Second Opinions

SECOND OPINIONS: Forms and Instructions for ACA Health Coverage Information

September 24, 2014 (PLANSPONSOR.com) - Code section 6056, as enacted by the Affordable Care Act (ACA), requires “applicable large employer members” subject to the employer “shared responsibility” mandate Internal Revenue Code section 4980H to report to the Internal Revenue Service (IRS) information about their compliance with the mandate and any health care coverage offered to employees.

By PS | September 24, 2014
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Section 6056 also requires applicable large employer members to furnish related statements to employees so that the employees may use the statements to help determine eligibility for the ACA premium tax credit. A similar reporting requirement in Code section 6055 requires health insurance issuers, employers that sponsor self-insured plans and other providers of minimum essential coverage to report and provide statements on minimum essential coverage offered under their plans.

On August 28, 2014, the IRS released draft instructions for use by applicable large employer members to satisfy the Code section 6056 reporting requirements. (Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return and Form 1095-C, Employer-Provided Health Insurance Offer and Coverage.) Also on August 28, 2014, the IRS released a revised form, and draft instructions, for use by sponsors of minimum essential coverage to report such coverage to the IRS and to covered individuals under the Code section 6055 requirements. (Draft Instructions to Form 1094-B, Transmittal of Health Coverage Information Returns and Form 1095-B, Health Coverage, released along with a revised draft Form 1095-B.) The IRS previously issued draft Forms 1094-B, 1095-B, 1094-C, and 1095-C on July 24, 2014.    

In this column, we answer some of the frequently asked questions we have received on these draft forms and instructions.

Are employers that are subject to the employer mandate and that sponsor a self-insured health plan for their employees required to file Form 1095-B?   

No, employers that are subject to the employer mandate and that sponsor a self-insured group health plan will report information about the coverage provided to employees in Part III of Form 1095-C instead of on Form 1095-B. Note, employers that sponsor self-insured health coverage for their employees but are not subject to the employer mandate are not required to file Forms 1094-C and 1095-C and will report details of the coverage on Form 1095-B (and file a Form 1094-B transmittal).

If an applicable large employer member is providing health coverage to employees through an insured health plan or in some other manner (e.g., through a multiemployer health plan), the issuer of the insurance or the sponsor of the multiemployer or other plan providing the coverage will provide the information about the health coverage to any enrolled employees on Form 1095-B (and file a Form 1094-B transmittal). The employer in these cases would not file a Form 1095-B or complete Part III of Form 1095-C for those employees.

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