Businesses Affected by ACA Reporting

ACA reporting responsibilities depend on employer size and the type of insurance you maintain, whether insured or self-insured.

In general, the reporting requirements apply if you're an employer with 50 or more full-time employees or equivalents, a self-insured employer, regardless of size, or a health insurance provider. The IRS forms used to report this information are 1095-B and 1095-C, along with transmittal forms 1094-B and 1094-C.

For clarification, you're a self-insured -- or self-funded – employer if you pay for medical claims directly instead of paying premiums to an insurance provider.

ACA Reporting for Smaller, Self-Insured Employers

There are relatively few small businesses that must comply with ACA reporting requirements.
The ACA defines a small business as those with fewer than 50 full-time employees, or FTEs.

If you're a self-insured businesses, you'll need to fill out the 1095-B (and 1094-B transmittal form) to report the name, address and Social Security number (or date of birth) of covered individuals.

Small businesses that aren't self-insured don't need to file anything.

ACA Reporting for Applicable Large Employers (ALEs)

For the most part, the biggest impact with the ACA reporting requirements is with applicable large employers with 50 or more full-time or full-time equivalent employees.

Keep in mind an ALE may be a single entity or may consist of a group of related entities (such as parent and subsidiary, or other affiliated entities). If the combined number of full-time and full-time equivalent employees for the group is large enough to meet the definition of an ALE, then each employer in the group (called an ALE member) is part of an ALE – and subject to the Employer Shared Responsibility provision, even if it wouldn't be an ALE separately.

Calculating Full-Time and Full-Time Equivalent Employees (FTEs)

Since the definition of an applicable large employer includes full-time and full-time equivalent employees in a preceding calendar year, it's important to understand the distinctions.

• Full-time employee: Averages at least 30 hours of service per week during the month (or 130 hours in a calendar month)
• Full-time equivalent employee: Combination of employees, each of whom is not treated as a full-time employee, but that, together, count as a full-time employee
• Don't forget to include former employees who meet these requirements during your measurement period

Note: Hours of services represent each hour an employee is paid or entitled to payment, including vacation, leave, holiday, illness, incapacity, layoff, jury duty, military duty and other leaves of absence.

To determine the number of full-time equivalent employees for a month:

Once you've calculated your FTEs, add that number to your total number of full-time employees on staff to determine whether or not you're an applicable large employer.

Compliance insight

Keeping track of the number of full-time and full-time equivalent employees, as it pertains to the ALE classification, is critical. This classification is determined each calendar year and depends on the average size of your workforce in the prior year.

For hourly employees, count the actual hours worked. For non-hourly employees, count either: 1) the actual hours worked, 2) days worked equivalence – 8 hours for each day with at least one hour of service or 3) weeks worked equivalence – 40 hours for each week with at least one hour of service. Not included in the calculation are independent contractors, certain variable hour workers, seasonal employees working 120 days or less in a year, and COBRA and retired enrollees.

Calculating employee hours for ACA reporting is a huge undertaking. For this reason, you may want to explore dedicated time-tracking software, or choose to outsource this responsibility to a payroll vendor or benefits administrator.

Form 1095-B Filing Instructions for Smaller, Self-Insured Businesses

Self-insured businesses with fewer than 50 full-time employees must complete Form 1095-B (and the 1094-B transmittal form if not e-filing).

To report the necessary information to the IRS and furnish a form to employees, you'll need to complete:

• Part 1: Responsible Individual – Includes name and address of primary person insured, Social Security number and code for Origin of the Policy (A. Small Business Health Options Program (SHOP), B. Employer-sponsored coverage, C. Government-sponsored program, D. Individual market insurance, E. Multi-employer plan, F. Other designated minimum essential coverage)
• Part 2: Employer Sponsored Coverage -- Not applicable for self-insured employers; can be left blank
• Part 3: Issuer or Other Coverage Provider – Includes name and address of coverage provider (in this case, the employer), Employer Identification Number (EIN), address and phone number
• Part 4: Covered Individuals – Includes Social Security number (or date of birth, if not available) for each covered individual, as well as coverage offered each month

1094-B Transmittal Form at a Glance

The 1094-B transmittal form represents the total 1095-B filings submitted. Acting as a cover sheet, it is a brief form that includes:

• Identifying information for your organization, such as name, address and Employer Identification Number (EIN)
• Total number of 1095-Bs being submitted with this cover sheet

Form 1095-C Filing Instructions for Insured and Self-Insured ALEs

To satisfy the reporting requirements, fully insured and self-insured applicable large employers must complete Form 1095-C (and the 1094-C transmittal form).

