IRS Reporting for NON-Large Employers

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1 IRS Reporting for NON-Large Employers NMASBO Fall Conference September 24, 2015 Nura Patani, PhD Senior Actuarial Analyst Copyright 2015 by The Segal Group, Inc. All rights reserved. Ø Am I a Large Employer? Ø Overview of 4980H Penalties Ø IRS Reporting Forms 1094-B and 1095-B 2 1

2 Applicable Large Employer (ALE) Determination* Ø This determination is completed each calendar year, and depends on the average size of an the workforce during the prior year. Ø The following counts are ONLY for the purpose of determining if an employer is an Applicable Large Employer. Ø For each calendar month: Full-Time EE Count = # of EEs who averaged 130+ hours of service during month Full-Time Equivalent EE Count = Total hours of service for all non-full-time EEs (do not include more than 120 hours of service per EE) 120 Workforce size for the month = Full-Time EEs + Full-Time Equivalent Ees Ø Workforce size for the year is the workforce size for each calendar month of the prior calendar year divided by 12. *See fine print on slide 6 for details on a seasonal workers exception 3 Example 1: Employer IS an ALE Ø Employer X has a total of 60 employees: 40 employees had 130+ hours of service during each month of employees had 60 hours of service during each month of 2015 Ø Workforce size in each month: Full-Time EE Count = 40 Full-Time Equivalent EE Count = (20 x 60) 120 = 1, = 10 Workforce size = = 50 Ø Workforce size for the year: (12 x 50) 12 = 50 Ø Employer X has 50 full-time employees (including full-time equivalents) for purposes of ALE determination Ø Although Employer X has only 40 full-time employees, it IS an ALE 4 2

3 Example 2: Employer is NOT an ALE Ø Employer Y has a total of 55 employees: 40 employees had 130+ hours of service during each month of employees had 60 hours of service during each month of 2015 Ø Workforce size in each month: Full-Time EE Count = 40 Full-Time Equivalent EE Count = (15 x 60) 120 = = 7.5 Workforce size = = 47.5 Ø Workforce size for the year: (12 x 47.5) 12 = 47.5 Since this is not a whole number, round down to the next lowest whole number (i.e. 47) Ø Employer Y has 47 full-time employees (including full-time equivalents) for purposes of ALE determination Ø Since 47 is less than 50, Employer Y is NOT an ALE 5 Some Fine Print Ø Seasonal Workers Exception An employer is no considered to have more than 50 full-time employees (including full-time equivalents) if both of the following apply: If an employer s workforce exceeds 50 full-time employees (including full-time equivalents) for 120 days or fewer and If the employees in excess of 50 during that 120-day period are seasonal workers (i.e., customary annual employment of 6 months or less) If you ARE an Applicable Large Employer, you hopefully attended yesterday s session. 6 3

4 If you are NOT an ALE Ø You will still need to determine that you are not an ALE each year Ø You will also need to meet the Section 6055 reporting requirement if you offer self-insured coverage (for example, NMPSIA coverage) 7 Ø Am I a Large Employer? Ø Overview of 4980H Penalties Ø IRS Reporting Forms 1094-B and 1095-B 8 4

5 Two Penalties in a Nutshell Ø Individual Shared Responsibility Penalty (Individual Mandate) Ø Starting January 2014, a penalty on certain individuals who fail to maintain minimum essential coverage (MEC). Ø If a taxpayer (or an individual for whom the taxpayer is liable) isn't covered under MEC for one or more months then, unless an exemption from the penalty applies, the taxpayer is liable for the individual shared responsibility penalty payment on his or her individual income tax return. Ø Employer Shared Responsibility Penalty (4980H Penalty) Ø Beginning with the first day of the plan year in 2015, applicable large employers (ALEs) may be subject to a penalty tax for failing to offer minimum essential coverage (MEC) to the required percentage of full-time employees and their dependent children to age 26 (4980H (a) $2,000). OR Ø Offering MEC coverage that is not Affordable and does not offer a Minimum Value (4980H (b) $3,000). Any NON-ALE who provides Self-Insured Coverage (for example, NMPSIA coverage) will still need to meet reporting requirements related to the Individual Mandate. 9 Ø Am I a Large Employer? Ø Overview of 4980H Penalties Ø IRS Reporting Forms 1094-B and 1095-B 10 5

6 IRS Reporting Ø How will the government know that YOU, as an applicable large employer (ALE), have created the opportunity to obtain a 4980H penalty? YOU will give them the data they need to assess your penalty in the reports you begin to submit annually to the IRS starting in 2016 (reporting on the 2015 calendar year). A forms used by (State Exchanges/Federal Marketplace) B forms used by (Insurers, ME plans, non-ales) C forms used by (Self-funded and fully insured ALEs) IRS forms and instruction for reporting (all will be updated periodically): 2015 draft forms are generally unchanged from the 2014 forms ü 2015 DRAFT IRS form 1095-C: ü 2015 DRAFT IRS form 1094-C: ü 2015 DRAFT IRS form 1094-B: ü 2015 DRAFT IRS form 1095-B: ü 2015 DRAFT IRS form 1095-A: ü IRS website with Q&A about Employer Information Reporting on Form 1094-C and Form 1095-C: ü IRS website with Q&A on 6056 reporting: ü Instructions for C series forms: ü Instructions for B series forms: ü April 2015: DRAFT electronic filing instructions: 11 IRS Reporting: Who Has Reporting Obligation? Type of Employer Plan Type 6055 Reporting 6056 Reporting Individual Mandate for Reporting on Minimum Essential Coverage (MEC) Employer Shared Responsibility Mandate Reporting on FT employee status and potential 4980H penalty reporting Applicable Large Employer (ALE) with 50 or more FT employees Employer who is NOT an ALE and is not part of a controlled group Self-funded medical plan Fully insured medical plan Contributes to a multiemployer plan Self-funded medical plan Fully insured medical plan Contributes to a multiemployer plan ALE completes 1095-C (Part III) for employee and all of 1095-C for IRS Insurer completes 1095-B for employee and 1095-B & 1094-B for IRS Multiemployer plan sponsor completes 1095-B for employee and 1095-B & 1094-B for IRS Employer completes 1095-B for employee and 1095-B & 1094-B for IRS Insurer completes 1095-B for employee and 1095-B & 1094-B for IRS Multiemployer plan sponsor completes 1095-B for employee and 1095-B & 1094-B for IRS ALE completes 1095-C (Part I, II & III) & 1094-C for IRS ALE completes 1095-C (Parts 1 & II) & 1094-C for IRS ALE completes 1095-C and 1094-C for IRS Not applicable Not applicable Not applicable All employees in a controlled group are counted when determining whether related employers are ALE members. Each ALE member must file for its own employees. Where an ALE reports for separate divisions, employees working for multiple divisions must receive aggregated information on a single Form C. Where ALEs are part of a controlled group, employees will receive a separate Form 1095-C for full-time employment with each ALE in the controlled group. 12 6

