Final rules describe health coverage reporting requirements for 2015

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1 frm Human Resurce Services Final rules describe health cverage reprting requirements fr 2015 April 22, 2014 In brief Final regulatins n reprting requirements f the Affrdable Care Act (ACA) give needed guidance t emplyers and insurers wh must reprt t the IRS abut 2015 health cverage. The reprts will prvide infrmatin the IRS needs t enfrce bth the individual mandate and the emplyer mandate. These reprts will als enable the IRS t administer tax subsidies available t certain individual taxpayers fr purchasing insurance n an exchange. Under the new regulatins, emplyers and insurers must cmpile mnthly infrmatin n the health cverage they ffer and n cvered individuals and reprt this infrmatin t the IRS and cvered individuals. Emplyers generally must cmpile mnthly infrmatin n full-time emplyees and their health cverage, and reprt this infrmatin at the end f each year t the IRS and full-time emplyees. Sme simplified reprting will be available. The first reprts must be issued early in 2016 based n 2015 health cverage. IRS frms fr these reprting requirements are being develped and will be made available in the future. In detail Backgrund Under ACA s individual mandate, mst US citizens and residents withut health cverage that meets minimum standards minimum essential cverage r MEC may face penalties. In additin, emplyers with at least 50 fulltime equivalent emplyees ( applicable large emplyers ) may face penalties if they fail t ffer MEC t full-time emplyees, r if the cverage ffered is nt affrdable, minimum value cverage. These emplyer shared respnsibility r emplyer mandate penalties are triggered if a full-time emplyee gets premium tax credits t buy health insurance n an exchange/marketplace. Premium tax credits are nt available t individuals wh are eligible fr MEC frm their emplyers if the cverage prvides minimum value and is affrdable fr them. T enfrce these penalties and prperly administer the premium tax credits, ACA impses tw annual reprting requirements n health insurance issuers and emplyers. The first requirement is that issuers and self-insured emplyers prviding MEC (regardless f emplyer size) must reprt abut the MEC they prvide t the IRS and t cvered individuals. Under the secnd requirement, applicable large emplyers must separately reprt infrmatin abut their full-time emplyees and the cverage they ffer. Like Frm W-2 reprting, the general structure fr these reprts is fr the infrmatin t be reprted t the IRS n an aggregated basis alng with a transmittal frm, and fr individuals t receive reprts with the infrmatin that is relevant t r specifically abut them. The final regulatins make a number f changes t last year s prpsed regulatins and ffer simplified reprting ptins that may be helpful t sme emplyers.

2 HRS Insight Reprting under Sectins 6055 and 6056 is separate frm and in additin t Frm W-2 reprting. Emplyers must cntinue t reprt the cst f emplyer-prvided cverage n the Frm W-2, a requirement that has been in effect since Reprting minimum essential cverage Sectin 6055 reprting T help the IRS enfrce ACA s individual mandate, insurers and emplyers maintaining self-insured health plans must reprt t the IRS and t all cvered individuals the minimum essential cverage they prvide. This includes an infrmatin return prvided t the emplyee r primary insured and a transmittal t the IRS. What is Minimum Essential Cverage? Many types f health cverage are cnsidered MEC and must therefre be reprted. The fllwing chart lists varius types f cverage and whether each type is minimum essential cverage r nt. Mst emplyer-spnsred grup health cverage, including grandfathered plans, will be cnsidered MEC. Anyne cvered n at least ne day f a mnth under an emplyer-spnsred grup health plan will be cnsidered t have MEC. Emplyers and their vendrs must be able t track and reprt n emplyees and their cvered family members. Emplyers ffering emplyee assistance prgrams that prvide significant medical benefits may have t wrk with their EAP prvider t determine reprting requirements and rles. Minimum essential cverage Emplyer-spnsred self-insured cverage