The following memorandum contains important information regarding upcoming reporting requirements related to the Affordable Care Act (ACA) or ObamaCare. The only employers that should be concerned with this memo and the detailed information within it are the following types of employers:
- Employers with less than 50 full-time-equivalent employees, but only if they sponsor a self-insured group health plan. If an employer has less than 50 full-time equivalent employees and either (1) does not offer group health insurance or (2) offers fully-insured group health insurance, they are not subject to the reporting requirements that are discussed below.
- Employers with 50 full-time-equivalent employees or more regardless of whether they offer fully-insured, self-insured or no health insurance are subject to the reporting requirements that are discussed below.
The Affordable Care Act created new reporting requirements under Internal Revenue Code (Code) sections 6055 and 6056. Under these new reporting rules, certain employers discussed above must provide information to the Internal Revenue Service about the health plan coverage they offer (or do not offer) to their employees.
The additional reporting is intended to promote transparency with respect to health plan coverage and costs. It will also provide the government with information to administer other ACA mandates, such as the large employer shared responsibility penalty and the individual mandate. While this reporting is not due until January 2016 for the 2015 year, it is essential that employers make plans to start tracking information in January 2015 to capture all relevant information needed to fulfill the reporting requirements.
On March 5, 2014, the Internal Revenue Service (IRS) released two final rules on these reporting requirements:
The Section 6055 final ruling (Forms 1094-B and 1095-B) requires applicable small employers (an employer with less than 50 full-time-equivalent employees) who provide self-insured plans to employees to report information on that coverage to the IRS and covered individuals. Employers will have to file form 1094-B and 1095-B to report information on each full-time employee.
The Section 6056 final ruling (Forms 1094-C and 1095-C) requires applicable large employers (an employer with at least 50 full-time-equivalent employees) to report to the IRS and covered individuals information on the health coverage offered to full-time employees. Employers will have to file form 1094-C and 1095-C to report information on each full-time employee.
Below is a chart summarizing the filing requirements based on the size of the employer. For purposes of these filings, a small employer is one with less than 50 full-time employees (including equivalents) and a large employer is one with at least 50 full-time employees (including equivalents) during the preceding calendar year.
| Employer Size |
Employer Health Plan |
Employer Files Forms 1095-B/ 1094-B |
Employer Files Forms 1095-C/ 1094-C |
| Small employer |
None |
No |
No |
| Small employer |
Fully-Insured |
No (insurer files forms) |
No |
| Small employer |
Self-insured |
Yes |
No |
| Large employer |
None |
No |
Yes |
| Large employer |
Fully-Insured |
No (insurer files forms) |
Yes |
| Large employer |
Self-insured |
Combined with 1095-C Reporting |
Yes |
Reporting of Health Coverage for Issuers and Self-insured Plans (Code § 6055)
The ACA requires every health insurance issuer, sponsor of a self-insured health plan, government agency that administers government-sponsored health insurance programs and any other entity that provides minimum essential coverage (MEC) to file an annual return with the IRS reporting information for each individual who is provided with this coverage. Related statements must also be provided to individuals.
The IRS will use the information from the returns to implement the ACA’s individual mandate (that is, the requirement that individuals obtain acceptable health insurance coverage for themselves and their family members or pay a penalty).
The information that will need to be captured regarding each covered employee along with family members who have coverage under the self-insured plan relating to Code Section 6055 (Form 1095-B) consists of:
- Full name
- Address
- Social Security number (or date of birth)
Applicable Large Employer Health Coverage Reporting (Code § 6056)
Applicable large employers are required to file information returns with the IRS under IRS Section 6056. Applicable large employers are those with 50 or more full-time employees during the previous year. Employers file forms 1094-C and 1095-C to report information on each full-time employee whether the employee is participating in an employer-sponsored group health plan or not. Employees must also be provided with a statement of this data by January 31st each year for the prior year.
The information that will need to be captured regarding each covered employee along with family members who have coverage under the self-insured plan relating to Code Section 6056 (Form 1095-C) consists of:
- The employee’s name, address and Social Security number
- The employer’s name, address and employer identification number
- Whether the employee and family members were offered health coverage each month that met the minimum value standard
- The employer’s share of the monthly premium for the lowest-cost minimum value health coverage offered
- Whether the employee was a full-time employee each month
- The affordability safe harbor applicable for the employee
- Whether the employee was enrolled in the health plan
- If the health plan is self-insured, the name and Social Security number (or birth date if Social Security number is unavailable) of each employee and family member covered by the plan by month
Please contact your payroll processor, Human Resources department, or your insurance provider for more information on how to start accumulating this data beginning in January 2015.