1 What Employers Need to Know about the Final ACA Reporting Forms We highly recommend that you download the slides prior to the webinar at (case sensitive) Laura Kerekes, SPHR, SHRM-SCP Chief Knowledge Officer Bethany Lopusnak, SPHR, SHRM-SCP Senior Benefits Advisor
2 This session is being recorded. Download the slides at (case sensitive) You will receive a link to the recording after the webinar. We will provide the HRCI code at the end of the webinar. Ask questions using the question box. We will send a booklet of all questions and answers to everyone next week.
3 ACA general updates Filing requirements for employers Employee information tracking ThinkHR support and HRCI
4 1 ACA updates
5 ACA Updates Legislative Tax credits for state and federal exchanges King v. Burwell Supreme Court oral arguments heard 3/4/15 At issue: Validity of IRS regulations providing premium tax credits on both state and federal exchanges Decision expected late June Cadillac Tax (2018) 40% excise tax on employer-sponsored high cost health coverage exceeding thresholds of $10,200/individual or $27,500/family
6 ACA Updates Legislative Congressional action to repeal ACA (or portions of it) Since 2011, 50+ challenges to ACA in Congress, including: Repealing the entire law Repealing the Individual Mandate Repealing the Employer Shared Responsibility Mandate Changing full-time employee definition to 40 hours/week Adding copper level plan with higher deductibles Repealing medical device and Cadillac Plan taxes
7 2 Filing requirements for employers
8 Poll How knowledgeable do you feel about the IRS/ACA reporting requirements?
9 Acronyms Acronym ACA ALE EIN FPL FTE LNAP MEC MV Meaning Affordable Care Act Applicable large employer Employer identification number Federal poverty line Full time equivalent Limited non assessment period Minimum essential coverage Minimum value coverage
10 Reasons for Reporting Individual mandate reporting and penalty Internal Revenue Code Section 6055: Verification of minimum essential coverage for the individual mandate Employer mandate reporting and penalty Internal Revenue Code Section 6056: Verification and enforcement of the employer shared responsibility mandate Confirmation of eligibility for premium tax credits
11 Who Needs to Report for Calendar Year 2015 Applicable Large Employers (ALEs) 50 or more full-time equivalent employees (FTEs) ALEs with FTEs must also report Self-funded employers of ANY size must also report.
12 When the Reports Are Due 1094 Paper forms due February 29, 2016 Electronic forms due March 31, 2016 Required if ALE filing 250+ returns under Section Individual statements due February 1, 2016 on paper unless individual consents to electronic consent (specific to 1095, not W-2)
13 What Needs to be Reported Information to Report Applicable large employer status based on employee count and eligibility hours tracked Certification of minimum essential coverage (MEC), minimum value and affordability Offers of coverage
14 The Big Picture on Forms 1094 and 1095 IRS Forms 1095 (similar to employee W-2): Reports on individual coverage 1094 (similar to W-3 transmittal): Transmits the 1095 data A Forms Marketplace exchanges will issue 1094/1095-A forms B Forms Insurers, non-applicable large employer sponsors of self-funded plans will issue 1094/1095-B forms C Forms Applicable large employers will issue 1094/1095-C forms
16 1095-C Details Form s intent: Provides documentation to individual employees about their company-provided group health insurance to file with their tax returns Provides documentation to the IRS regarding offers of minimum essential coverage (MEC) Assists the IRS in determining Employer Shared Responsibility assessments (if any) Assists the IRS in determining whether the company s fulltime employees and dependents are eligible for premium tax credits Applies to fully insured and self-funded large employers
17 Completing C Forms 1095-C: ALE s name, Employer Identification Number (EIN) and other contact information Employee s name, address, and Social Security number Employee share of cost for lowest-cost, employee only minimum essential coverage Employer certification of benefits offers to full-time employees
18 Completing C Forms 1095-C: Employee information Name, address, Social Security number Months covered or offered coverage under the benefit plan Dependent eligibility and identifying information (including Social Security numbers if plan is self-funded) Whether coverage meets the MEC and MV standards Affordability safe harbors met
19 1095-C Details Part I Demographic information for employees and ALE
20 1095-C Details Part II: Employee Offer and Coverage FORM line 14 Line 14: Offer of coverage Enter one of nine codes for every employee every month. This line cannot be left blank. Use All 12 months box if code is the same for all months. A Line 14 offer of health coverage means coverage for the entire month. Partial month=no offer BUT, employees terminating mid-month can reflect offered if they would have had coverage for the month if not termed.