fr active, retired r terminated emplyees Individual r emplyer-spnsred grup health insurance subject t State law (including cverage bught n a public exchange) Medicare Part A r Medicare Advantage Mst Medicaid r CHIP cverage Mst Tricare cverage Cverage recgnized as MEC by the Department f Health & Human Services (e.g., cverage prvided by a freign gvernment, cverage prvided t certain selfemplyed individuals r partners), prvided that the spnsr cmplies with ntice and reprting requirements. Nt minimum essential cverage Excepted benefits, including stand-alne dental, stand-alne visin, fixed indemnity plans, critical illness cverage, nsite medical clinics, mst health flexible spending arrangements, emplyee assistance prgrams (EAPs) that d nt prvide significant medical benefits Health Reimbursement Arrangements integrated with grup health cverage Health Savings Accunts MEC that supplements a primary plan f the same plan spnsr, r that supplements Medicare r ther gvernment-spnsred cverage Certain self-insured student health cverage 2 pwc

3 Wh must file MEC reprts? Health insurance issuers must reprt fr all insured cverage. The plan spnsr is respnsible fr reprting fr a self-insured grup health plan. The plan spnsr is the emplyer fr a single-emplyer plan (determined withut aggregating members f a cntrlled grup), the emplyee rganizatin fr a plan maintained slely by an emplyee rganizatin, r the jint bard f trustees r similar grup fr a multiemplyer plan. Fr ther plans maintained by mre than ne emplyer, each participating emplyer must file n behalf f its wn emplyees. Special rules apply fr gvernmental emplyers and gvernment-spnsred prgrams such as Medicare and CHIP. Althugh all emplyee hurs wrked fr any member f a cntrlled grup must be aggregated fr purpses f determining an emplyee s status as a full-time emplyee r an emplyer s status as an applicable large emplyer, emplyers and their vendrs will generally have t reprt MEC n an emplyer-by-emplyer (e.g., EIN) basis, even if health cverage is ffered by a parent cmpany. Wh must receive a reprt? The reprts must be filed with the IRS, and each cvered individual must receive a cpy with the individual s infrmatin. The regulatins d nt require separate individual reprts fr each family member; instead a single reprt is t be furnished t the respnsible individual the primary insured, emplyee, frmer emplyee r ther persn wh enrlls ne r mre individuals, including him r herself, in MEC. N reprts are required fr individuals wh are nt enrlled in cverage. What infrmatin must be reprted? The MEC reprting frms will require the fllwing infrmatin: the name, address and emplyer identificatin number (EIN) f the insurer r self-insured plan spnsr the name, address and EIN f the emplyer spnsring the plan when an insurer is reprting n an emplyer-spnsred grup health plan, and whether the plan is enrlled thrugh the SHOP prgram fr small emplyers the name, address and taxpayer identificatin number (TIN, typically the Scial Security number) f the insured r emplyee (the respnsible individual) the name and TIN f each individual cvered under the plicy r prgram fr each cvered individual, the mnths fr which the individual was cvered fr at least ne day any ther infrmatin required by the frm and instructins. Are we required t btain Scial Security numbers fr cvered dependents? Yes, TINs must be reprted fr each cvered individual. Issuers and plan spnsrs must use existing regulatins gverning infrmatin returns and payee statements that prvide a prcess fr btaining TINs. Under these rules, the reprting entity must slicit the TINs at the time the relatinship with the payee is first established, and then again by December 31 f that year (January 31 if the relatinship began in December). If a TIN is still nt prvided, a secnd annual slicitatin is required by December 31 f the next succeeding year. If after these effrts a TIN has still nt been prvided, the reprting entity may reprt the date f birth in lieu f the TIN fr the individual. In the cntext f health cverage, applying these rules means that insurers and plan spnsrs shuld ask fr Scial Security numbers fr all cvered family members upn initial enrllment, and fr at least the next tw renewals r