Let’s look at some specifics.
Q: What are the employer requirements for reporting health care information on Forms 1094 and 1095?
A: The IRS has provided both new and updated Q&A guidance on the reporting requirements for large employers, as defined under the Affordable Care Act (ACA). Beginning in 2016, these large employers must file Forms 1094 and 1095 to provide information to the IRS and plan participants about health coverage provided in the previous year. The forms are used by the IRS to enforce the ACA’s shared-responsibility (or “play or pay”) provision, as well as individual mandate and tax credit eligibility rules.
Clarifying Who Reports and How
The guidance clarifies that a large employer with no full-time employees for any month of the year isn’t obligated to report unless the organization sponsors a self-insured health plan in which any employee, spouse or dependent is actually enrolled. In that case, it must still file Forms 1094-C and 1095-C even if it has no full-time employees.
The guidance also confirms that a large employer must file and provide Form 1095-C to all full-time employees regardless of whether they were offered coverage during the year.
Examples show how reporting differs in a couple of specific situations:
- If a large employer reports for separate divisions, employees working for multiple divisions must receive aggregated information on a single Form 1095-C.
- If a large employer is part of a controlled group of companies, employees should receive a separate Form 1095-C for full-time employment with each large employer in the controlled group.
The guidance verifies that large employers may designate third parties to perform reporting on their behalf. In fact, the new Q&As confirm that a governmental large employer may designate another governmental entity to accept reporting responsibility on its behalf. The allocation of responsibilities under various combinations of self-insured and fully insured coverage options is also explained.
In addition, the guidance confirms that a Form 1095-C may be delivered to employees in any manner permitted for delivery of Form W-2—including by hand. But, unlike with Form W-2, employers need not furnish a midyear Form 1095-C upon an employee’s request following termination of employment.
Applying the Qualifying Offer Method
The updated Q&As now address reporting under the qualifying offer method, which allows large employers to furnish a simplified statement to employees receiving qualifying offers for all 12 months of the year. The Q&As emphasize that use of simplified statements isn’t available for employees who actually enroll in a large employer’s self-insured health plan.
The guidance doesn’t mention the qualifying offer method transition relief available in 2015. This relief allows a large employer to use a different simplified statement provided that it makes qualifying offers to at least 95% of its full-time employees.
Handling Hires and Terminations
When reporting offers of coverage on Part II of Form 1095-C, large employers may indicate that an offer of coverage was made for a month only if the offer would have provided coverage for every day of the month. Thus, large employers should report on Form 1095-C that no coverage was offered in the month an employee was hired unless an offer of coverage extended to every day of that month.
Similarly, if a terminating employee’s coverage ends before the end of the month of termination, the large employer must report that no coverage was offered for the month. (In each case, the large employer may be able to avoid pay-or-play liability even though coverage wasn’t offered for the full month.) In contrast, when reporting coverage information under Part III of Form 1095-C, an employee should be reported as having coverage if he or she is enrolled on any day of the month.
The disparate treatment of partial months of coverage highlights the multiple purposes of Form 1095-C. Under the play-or-pay provision, large employers generally get credit for offering coverage for a month only if the offer applies to the full month—but an individual avoids the individual mandate penalty for a month by having coverage on any day of the month.
Reporting COBRA Offers
The new Q&As illustrate reporting under various COBRA scenarios. The guidance explains how sponsors of self-insured plans should report enrollment information for nonemployee COBRA beneficiaries, such as former spouses. Qualified beneficiaries electing COBRA independently from the employee must receive separate forms, while those who have COBRA because of an employee’s election should be included on the same form provided to the employee. (Reporting may be made on either Form 1095-B or 1095-C for individuals who weren’t employees at any time during the year.)
Several examples illustrate how a large employer should complete Form 1095-C for full-time employees who receive a COBRA offer because of:
Termination. In general, a COBRA offer made because of termination is reported as an offer of coverage only if the former employee enrolls in COBRA coverage and the employee’s cost of coverage reflects the COBRA premium for the lowest-cost, self-only coverage providing minimum value.
Reduction of hours. In contrast, a COBRA offer made to an active employee because of reduced hours would be reported as an offer of coverage on Form 1095-C even if the employee declines COBRA coverage. The example used to illustrate this final point, however, doesn’t extend more than 60 days after the loss of eligibility. So it’s unclear whether the large employer would still report that coverage is offered after the employee’s COBRA election period has ended.
With mandatory reporting starting in early 2016 (for 2015 coverage), understanding the complexities of these reporting requirements is critical. Although some of the Q&As contained in this guidance were previously addressed in the instructions for Forms 1094 and 1095, others provide helpful clarifications and new information. If your organization is subject to the large-employer reporting requirements, pay close attention to this and future guidance as the reporting deadline draws nearer.
Seek the services of a legal or tax adviser before implementing any ideas contained in this blog. To reach a financial advisor at Lane Gorman Trubitt PLLC, call (214) 871.7500 or email firstname.lastname@example.org.