ACA Reporting and Disclosure: The Complexity Continues (Part 1 of 3)

The unexpected occurred in 2013 when implementation of the Employer Mandate was delayed due to the inability of the IRS to timely issue the requisite reporting and information forms. Now that those forms have finally been issued, we can readily appreciate why it took so long.

The forms, while deceptively simply in appearance, are challenging to complete properly. In fact, the IRS is currently drafting FAQs to address numerous outstanding questions.

This is Part 1 in our 3-part discussion of the ACA reporting and disclosure forms. In this discussion, we focus on the basics: identifying the various forms, the reporting entities, and deadlines for filing. In Part 2, we will discuss the differences between the draft and final forms. In Part 3 we will focus on the penalties for failing comply with these filing obligations.

Forms: There are 4 forms: 2 information returns (the 1095 series) and 2 transmittal forms (the 1094 series).

  • 1095-B – Health Coverage
  • 1094-B – Transmittal of Health Coverage Information Returns
  • 1095-C Employer Provided Health Insurance Offer and Coverage
  • 1094-C – Transmittal of Employer Provided Health Insurance Offer and Coverage Information Returns

Filing Requirements:

The basic requirements for the forms are as follows:

Insured Health PlanSelf-Insured Health PlanSmall employer –(Fewer than 50 full-time equivalent employees (FTEs))Small employer does not fileInsurer files Form 1095-BFile Form 1095-BApplicable Large Employer(ALE) –(50 to 99 FTEs)ALE control group member files Form 1095-C Parts I and II (not Part III), even though may not be subject to employer mandate in 2015Insurer files Form 1095-BFile Form 1095-C Parts I, II and III, even though may not be subject to employer mandate in 2015ALE –(100 or more FTEs)ALE member files Form 1095-C Parts I and II (not Part III)Insurer files Form 1095-BALE member files Form 1095-C Parts I, II and III

This chart is adapted with permission from a summary prepared by Linda Mendel with Vorys, Sater, Seymour and Pease.

When Must Forms be Filed: These forms are not required to be filed for 2014, but reporting entities may voluntarily file in preparation for the first required filing which will be respect to 2015. The 2015 forms are due by Feb. 28 (March 31 if e-filing). Form 1095-B or –C must be provided to covered full-time employees by Jan. 31.

Additional Guidance: For further details, ALEs may consult IRS Publication 5196, “Affordable Care Act: Reporting Requirements for Applicable Large Employers.” Employers should also be on the watch for additional guidance, particularly the previously mentioned FAQs.