annual enrllments if Scial Security numbers have nt been previusly prvided. Entities that autmatically enrll r renew cverage and d nt ask fr Scial Security numbers n a regular basis may have t revise their prcesses t be able t satisfy the rules and use the birth date instead f a Scial Security number. Applicable large emplyer reprting Sectin 6056 reprting Emplyers subject t the emplyer mandate must reprt t the IRS and t all full-time emplyees abut the cverage they prvide, whether insured r self-insured. These reprts are needed in rder t enfrce the ACA s emplyer mandate. Infrmatin n the cst f the lwestcst self-nly ptin that prvides minimum value must be reprted, t help individuals and the IRS with determining an individual s eligibility fr premium tax credits fr insurance purchased n an exchange. Fr mre infrmatin n the final emplyer shared respnsibility rules, including determining full-time emplyees and applicable large emplyers, see ur Insight Final rules n ACA s emplyer mandate include new transitin relief. 3 pwc

4 What is an applicable large emplyer? An applicable large emplyer (ALE) is an emplyer with 50 r mre full-time (r full-time equivalent) emplyees in its cntrlled grup determined using the preceding calendar year s emplyee demgraphics. Full-time emplyees are thse emplyed n average at least 30 hurs per week. The number f an emplyer s full-time equivalent emplyees is determined by dividing the aggregate hurs f all emplyees wh wrked less than 30 hurs each week by 30. Transitin rules give emplyers with fewer than 100 full-time emplyees in their cntrlled grup an additinal year befre the emplyer mandate penalties will apply. The penalties will nt apply until the beginning f the 2016 plan year fr these emplyers if they satisfy certain requirements. These transitin rules d NOT extend the reprting requirements and deadlines, hwever. Such emplyers will still file reprts fr 2015, and must include a certificatin that they meet the requirements fr the transitin relief, n the transmittal frm t the IRS. If the emplyer has a nn-calendaryear plan, the certificatin will have t be made again n the 2016 filings with respect t any mnths during 2016 that fall within the 2015 plan year. Wh is a full-time emplyee? A full-time emplyee fr a mnth is a cmmn-law emplyee (nt a leased emplyee, a sle prprietr, a partner in a partnership r a 2 percent S crpratin sharehlder) wh wrks n average at least 30 hurs per week in the mnth. The regulatins under the emplyer mandate prvide several methds fr identifying full-time emplyees, including a mnth-bymnth methd and a lkback methd under which full-time emplyees are identified during a measurement perid and treated as full-time r nt during the fllwing stability perid based n that determinatin. Because emplyers must be able t identify and reprt t all full-time emplyees n a mnthly basis beginning with January 1, 2015, it is critical that they determine nw hw that identificatin will ccur. The use f the mnthly methd in the emplyer mandate regulatins may appear simplest, thugh the lkback methd ffers mre certainty. In either case, emplyers must nw be deciding n the methds t be used, and beginning t track the hurs f service f all emplyees. Wh must reprt? Once an aggregated emplyer is determined t be an ALE, each separate emplyer in the cntrlled grup (ALE member) is respnsible fr reprting based n that emplyer s cmmn law emplyees. Althugh the IRS will allw ne member f the cntrlled grup t d the reprting fr ther members f the cntrlled grup, r will allw third parties t file n behalf f an ALE member, the liability fr reprting and any penalty under the emplyer mandate will be assessed n a member-by-member basis. Special rules allw reprting by multiemplyer plans with respect t the full-time emplyees cvered by a cllective bargaining agreement eligible t participate in the multiemplyer plan, and ther rules address reprting fr related gvernment entities, althugh in bth cases, the ALE member retains liability fr reprting and shared respnsibility penalties. In additin, a disregarded entity is treated as an entity separate frm its wner fr purpses f the emplyer mandate and the reprting requirements; these rules apply t the ALE member