21 1095-C Details Part II: Employee Share of Lowest Cost Premium Line 15: leave blank unless codes 1B through 1E minimum value offers to employees are entered in Line 14. Enter the actual $$ amount for the employee share of cost for lowest cost self-only MV coverage available. This may not be the same as what the employee actually paid. Leave this line blank if no MV offer made to employee or Code 1A was used on Line 14. If contribution= $0, enter that. Don t leave blank. Use All 12 Months box if contribution is the same for all months.
22 1095-C Details Part II: Actual Coverage Line 16: shows whether ALE is subject to penalty or whether individuals can receive premium tax credits. Can leave blank if no codes apply.
23 1095-C Details Part III: Covered Individuals Complete ONLY if providing self-funded coverage. Must include any employees offered self-funded coverage whether full-time or not and family members. Use Code 1G for non-employees (directors, retirees, COBRA qualified beneficiaries). Only one Form 1095-C can be filed per year per employee!
25 1094-C Details Form s intent Transmittal document for filing Forms 1095-C with the IRS Consolidates employer data Assists the IRS in determining Employer Shared Responsibility assessments (if any) and the amounts of the penalties Helps the IRS in determine whether a company s full-time employees and dependents are eligible for premium tax credits Only one authoritative transmittal allowed per ALE More than one 1094-C transmittals (different companies in controlled groups, company divisions, etc.) may be filed Aggregated data must be in the authoritative transmittal
26 Completing C Forms 1094-C ALE s name, Employer Identification Number (EIN) and other contact information Number of 1095-C statements attached Information about members of aggregated ALEs (if any) Full-time employee and total employee counts by month Eligibility for transition relief
27 1094-C Details Part I: ALE Member Information Part I, Line 18: Enter total number of Forms 1095-C included for single transmittal form.
28 1094-C Details Part II: ALE Member Information Includes more information for aggregated reports. Yes answer on Line 21 means Part IV must be completed (listing other members of the aggregated ALE).
29 1094-C Details Part II: ALE Member Information Line 22: Certifications of eligibility four options Box A: Qualifying Offer applies if ALE made MV offer to at least one FT employee for all months FT plus offered MEC to spouse and dependents costing no more than 9.5% of FPL.
30 1094-C Details Part II: ALE Member Information Line 22: Certifications of eligibility four options Box B: Qualifying Offer Method Transition Relief (2015 only) applies if offer made to at least 95% 70% of FT employees for one or more months. If either Box A or B is checked, ALE can use simplified generic 1095-C instead of individual 1095-Cs.
31 1094-C Details Simplified Reporting or Alternative Method Can be used by employers who checked boxes A or B on Line 22 Simplified reporting option is a statement and includes: Name, address, and EIN for ALE Contact name and phone number for employees to ask questions Language indicating that this employee and their dependents (if applicable) received a qualifying offer for all 12 months of the year A statement telling the employee to see IRS Publication 974 Premium Tax Credit (PTC) for more information on eligibility for that credit
32 1094-C Details Part II: ALE Member Information Line 22: Certifications of eligibility four options Box C: Section 4980H Transition Relief two types Option 1: FT employees with no reduction in workforce or hours of work to qualify and cannot have eliminated or reduced coverage Option 2: ALEs with 100+ employees subject to assessable penalty reduced by 80 instead of 30 employees
33 1094-C Details Part II: ALE Member Information Line 22: Certifications of eligibility Four options Box D: 98% Offer Method where ALE offers affordable/mv coverage for all months to at least 98% of employees for whom a 1095-C is filed (enrolled FT and PT employees).
34 1094-C Details Part III: ALE Member Information Monthly Column (a) Minimum Essential Coverage Offer Answer Y or N to whether MEC was offered to at least 95% 70% of FT employees and dependents.
35 1094-C Details Part III: ALE Member Information Monthly Include dependent children (not step- or foster children) through last day of 26 th birthday month. Must provide opportunity to enroll/decline at least once per year. Evergreen elections with opt out ability permissible. AND this is not required for MV offer if employee cost is $0 or at or below the FPL for single-only plan. Failure to offer for 1 day = failure to offer for the month. Do not include employees in limited nonassessment period (waiting period, measurement period, etc.) in 95% count. ALEs can answer Y if transition relief applies.
36 1094-C Details Part III: ALE Member Information Monthly Column (b): Employee Counts OK to skip if ALE selected Box D (98% offer). Do not include employees in limited nonassessment period (waiting period, measurement period, etc.) in count.
