On Monday, February 9, 2015, the Internal Revenue Service (IRS) released final forms that applicable large employers and health insurance issuers will use to report information regarding employees’ full-time status and health coverage, as required under the Affordable Care Act (ACA) starting in 2015. The first reporting will be due in the first quarter of 2016, reflecting the 2015 calendar year.
Final ACA Forms: 1094B, 1095B, 1094C & 1095C
The forms may be found by following these links:
• Form 1094-B: Transmittal of Health Coverage Information Returns
• Form 1095-B: Health Coverage
• Instructions for Forms 1094-B and 1095-B
• Form 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return
• Form 1095-C: Employer Provided Health Insurance Offer and Coverage
• Instructions for Forms 1094-C and 1095-C
ALE (50+ FTE): Forms 1094-C to IRS & 1095-C to Employees
Applicable large employers-generally those with 50 or more full-time equivalent employees on average during the prior calendar year-will satisfy their reporting requirements by filing Form 1094-C (a transmittal to the IRS) and Form 1095-C (a statement to employees). Applicable large employers that sponsor self-insured plans will complete all parts of Form 1095-C (Part I, II and III), as applicable, to satisfy their obligation, whereas an employer sponsoring a fully insured plan will complete only the top half (Parts I and II) of Form 1095-C, and generally only for full-time employees.
IRS Uses 1095-C for Play or Pay Mandate
The IRS will use Form 1095-C to assess an employer’s compliance with the play-or-pay mandate as well as whether an employee is eligible for premium tax credits to purchase coverage through the Health Insurance Marketplace. Employers must file Form 1094-C with the IRS by February 28 following the reporting year (March 31 if filing electronically) and must provide Form 1095-C to full-time employees by January 31 following the reporting year. Employers with self-insured plans provide Form 1095-C to all covered employees, as well as all full-time employees regardless of enrollment status (Part III is only completed for covered employees).
IRS Use 1095-B & 1095-C to Determine Minimum Essential Coverage
Health insurance issuers will satisfy their reporting obligations by filing Form 1094-B with the IRS and by providing Form 1095-B to covered employees, who will use the information to report compliance with the individual mandate on their federal income tax return. The IRS will use Form 1095-B (and Form 1095-C, when provided by a self-insured plan) to verify whether individuals have the minimum essential coverage necessary to comply with the ACA’s individual mandate.
Peter J. Marathas, Esq.
Heading both the Employee Benefits Practice in Proskauer’s Boston office and Proskauer’s Health Care Reform Task Force.
Legal & Compliance Director, Benefit Advisors Network
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