If you offer health insurance, you'll complete Parts I and II of the 1095-C. Self-insured employers will complete Parts I, II and III. Every employee of an ALE who is eligible for insurance should receive a 1095-C. That means even eligible employees who decline to participate in an employer's health plan still receive a 1095-C.

To report the necessary information to the IRS and furnish a form to employees, you'll need to capture a number of details, as follows:

• Part 1: Employee and Applicable Large Employer Member (Employer) – Includes identifying information for the employee, such as name, address and Social Security number (SSN) – and identifying information for the employer, such as name, address and Employer Identification Number (EIN).
• Part 2: Employee Offer and Coverage – This section is all about the offer of coverage. In the four lines here, you'll enter information about the health coverage offered by month (if any), the monthly employee required contribution for self-only coverage, and the months you met an affordability safe harbor or made other relief available to the employee.
• Part 3: Covered Individuals – If you're self-insured, this section is about the coverage that was actually supplied, which includes information about covered individuals' enrollment in the plan. This includes Social Security numbers or, if these numbers aren't available, date of birth. (This information isn't completed by insured employers because it's captured separately by the health insurance providers themselves, through the 1095-B.)

All ALEs need to submit this form (Parts I, II, and III) even if they do not offer insurance and are not self-insured and they still have to provide a copy of the 1095-C to their employees.

Lines 14-17 on the 1095-C

The bulk of the work in completing the 1095-C is with Lines 14-17 in Part 2.

The "Offer of Coverage" on Line 14 – which involves eleven codes, 1A through 1U -- describes whether or not minimum essential coverage was offered to an employee, spouse and/or any dependents. This is all about the offer and not necessarily the actual coverage. If one code applies for the entire 12 months, you only need to enter it once in the "All 12 Months" column.

For example, if the employee was offered coverage for themselves and spouse but enrolled in employee only, Line 14 must indicate that the employee was offered family coverage.

On Line 15, you're reporting the employee required contribution, which is the monthly cost to the employee for the lowest-cost self-only minimum essential coverage providing minimum value. This helps the IRS determine if affordable coverage was made available to the employee. You'll only fill out this section if you entered code 1B, 1C, 1D, 1E, 1J, 1K, 1L, 1M, 1N, 1O, 1P, or 1Q on Line 14. Include cents with this figure and don't round numbers. If you entered 1A on Line 14, nothing needs to be entered on Line 15 because this code indicates you offered essential coverage providing minimum value to the employee, spouse and/or dependents. This may not be the amount the employee is actually paying. See Notice 2015-87.

Line 16 – which involves nine codes again, 2A-2I – clarifies issues such as whether an individual was employed during the month, whether the employee was eligible and/or enrolled in coverage, if any affordability safe harbors applied when an employee declined coverage and if the employee was in a waiting period or other limited non-assessment period for which you'd be liable for a penalty. In a nutshell, you're giving the IRS a reason why you shouldn't be penalized under the Employer Shared Responsibility provision. Again, you only fill this out if a code applies to the employee for any particular month. This line is optional but it is in your (employer) best interest to provide this information to avoid penalties.

Line 17, you will need to enter the zip code for the employee.

1094-C Transmittal Form at a Glance

The 1094-C transmittal form represents the total 1095-C filings submitted with this transmittal. Acting as a cover sheet, it includes:

• Identifying information for your organization, such as name, address and Employer Identification Number (EIN)
• Information about whether your organization offered coverage to at least 95% of your full-time employees and their dependents
• Total number of 1095-Cs issued to employees
• Information about members of the aggregated applicable large employer group, if any
• Full-time employee counts by month
• Total employee counts by month
• Whether you're eligible for certain transition relief (including certifications)

Important Deadlines and Penalties to Avoid

1095 forms have different deadlines for paper and e-filing than 1099s and W-2s. This means:

Note: Electronic filing is required if the employer files 10 or more forms.

