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.

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.    

Get more!  Sign up for PLANSPONSOR newsletters.

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.

What is the deadline for providing the IRS returns and employee statements? 

The forms generally must be filed with the IRS annually no later than February 28 (March 31 if filed electronically) of the year immediately following the calendar year to which the return relates. Each employee statement generally must be furnished to a full-time employee on or before January 31 of the year succeeding the calendar year to which the return relates. 

Under transition relief provided in 2013 (IRS Notice 2013-45), the first returns and statements for the 2015 calendar year will be due in early 2016. 

Do employers with 50 to 99 employees that qualify for the 2015 transition relief from the employer mandate penalties have to file Forms 1094-C and 1095-C for 2015?   

Yes. The instructions to Forms 1094-C and 1095-C specify that such an employer remains subject to the Forms 1094-C and 1095-C reporting requirements for 2015 because the IRS needs the information to determine the employee’s potential eligibility for the premium tax credit.  

Must a Form 1094-C transmittal form be filed each time an employer files Forms 1095-C? 

Yes, a Form 1094-C must be attached to any Forms 1095-C filed by an employer. The instructions state that an employer may submit multiple Forms 1094-C, each accompanied by Forms 1095-C for some of its employees, provided that, in combination, Forms 1095-C are filed for each employee for whom the employer is required to file. In addition, an employer must file a single Form 1094-C reporting aggregate employer-level data for all full-time employees of the employer and identify the form, on line 19 of Part II, as the employer’s Authoritative Transmittal.

Got a health-care reform question?  You can ask YOUR health-care reform legislation question online at http://www.surveymonkey.com/s/second_opinions.   

You can find a handy list of Key Provisions of the Patient Protection and Affordable Care Act and their effective dates at http://www.groom.com/HCR-Chart.html.     

Contributors:   

Christy Tinnes is a Principal in the Health & Welfare Group of Groom Law Group in Washington, D.C. She is involved in all aspects of health and welfare plans, including ERISA, HIPAA portability, HIPAA privacy, COBRA, and Medicare. She represents employers designing health plans as well as insurers designing new products. Most recently, she has been extensively involved in the insurance market reform and employer mandate provisions of the health-care reform legislation.   

Brigen Winters is a Principal at Groom Law Group, Chartered, where he co-chairs the firm's Policy and Legislation group. He counsels plan sponsors, insurers, and other financial institutions regarding health and welfare, executive compensation, and tax-qualified arrangements, and advises clients on legislative and regulatory matters, with a particular focus on the recently enacted health-reform legislation.   

PLEASE NOTE: This feature is intended to provide general information only, does not constitute legal advice, and cannot be used or substituted for legal or tax advice.

American Benefits Council Outlines Long-Term Vision

September 23, 2014 (PLANSPONSOR.com) - A new strategy outline issued by the American Benefits Council (ABC) suggests the advocacy group will work to achieve public policy reform that more closely unifies health care and retirement concerns.

ABC’s new strategy manifesto shows the organization expects recent trends in personal health and financial well-being to gain steam in the medium- and long-term, through which individuals and employers are embracing a broader view of lifetime income protection that includes not only health coverage and retirement savings, but also incorporates life insurance, disability and long-term care coverage in a much more integrated way.

The main driver behind the focus on protecting lifetime income through a total financial wellness approach, ABC says, is the fact that people’s lives are getting longer at a time that the pension system in the U.S. continues to cover fewer individuals. Indeed, according to data pulled by ABC from a recent U.S. Centers for Disease Control report, the average time spent in retirement has lengthened from 9.6 years in 1970 to 17.6 years today for men, and from 14 years to 20.6 years for women over that same time period. Meanwhile, individuals retiring today can expect the cost of health care to grow 7% annual through the end of their lifetime (see “Employees Need Help Planning for Retirement Health Care Costs”).

Get more!  Sign up for PLANSPONSOR newsletters.