and nt its wner. Wh must receive a reprt? Emplyers must create and file a separate return with the IRS fr each full-time emplyee, accmpanied by a single transmittal frm fr all f the returns filed fr a given calendar year. Each full-time emplyee must receive a statement that includes the name, address and EIN f the emplyer and certain emplyee-specific infrmatin. This reprting is similar t emplyers Frm W-2 reprting. Self-insured emplyers shuld be able t cmbine the MEC reprting with the large emplyer reprting, as described belw in The mechanics f filing. What infrmatin must be reprted? Generally, each ALE member must reprt with respect t each full-time emplyee fr each f the 12 mnths in the calendar year: Emplyer infrmatin: the name, address and EIN f the emplyer the name and telephne number f a cntact persn the calendar year fr which the reprt is prvided a certificatin as t whether the emplyer ffered t its full-time emplyees and their dependents the pprtunity t enrll in MEC under an eligible emplyer-spnsred plan, by calendar mnth 4 pwc

5 the number f full-time emplyees fr each mnth during the year Fr each full-time emplyee: the mnths during the calendar year fr which MEC was available t the full-time emplyee the emplyee s share f the lwest cst mnthly premium fr self-nly cverage prviding minimum value ffered t the full-time emplyee, by calendar mnth the emplyee s name, address and TIN and the mnths, if any, during which the emplyee was cvered under the plan Any ther infrmatin required by the frm and instructins. : The requirement t cllect and reprt infrmatin n a calendar mnth basis cmplicates the data cllectin and reprting, particularly fr emplyers that create and maintain recrds n a payrll perid basis. The preamble t the regulatins states that certain additinal infrmatin will be required t be reprted fr each calendar mnth by the use f indicatr cdes n the returns. Cdes will be used t indicate that: MEC meeting minimum value was ffered, by cverage tier (e.g., self, self and spuse, family) cverage was nt ffered t the emplyee, and a related explanatin (e.g., the individual was nt emplyed during a mnth, r was nt a full-time emplyee) cverage was ffered t the emplyee fr the mnth althugh the emplyee was nt a full-time emplyee the emplyee was cvered under the plan the ALE member met ne f the safe-harbrs fr determining the affrdability f cverage under the emplyer mandate regulatins Additinal infrmatin likely t be required n the transmittal frms will indicate: that the ALE member is using the transitin relief under the emplyer mandate regulatins, and any required certificatins the ttal number f returns being filed whether an emplyee s effective date f cverage was affected by a permissible waiting perid, by calendar mnth the ttal number f emplyees, by calendar mnth whether the ALE member had n emplyees fr the calendar mnth the name and EIN f each ther member f the aggregated grup f emplyers f which the ALE member is a part if the ALE member cntributes t a multiemplyer plan with respect t a full-time emplyee, and s is nt subject t penalties the name, address and EIN f any third party that is reprting with respect t the ALE member What alternative reprting methds are available? Tw alternatives are prvided fr emplyers that meet specific requirements: qualifying ffers and 98% ffers. Qualifying ffers. Emplyers that can certify that a qualifying ffer was made t full-time emplyees fr the entire year may prvide a simplified emplyee statement and transmittal with respect t thse full-time emplyees. A qualifying ffer is an ffer f MEC prviding minimum value (i.e., at least 60% actuarial value) at an emplyee cst fr emplyee-nly cverage nt exceeding 9.5% f the federal pverty line. : The federal pverty line fr 2014 fr a single individual is $11,670, s the emplyee cst culd nt exceed $92.39 per mnth ($1,109 per year) t meet this test if it applied in The federal pverty line changes each year. Cverage under a qualifying ffer must be available t the full-time emplyee and the emplyee s spuse and dependents fr all twelve mnths f the year. The emplyer must file under the general methd fr all fulltime emplyees that were nt made a qualifying ffer fr all twelve mnths f the year. Hwever, fr 2015 nly, this alternative methd may be used even fr emplyees nt receiving a qualifying ffer fr all twelve mnths f the year if the emplyer certifies that it made a qualifying ffer t at least 95% f full-time emplyees and their spuse and dependents. 