7 Form 1094-B Ø Sole purpose of this form is to identify the filer and transmit the 1095-B forms to the IRS Ø Identify contact person at your organization 13 Form 1095-B: Parts I, II, and III Ø Responsible Individual refers to the employee or eligible retiree Ø Origin of the Policy is reported by code A B C D Origin of the Policy Codes Small Business Health Options Program (SHOP) Employer-sponsored coverage Government-sponsored program Individual market insurance Ø Part III is completed by insurers, employers sponsoring self-insured health plans, and others (such as governmental agencies) E Multiemployer plan F Miscellaneous minimum essential coverage 14 7

8 Form 1095-B, Part IV Social security numbers are important to obtain! Follow the rules for reasonable efforts. Coverage for at least one day = coverage for the entire month for reporting purposes. Note that for the purpose of Section 4980H penalties, coverage must be offered for the entire month 15 Delivery Methods for 6055 Reporting Ø Mail to employee at last known permanent address, or if no known permanent address, the employee s temporary address Ø Can electronically distribute ONLY IF affirmative consent received Ø Hand delivery is permitted (as is the case with W-2 forms) An employer (or plan) may furnish a statement to a full-time employee (or participant) in an electronic format, ONLY IF certain criteria are met: ü Affirmative consent is required to receive the statement electronically; ü Notice is provided if the required hardware or software changes; ü Certain required disclosures are provided in advance of receiving consent; ü Format meets IRS standards; ü If the statement is furnished on a website, certain notice requirements are met; ü If the statement is furnished on a website, it is available through October 15 of the year following the year to which the statements relate; and ü Paper statements are furnished if electronic consent is withdrawn. 16 8

9 Electronic Filing of IRS Reporting Forms Large employers are familiar with the IRS Filing Information Returns Electronically (FIRE) system generally used to file Forms 1099 and similar information returns with the IRS. However, ALEs will not use the FIRE system for filing IRS forms required under Section Instead, the IRS has developed a NEW electronic filing system for ACA Information Returns the Affordable Care Act Information Return System (AIR). Draft AIR publication 5156 called Guide for Electronically Filing Affordable Care Act (ACA) Information Returns located at: with more information at: 17 Electronic Filing of IRS Reporting Forms Ø To file electronically, ALEs must initiate registration in the new AIR system by submitting an Application for Transmitter Control Code (TCC), which establishes the organization s registration as a Software Developer, Transmitter or Issuer. An Issuer is a business that is required to file ACA Information Returns and is transmitting only their information returns. ALEs that develop their own software may be required to provide additional information to obtain a Software ID. Ø The required format for all ACA Information Returns is XML. Returns will not be accepted electronically in any other format, and there are no online fill-in forms to facilitate small volumes of returns. Ø Testing is required. See Publication 5164, Test Package for Electronic Filers of Affordable Care Act (ACA) Information Returns, for details and test scenarios. Test files must be submitted in an XML format, and the submitter must verify that the IRS processed the transmission and returned a Receipt ID, acknowledgement and associated error file. Test submissions must exactly match the answer key for each test scenario ( including leading, trailing, and embedded spaces; punctuation, and capitalization ). Ø Many Rules Must be Followed for AIR Submission. For example, when filing Forms W-2, the SSA recognizes that a small number of validly work-authorized employees may not have a Social Security number assigned at the time that Forms W-2 must be produced and filed (for example, recent work-authorized immigrants with SSN applications pending). In these rare cases, Forms W-2 may be filed with the SSN reported as all zeros. The IRS AIR system will not accept any Forms 1095-C without a valid SSN for an employee. 18 9

10 Penalty for Non-Compliance with IRS Reporting Ø Employers that fail to timely file complete 1095-B and 1095-C forms may be subject to a penalty up to $250 per return, with a maximum annual penalty of $3.0 million IRS says a provider of minimum essential coverage that fails to comply with the information reporting requirements may be subject to the general reporting penalty provisions under section 6721 (failure to file correct information returns) and section 6722 (failure to furnish correct payee statement). Special rules apply that increase the per-statement and total penalties if there is intentional disregard to complete IRS reporting. Waivers are available when failure to report is due to a reasonable cause Limited relief is also available for returns and statements filed or furnished in 2016 (for 2015 coverage) if incorrect or incomplete information is reported.if they are corrected 19 Questions? 20 10

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