In developing a new strategic plan, the Council concluded that, in the future, the three main stakeholders in the benefits system will continue to be individuals, employers and the government, although the roles of each one will evolve. Additionally, ABC says the principal objective of employee benefits policy will continue to be to help individuals achieve “personal financial security,” although that concept is perhaps more accurately now described as “personal health and financial well-being.”

ABC’s new strategy outline also takes into account the growing importance of “global competitiveness” in retirement and health coverage offerings. The global footprint of the largest employers and the increasing globalization of markets and economies mean global competition will dictate much of the design and perceived successes of employee benefit programs by the end of the next decade, ABC says.

Another major consideration for ABC’s strategic vision is that technological advances should be expected to continue their perpetual acceleration. Technologies available today make possible what could not even be imagined just 10 years ago when the ABC’s last strategic vision document was issued, the group says. Consequently, a new strategic plan must accommodate a continual and exciting evolution in technology, rather than simply allowing for what is possible today, ABC says.

ABC warned that the Patient Protection and Affordable Care Act (ACA), along with the Pension Protection Act (PPA) and other laws implemented in the last 10 years, have substantially increased administrative burdens for health and retirement plan sponsors. This is causing employers to confront difficult decisions about their future role as sponsors of benefits, ABC says. Keeping employers in the system—and helping workers meet current and future income needs—will require more flexibility, choice, transparency, simplicity, portability and predictability than presently exists.

ABC says most of the specific policy recommendations made in its new strategic plan will require modifications to the Internal Revenue Code. As the group explains, the tax incentives that support employer-sponsored benefits are often viewed primarily as large “tax expenditures” resulting in foregone revenue to the U.S. Treasury. Taken together, the exclusion from an individual’s income tax of contributions to employer-sponsored health and retirement plans—two of the largest tax expenditures in the federal budget—theoretically represent more than $1.8 trillion in lost revenue over the next five years. 

But this perspective exposes the peril of short-term thinking, ABC says, as tax revenue is eventually collected on retirement plan contributions (and any earnings) upon distribution or withdrawal. So the “loss” is largely a matter of timing, ABC explains (see “The Tax Deferral vs. Benefit Debate Goes On”).

Similarly, ABC says incentivizing employers to maintain health coverage reduces the financial consequences to the government of providing direct subsidies to many individuals who would otherwise obtain coverage through the health insurance exchanges/marketplaces established by ACA. Although the tax expenditure for employer-sponsored health coverage is often viewed as regressive because the tax benefit favors higher-income individuals, in fact, the expenditure is quite progressive because the value of the health benefit it provides is more significant for lower-income individuals, for whom it would be a greater financial burden to purchase coverage absent an employer-sponsored plan, ABC says.

ABC suggests that sending this message to policymakers and the general public will be a critical goal for the health and retirement benefits industries in the years ahead. Public policy must avoid the temptation to view the tax expenditure scores associated with benefit plans as a convenient source of revenue for unrelated tax policy changes or other government spending, the group says.  

The ABC expects employer engagement may vary in the future as some companies continue a more traditional plan sponsor role, while others choose to facilitate workers’ ability to take more direct ownership of their benefits. Any changes must permit an employer to maintain its responsibilities in the most effective way as determined by that employer, ABC says. Under either scenario, employers must communicate effectively about their benefit programs to align employer and employee expectations. Those entities that provide services to employer-sponsored plans also must help employers fulfill their responsibilities.

Beyond tax policy, the ABC says the federal government must ensure stability in Social Security, Medicare and other public programs, such as health insurance exchanges. This is critical to minimize volatility and cost-shifting to either individuals or employers, the ABC explains. The government also must adopt policies that support traditional plan sponsorship but also give employers and employees the flexibility to meet their respective obligations in innovative and cost-effective ways. Furthermore, the judicial system should be sufficiently informed so its decisions reflect the value of employer-sponsored plans.

ABC members all sponsor directly or provide professional services to retirement, health and deferred compensation plans. Together the organization’s members provide health and retirement benefits to more than 100 million Americans and millions of others internationally.

A full copy of “A 2020 Vision: Flexibility and the Future of Employee Benefits,” including a list of more specific policy recommendations, is available for download here.

«