New Reporting for Health Plans
As the implementation of the Patient Protection and Affordable Care Act (PPACA) continues, new reporting requirements will exist in 2016 for employers. The new requirements fall under IRS Code §6055 and IRS Code §6056, as reviewed below.
Reporting of Minimum Essential Coverage Provided – IRS Code §6055
Under IRS Code §6055, employers and plan issuers must report health insurance information to the IRS and provide a statement to those who are covered under the plan. This reporting requirement is a result of IRS Code §5000A, which outlines the individual mandate for health insurance coverage. As a reminder, all individuals, other than exempted individuals, must have health insurance coverage that meets the minimum essential coverage requirements or pay a penalty.
For fully insured plans, the reporting will be completed by the issuer of the policy. The issuer will also be responsible for sending the statement to those covered under the plan. In the case of a self-insured plan, the plan sponsor must report the information to the IRS and provide the statements to the covered individuals.
Certain plans are exempt from reporting. These include:
- Plans that only offer excepted benefits (ex: limited scope dental or vision plans)
- Plans offered through the individual marketplace
- Plans that are a secondary plan offered by the same employer (ex: HRAs that are offered by the same employer who is offering a health insurance plan that meets the requirements)
- Supplemental government plans, like Medicare
Reporting is not required for Health Reimbursement Arrangements (HRAs) since they can only be offered as an integrated HRA plan along with another group health plan.
Reporting of Minimum Essential Coverage Offered – Code §6056
Under IRS Code §6056, employers that are considered applicable large employers subject to the shared responsibility requirement, must report to the IRS whether or not they offer full-time employees the opportunity to enroll in minimum essential coverage. This reporting requirement is a result §4980H, which outlines the employer shared responsibility requirement. Employers must also provide a statement to employees regarding the offering of coverage.
Employers that are required to report under both IRS Code §6055 and IRS Code §6056 can complete a combined form.
While the reporting is applicable for calendar years beginning after December 31, 2014, reporting will not be required until 2016. Plan sponsors are encouraged to comply with the reporting for the 2014 plan year in 2015, but will not be required to report until 2016 (for the 2015 plan year).
Instructions and versions of Forms 1094 – B, 1095 – B, 1094 – C and 1095 – C are now available.
Depending on whether or not a plan is self-insured or fully insured will determine who is required to file the report and provide notices to those covered under the plan.
|Employers Required to File||Form||Insured||Self-Insured|
|Small Employers Not Subject to Employer Shared Responsibility Provisions||1094 – B||Insurance Carrier||Plan Sponsor (Employer)|
|Small Employers Not Subject to Employer Shared Responsibility Provisions||1095 – B||Insurance Carrier||Plan Sponsor (Employer)|
|Applicable Large Employers (ALE)*||1094 – C||Employer||Employer|
|Applicable Large Employers (ALE)*||1095 – C||Issuer of Policy/Sponsor of Plan||Employer|
*ALE means any employer with 50 or more full-time employees (this includes full-time equivalent) in the previous year.
The instructions for Forms 1094 – B, 1095 – B clarify that if an employer offers a fully insured health plan and a self-insured plan such as a Health Reimbursement Arrangement (HRA) and an employee is covered by both plans, they do not need to be reported twice. The report does not need to be filed for both the fully insured health plan and the HRA. This also applies to employers that offer a self-insured group health plan and a supplemental plan such as an HRA.
The filing deadlines to submit the forms to the IRS for the 2015 plan year are February 29, 2016 (manual filing) or March 31, 2016 (electronic filing).
Forms must be provided to individuals by February 1, 2016.
To view the instructions for Form 1094 – B and 1095 – B, click here.
To view the instructions for Form 1094 – C and 1095 – C, click here.
BusinessPlans, Inc. – myCafeteriaPlan does not intend to provide legal or tax advice and information contained in this article should not be interpreted as such. Regulations governing pretax plans are often open to interpretation and should be reviewed with your legal or tax advisor before making any decisions regarding your plan.