98% ffer. The secnd alternative permits emplyers t reprt withut identifying all full-time emplyees if it ffers MEC prviding minimum value that was affrdable t at least 98% f all emplyees (and their dependents) regardless f whether the emplyee is a full-time emplyee. Fr this purpse, the emplyer may use any f the affrdability safe harbrs permitted under the emplyer mandate regulatins. Emplyers using this apprach wuld nt have t identify r give a cunt f full-time emplyees fr each calendar mnth, 5 pwc

6 but wuld have t prvide ther infrmatin. The tw alternatives shuld prvide simplified reprting fr sme emplyers, althugh the requirements may be a high bar, particularly fr emplyers that have a waiting perid r that d nt ffer cverage t nearly all emplyees. Even emplyers able t use an alternative reprting methd will have t create and retain detailed infrmatin t justify use f the simplified apprach. The mechanics f filing What frms must be filed? When and hw are they t be filed? Entities reprting nly MEC under Sectin 6055 will reprt n IRS Frm 1095-B with the 1094-B transmittal frm. This stand-alne reprting n Frms 1094-B and 1095-B shuld nly apply t self-insured emplyers with fewer than 50 full-time and full-time equivalent emplyees, and t insurance issuers and gvernmental entities respnsible fr reprting MEC. Emplyers wh must als reprt under Sectin 6056 as ALEs will reprt the MEC infrmatin alng with the ALE infrmatin n Frms 1095-C and 1094-C, which will include sectins fr bth reprts. Individuals must receive a cpy f the 1095-B r -C that relates t them, r a substitute statement that includes all f the relevant infrmatin. They may be identified n these statements using an IRS truncated TIN rather than their full Scial Security number. Reprts t cvered individuals and full-time emplyees are due by January 31 f the year fllwing the calendar year in which MEC was prvided r in which the individual was a full-time emplyee. They may be prvided electrnically if the individual has given electrnic r written cnsent t receive the frm electrnically. Emplyers and thers prviding reprts will have t plan ahead t btain cnsent befre delivering reprts t emplyees and cvered individuals electrnically. The same prcess fr btaining cnsent fr electrnic distributin f W-2s may be used, but an individual must specifically cnsent t receiving the 1095-B r -C electrnically. In additin, reprting entities will want t retain evidence f cnsent t receive reprts electrnically. Reprts are due t the IRS n r befre February 28 (March 31 if filed electrnically) f the year fllwing the calendar year t which the reprts relate. These frms must be filed electrnically if the reprting entity is required t file at least 250 Frms 1095-B r -C. These reprts are based n calendar years, nt plan r fiscal years, because the individual and emplyer mandates apply n a calendar year basis. Althugh the individual mandate is in effect in 2014, reprting is ptinal fr this year. What are the penalties fr nt reprting, r fr inaccurate r incmplete returns? The penalties fr nt reprting will be the same as the penalties fr late r incrrect reprting Frms W-2 and transmittals t the IRS. The penalty is generally $100 per return, with a maximum f $1.5 millin. The penalties apply separately t reprting under Sectins 6055 (MEC) and 6056 (ALEs). Penalties may be waived if the failure t file timely r accurate returns is due t reasnable cause and is nt due t willful neglect. Are there any transitin rules fr these reprting requirements? Yes, the IRS has said that penalties will nt be enfrced fr 2015 reprting fr any issuer r emplyer that has made a gd faith effrt t cmply, but has prvided incrrect r incmplete infrmatin such as TINS r dates f birth. The takeaway Emplyers wh are analyzing the new regulatins n the emplyer mandate need t cnsider these reprting requirements as well, and hw they relate t the ptential emplyer shared respnsibility penalties. Emplyers cnsidering