In February 2015, the IRS provided guidance on the final version of forms employers are subject to in regards to the PPACA mandate. The information will be used by the IRS to administer and individuals to show compliance with the individual shared responsibility provision. The following are important reporting obligations which are key in administering the ACA individual and employer requirement mandates. Statements and employer reporting will be furnished to IRS and individuals in 2016, to report coverage information in calendar year 2015.
6055 Reporting requirements applies to all entities providing minimum essential coverage to its employees. The health plan issuer (insurance company for fully insured plans or the employer for self-insured plans) Entities must report healthcare coverage information to the IRS. The reports identifies which individuals were covered and for how many months within the year
1094 B – Reporting transmittal form to be filed with the IRS
1095 B – Provided to insured individual and filed with the IRS
6056 Reporting applies to applicable large employers (ALEs), generally 50 or more full-time and full-time equivalent employees and responsible for a shared responsibility payment. Large employers are required to offer a qualified plan or pay a penalty.
1094 C – Transmittal form to IRS
1095 C – Provided to insured individual and filed with the IRS
Requirements for Reporting
- 60% minimum value coverage requirement
- Affordability requirement for employee-only coverage being no more than 9.5% of federal poverty line
- Offer minimum essential coverage to the employee’s spouse and dependent children
- Coverage to be available for 12 months of the year
- Information returns must be provided to all full time employees by January 31 via first class mail, or obtain EE approval to provide forms online
- Reporting employer forms must be filed with the IRS by February 28 for paper filings and March 31 for electronic filing, if more than 250 returns are included, electronic filing is mandatory