Avoiding Filing and Furnishing Penalties

You must comply with ACA reporting requirements, or risk steep penalties. Penalties can apply for:

• Failure to file
• Failure to furnish recipient statements
• Failure to file on time
• Failure to file electronically when required to do so (if filing 250 or more forms)

Reporting Penalty	Amount of Penalty
Failure to file with the IRS Section 6721	$310/form $3,783,000 calendar year maxiumum
Failure to furnish a recipient copy Section 6722	$310/form $3,783,000 calendar year maxiumum
Filed/furnished after August 1 or not at all Combined calendar year maximum	$310/form $7,566,000 ($2,522,000 for small businesses)
Intentional Disregard to file/furnish	$630/form no calendar year maxiumum

Capturing and Tracking Necessary Data

The information gathering process will be challenging for many businesses. To capture all the data required for 1095 reporting, you'll need to pull from four major sources or internal departments: HR, payroll, benefits and time-tracking systems. This will require careful coordination, sharing and monitoring to complete the forms accurately and on time.

The key items you'll need to track:

• Full-time employees
• Full-time equivalent employees
• Coverage on a monthly basis for employees, spouses and dependents

Strict security is also necessary. Because the employee's name and health insurer appears on the same form, the data is considered protected health information (PHI). Using a solution that is SOC-certified and HIPAA-compliant, like efile4Biz.com, can provide an added layer of protection with this type of data.

A few essential Dos and Don'ts will ensure a smooth filing process:

• DO notify employees they will be receiving a 1095-C and may need information from it to complete their previous year tax filing.
• DON'T file more than one 1094-C authoritative transmittal. (You may file multiple 1094-C forms but only one authoritative transmittal)
• DO file corrected returns as soon as possible after an error is discovered.
• DO file Form 8809, either by paper or electronically if necessary, for a 30-day extension for filing with the IRS. No signature or explanation is necessary for this extension.
• DON'T file more than one 1095-C per employee. If an organization has different divisions with different benefits – and an employee moves between divisions during the year – you'll need to consolidate data onto one 1095-C.

It is important to keep HIPAA compliance in mind when filing healthcare coverage ACA forms, 1095-B and 1095-C. These forms may contain protected health information (PHI), meaning an employer's medical plan is a covered entity subject to HIPAA privacy, security and breach notification rules.

Use Caution When Collecting Sensitive Data

When gathering information for Forms 1095-B and 1095-C, it is probable that you will require Social Security numbers (SSNs) for employees, as well as spouses and dependents covered under the plan.

Collecting SSNs for employees may be a common occurrence, but now you face the added responsibility of obtaining SSNs for spouses and dependents with the ACA reporting requirement, thereby increasing the risk of data privacy and security breaches.

To take the necessary precautions when handling sensitive data, here are some useful tips:

Is the data collected subject to HIPAA?

Determine whether the information gathered for ACA reporting is protected health information (PHI) under HIPAA, or if it falls under any HIPAA exception.

Ensure PHI precaution measures are in place

If data gathered is PHI, certain measures need to be taken under the HIPAA privacy and security rules. All employees should be trained on PHI policies and procedures, with a designated privacy officer implementing practices, including appropriate administrative, technical and physical safeguards to protect the privacy of PHI. All unauthorized use or disclosure of PHI should be reported.

Verify vendors are HIPAA-certified

Third-party vendors are approved by the IRS and can assist in the ACA reporting process. It is important to ensure that the vendor, even as a "business associate" under HIPAA, is HIPAA-certified and contractually bound to maintain and implement the appropriate privacy and security practices.

E-filing for Secure, Streamlined Filing

Need help meeting the demands of these ACA reporting requirements? Choose efile4Biz.com for quick, efficient and secure e-filing for ACA forms (in addition to 1099s and W-2s). There's no software to download and no forms to purchase, so you enjoy streamlined, one-step processing.

Take advantage of:

E-file support - Simply enter or import applicable employee information and efile4Biz.com will electronically file forms 1095-B and 1095-C (and transmittals 1094-B and 1094-C) with the IRS - as well as print and mail employee copies.

Print and mail - For health insurance providers, payroll service providers and employers seeking high-volume processing of ACA forms, efile4Biz.com offers comprehensive print-and-mail services out of a secure, SOC- and HIPAA-certified facility.