By Deborah Pinnock on Aug 2, 2016 2:40:04 PM
Looking at the pieces of a jigsaw puzzle and trying to make sense of it is beyond challenging if you don’t know what the pieces are supposed to create or in other words, if you don’t know the purpose of the pieces. This is why the colorful picture on the box is so powerful. It helps you understand why some parts are a certain color and why they are shaped the way they are. Similarly, it’s difficult to understand Affordable Care Act (ACA) reporting and the associated forms until you first understand that the big picture is healthcare reform. ACA reporting is the tool used to ensure that this picture (i.e. providing healthcare for those across the nation) comes together, one report at a time.
What is the employer mandate?
Healthcare reform law, specifically the employer mandate, is a directive requiring that applicable large employers (ALEs) provide health insurance for its full-time employees (i.e. those who work at least 30 hours per week), or full-time equivalent employees (i.e. a combination of employees, who together, work 30 hours per week). The employer must offer coverage for at least 95 percent of its employees. Furthermore, the coverage should meet the following criteria:
- Be affordable
- Offer minimum essential coverage
- Provide minimum value to employees working 30 hours or more
ACA Reporting: Forms 1095-A, 1095-B, 1095-C and 1094-C
Here’s where the forms come in; they help the government determine whether or not an employer is complying with the employer mandate; those who are not complying may face penalties. Here’s a breakdown on the various forms.
A. Form 1095-A, Health Insurance Marketplace Statement (Form for public health exchanges and individuals)
Public health exchanges and individuals use Form 1095-A (so no need for your employer groups to concern themselves with this form).
- Public health exchanges must file this form with the IRS. It provides information on all the persons, in the “individual” category, that have health coverage, including dental coverage, through the public health exchanges.
- It is also given to Individuals in order to apply for and reconcile the premium tax credit, as well as file correct tax returns.
B. Form 1095-B, Health Coverage (Form for Insurance carriers and individuals)
Form 1095-B is filed by those who provide minimum essential coverage to individuals throughout a calendar year, namely insurance companies. It reports particular information to the IRS about persons who have minimum essential coverage and as such, are not subject to the penalty called the individual shared responsibility.
Taxpayers who receive this form use it to assist them as they file their tax returns. It indicates the following about the tax payer:
- Coverage type
- Number of dependents covered
- Coverage period
C. Form 1095-C, Employer-Provided Health Insurance Offer and Coverage (Form for ALEs)
Only your groups that are classified as ALEs are required to file Form 1095-C. ALEs are employer groups that have at least 50 full-time workers or full-time equivalent. Form 1095-C is used to do the following:
- Used by employers that offer employer-sponsored, self-insured coverage to send information to the IRS concerning individuals whose coverage has the minimum essential coverage and do not have to make a shared responsibility payment.
- Helps to determine if employees are eligible for the premium tax credit.
D. Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns (Form for ALEs)
Form 1094-C is filed with the 1095-C. It is in essence a transmittal/cover sheet for the 1095-C and is only utilized when Form 1095-C is being sent to the IRS.
Even after seeing the big picture, the volume of jigsaw puzzle pieces necessary to recreate it can be overwhelming. Plus, depending on the size of the picture, the process can take a long time. As you encounter these different ACA reports and try to keep track of the various updates, it can be difficult to understand and frustrating as you try to be an invaluable knowledge resource for your groups; however, as you remember that the purpose of the pieces is to create a picture of a reformed healthcare system, this will make understanding these forms less of a puzzle.
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