37 1094-C Details Part III: ALE Member Information Monthly Column (c): Employee Counts If count is same for entire year, use All 12 Months box. If not, use consistent counting method for each month. Include employees in limited nonassessment period in count.
38 1094-C Details Part III: ALE Member Information Monthly Section (e): Section 4980H Transition Relief Indicator If ALE checked Line 22, Box C, complete this section Code A: FT employee relief no penalty for 2015 plan years for certain small ALEs meeting the transition relief rules Code B: 100+ FT employee relief
39 1094-C Details Part IV: Other ALE Members of Aggregated ALE Group ALEs can skip this section unless they are filing multiple Forms 1094-Cs. If aggregated Line 19 checked, this section must be completed. Report in descending order based on ALE member with the highest number of FTEs (must list top 30 ALE members).
40 Summary Summary of 1094-C and 1095-C Filing Rules ALE reporting applies to companies averaging 50+ employees in the preceding calendar year. Employers can use any consecutive 6-month period in 2014 instead of counting all 12 months for ALE status. ALEs with employees who are exempt from the Shared Responsibility Payment in 2015 STILL MUST REPORT! Self-funded plans of ANY size must report due to the individual mandate. There is no delay in reporting for non-calendar year plans these reports apply on a calendar-year basis NOT on plan year.
41 Code IRS Codes for Form 1095-C: Line 14 Code Meaning 1A 1B 1C 1D 1E 1F 1G 1H 1I Qualifying Offer MEC providing MV offered to FT employee with contribution for self-only coverage < or = to 9.5% federal poverty line AND MEC offered to spouse and dependents MEC providing MV offered to employee only MEC providing MV offered to employee and MEC offered to dependent MEC providing MV offered to employee and MEC offered to spouse MEC providing MV offered to employee and MEC offered to spouse and dependent MEC not providing MV offered to employee, OR employee + spouse or dependents, OR employee + spouse and dependents Offer of coverage to non-ft employee for any month of the year who is enrolled in self-funded coverage for one or more months of the year No offer of coverage (includes offer of coverage to employee that is not MEC) Qualifying Offer Transition Relief 2015: Employee and spouse or dependents received no offer or coverage, received a non qualifying offer, or received qualifying offer for less than 12 months
42 IRS Codes for Form 1095-C: Line 14 Code Code Meaning 2A Employee not employed during the month 2B 2C 2D 2E 2F 2G 2H 2I Employee not a full-time employee Employee enrolled in coverage offered. This code trumps all others that might apply. Employee in Limited Non Assessment Period Multi-employer interim relief rule Form W-2 Affordability Safe Harbor. If used, must be used for all months of the year in which employee is offered coverage. Federal Poverty Line Safe Harbor Affordability Rate of Pay Safe Harbor Non-calendar year transition relief applies to this employee.
43 3 Information employers should be tracking now
44 Employee Data Recommendations Start tracking the data so reporting will be smoother at year-end! Get your HR, finance, IT and legal team together Determine who owns this reporting requirement. Ensure that the entire team understands the rules. Determine methods and tools for tracking and measuring data from multiple sources.
45 Employee Data Recommendations Start tracking the data so reporting will be smoother at year-end! Use benefits, payroll and time off data. Start collecting Social Security numbers for dependents as soon as possible (modify open enrollment materials to collect this data). Use 2014 forms as your guide for 2015 reporting. Develop process to deal with one offs. If you re planning to use electronic communications/delivery, obtain consent.
46 Summary of Information to Collect ALE Employer Identification Number(s) plus ALE member and employee identifying information Monthly counts of total employees (month by month) Identification of full-time employee status and full-time employee counts by month Information about coverage offered for month Family member eligibility MEC/MV coverage Employee share of lowest-cost employee-only MV coverage
47 Summary of Information to Collect Offers of minimum essential coverage to full-time employees and dependents Get written acceptance/declinations for your documentation Eligibility for qualifying transition relief Eligibility for or minus 80 transition relief Eligibility for 98% offer relief
48 Summary of Information to Collect If an aggregated ALE group: Information about all ALE members (if applicable) Enrollment information for self-funded groups: Enrolled full time and non-full time employees and non-employees Enrolled family members, including Social Security numbers
49 Forms 1094/1095-C IRS Form 1095-C: IRS Form 1094-C: IRS Forms 1094-C and 1095-C Instructions: Forms issued in February 2015 still have 2014 date and reference 2015 reporting rules. Use them for now. IRS Overview Brochure on 1094-C and 1095-C:
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