utilizing the lk-back methd t identify full-time emplyees beginning in January 2015 must be preparing t track emplyees hurs f service fr the measurement perid beginning n later than July 1, 2014 if they have nt already begun t d s. These new reprting requirements will necessitate crdinatin between HR and benefits departments, payrll and TPAs, as well as between different members f aggregated entities. In additin, until the actual Frms and reprting cdes have been released, it will be difficult t create reprting systems and testing. All stakehlders within an rganizatin that are invlved with regulatry reprting and cmpliance shuld appreciate the risks invlved in these ptential ACA penalties, and wrk t assure cmpliance with the reprting rules in rder t avid the significant penalties fr failure t ffer cverage as required. 6 pwc

7 Wh reprts T Whm When Hw What Why MEC Reprting Frms 1094-B and 1095-B Insurers, gvernment agencies and selfinsured emplyers f any size prviding minimum essential cverage (MEC) t individuals NOTE these reprts are cmbined n the C- series frms fr emplyers wh must file under bth sectins All individuals receiving minimum essential cverage, including emplyees, pre-medicare retirees, COBRA beneficiaries and cvered dependents Separate statements nt required fr enrlled family members they are t be listed n reprt t respnsible individual IRS Cvered individuals by January 31 fllwing the calendar year f cverage IRS by February 28 (March 31 if filed electrnically) f 2016 fr 2015 cverage with vluntary reprting encuraged fr 2014 cverage T cvered individuals by first-class mail r electrnically with participant cnsent T IRS electrnically if required t file 250 r mre returns, n Frm 1095-B with 1094-B Transmittal frm Name, address and EIN f reprting entity Name, address and Scial Security number (TIN) f the respnsible individual (e.g., the emplyee) Name and Scial Security number (r birth date if TIN nt btainable) f each cvered individual (e.g., the emplyee s cvered dependents) Mnths f MEC fr each cvered individual Enfrcement f individual mandate, recnciliatin f individual federal subsidies ALE Reprting Frms 1094-C and 1095-C Applicable large emplyers thse with 50 r mre full-time equivalent emplyees in the cntrlled grup during the prir calendar year Required fr 2015 even if emplyer is exempt frm emplyer mandate fr 2015 (between 50 and 100 FTEs) All full-time emplyees (FTEs) IRS Emplyees by January 31 fllwing the calendar year f cverage IRS by February 28 (March 31 if filed electrnically) f 2016 fr 2015 cverage with vluntary reprting encuraged fr 2014 cverage T emplyees by first-class mail r electrnically with advance cnsent T IRS electrnically if required t file 250 r mre returns, n Frm 1095-C with 1094-C Transmittal frm Emplyer identifying and cntact infrmatin Emplyer certificatin f MEC ffer t FTEs and dependents FTE infrmatin: mnths cverage was available, emplyee s share f lwest cst selfnly minimum value ptin, number f FTEs each mnth, Name, address, TIN f each FTE and mnths in which the emplyee was cvered. Additinal infrmatin will be required t be reprted using indicatr cdes. Enfrcement f emplyer shared respnsibility, recnciliatin f individual federal subsidies 7 pwc

8 HRS Insight Let s talk Fr mre infrmatin, please cntact ur authrs: Anne Waidmann, Washingtn, DC (202) Amy Bergner, Washingtn, DC (202) Kerry Easn, Chicag (312) r yur reginal Human Resurce Services prfessinal: Charlie Yvin, Atlanta (678) Terry Richardsn, Dallas (214) Ed Dnvan, New Yrk Metr (646) Sctt Pllak, San Jse (408) Craig O'Dnnell, Bstn (617) Tdd Hffman, Hustn (713) Bruce Cluser, Philadelphia (267) Nik Shah, Washingtn Metr (703) Pat Meyer, Chicag (312) Carrie Duarte, Ls Angeles (213) Jim Dell, San Francisc (415) PricewaterhuseCpers LLP. All rights reserved. In this dcument, PwC refers t PricewaterhuseCpers (a Delaware limited liability partnership), which is a member firm f PricewaterhuseCpers Internatinal Limited, each member firm f which is a separate legal entity. SOLICITATION This cntent is fr general infrmatin purpses nly, and shuld nt be used as a substitute fr cnsultatin with prfessinal advisrs. 8 pwc

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