When it comes to health plan reporting, employers can easily feel confused and overwhelmed. Are you are responsible for reporting? What forms do you need to fill out? Will you face penalties? In WEA Trust’s Health Plan Reporting 101 webinar, our Affordable Care Act specialist will help you create your reporting to-do list. You’ll learn about 1095 forms, sections 6056 and 6055, and reporting best practices.

1. 06/03/2015
Diane Craney – Office of General Counsel
Mel Grau – Marketing Coordinator

2. ACA
reporting
MEC
reporting
Employer
reporting
(Form 1095-C)

4. •
Subject: ACTION REQUIRED: 2014 Transitional
Reinsurance Program Contribution Submission
Not Found – Case ID #_____
•
•

5. • Used to verify the months for which an
individual was offered and enrolled in
minimum essential coverage (major
medical)
• Required to administer:
– Individual mandate penalties
– Employer responsibility penalties
– Premium tax credit

6. Statements
due to
subscribers
Returns due
to IRS
(if filed manually)
Returns due
to IRS
(if filed electronically)*
Jan. 31 Feb. 28 Mar. 31
*You must file electronically if you have 250 returns or more

8. • What is it for?
– Provides individuals and the IRS with
information about minimum essential
coverage
– Verifies whether an individual satisfied the
individual mandate for the preceding calendar
year

9. • Who is responsible for reporting?
– Fully insured plans = Insurer
– Self-funded plans = Employer
• WEA Trust will do the reporting for our Self-Funded
Group Health Benefits Arrangement
• Report on the “B” Forms
– Individuals = 1095-B
– IRS = 1094-B (transmittal) and copies of
1095-B

13. •
•
–
•
–

14. • Full-time employees +
Part-time FTEs > 50
• Example:
– 38 full-time employees
– 20 PT employees 24
hrs/week (96 hrs/month)
– (20 x 96)/120 = 16 FTE
– 38 + 16 = 54 = ALE
Full-time Part-time FTE
30 hours per
week, 130
hours per
month
120 hours
worked per
month

15. Reporting Penalties
No transition relief
(all ALEs must report in
2016 for 2015)
Transition relief for
employers with 50-99
employees

17. • Provide individuals and the IRS with information
about an employer’s compliance with the employer
mandate, minimum value, and affordability
– Used to determine employer penalties and confirm
eligibility for premium tax credits
• Responsible for reporting:
– Applicable Large Employers
• Report on the “C” Forms:
– Individuals: 1095-C
– IRS: 1094-C (transmittal) and copies of 1095-C

18. • Statement to every full-time employee
– Mailed to the last known address
– May be mailed with W2s
– May be provided electronically if employee
affirmatively consents for this document

23. First, determine if you are an ALE.
If you are an ALE:
 How will you track information necessary
to file? Who will be responsible?
 Who will actually file?
 How will you deliver statements? If
electronically, determine how to get
affirmative consent.
 Are you eligible for transition relief?