three lines Line 14 Line 15 Line 16
Line 14 Whether employee and/or family was offered coverage Series 1 codes
Line 14 generally meaning the employee was eligible for coverage under the plan Page 7 of instructions: second full paragraph
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
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
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
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
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
Series 1 Codes 1E: Offer to employee, spouse, and dependents 1G: Employee not full time and enrolled in selfinsured coverage 1H: No offer
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
Line 15 Net cost to employee for lowest-cost, employeeonly coverage.
Line 15 Only if code 1B, 1C, 1D, or 1E was entered on Line 14 Page 7 of instructions
Line 16 Safe Harbors and other relief series 2 codes Pages 7 8 of instructions
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
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
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
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
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
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
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 10 11 of instructions
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
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
2I: Non Calendar Year Transition Relief Employee was not offered affordable coverage for the 2014 15 plan year; AND Employee was offered affordable coverage as of the first day of the 2015 16 plan year Use 2I for the months of the 2014 15 plan year that fall in 2015 Page 8 of instructions
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 2015 2I 2I 2I 2I 2I 2I 2I 2I 2014 15 Plan Year Employee not offered affordable coverage Sept 2015 Oct 2015 Nov 2015 Dec 2015 2C 2C 2C 2C Jan 2016 Feb 2016 Mar 2016 Apr 2016 May 2016 Jun 2016 July 2016 Aug 2016 2015 16 Plan Year Employee offered affordable coverage
Recap Part II: Whether employee was offered coverage Cost of coverage Safe harbors and other relief from penalties Enrollee reporting only: Line 14, 1G
Part III Only if employee enrolled in PPO Pages 8 9 of instructions
Column a Name of each covered individual
Column b SSN s of all covered individuals
Column c If dependent SSNs are not available
Column d Individual was covered for at least one day in each month of the calendar year
Column d (cont.) Check the box(es) for the months in which the individual was covered for at least one day
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)
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
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
Employer TRS
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
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)
FORM 1094 C Overview Transmittal for 1095 C Authoritative transmittal Part II Part III
1094 C Page 1 of instructions: Reminders Voluntary for 2014! www.irs.gov/pub/irs pdf/f1094c.pdf (form) www.irs.gov/pub/irs pdf/i109495c.pdf (instructions)
Four Parts Part I Part II
Four Parts Part III
Four Parts Part Part III IV Part I
Transmittal for 1095 C 1095 C 1095 C 1095 C
Authoritative Transmittal Aggregate employerlevel data 1095 C 1095 C 1095 C
Part I Employer information
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. 54.4980H 1(a)(5)
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
Line 22: Certifications of Eligibility Check each applicable box
Certifications of Eligibility Qualifying Offer Method Qualifying Offer Method Transition Relief Section 4980H Transition Relief 98% Offer Method
Recap Certifications of Eligibility Qualifying Offer Method Qualifying Offer Method Transition Relief Section 4980H Transition Relief 98% Offer Method
Section 4980H Transition Relief 50 99 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
Part III Only on Authoritative Transmittal
Column a: Substantial Compliance Pages 5 and 12 of instructions
Column b: Full Time Employee Count Page 6 of instructions
Column c: Total Employee Count Page 6 of instructions
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
Column d: Aggregate Group Indicator Page 7 of instructions
Column e: Section 4980H Relief Code A or Code B Page 6 of instructions
Section 4980H Transition Relief 50 99 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
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?
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.