Health insurance reporting requirements (2024)

August 15, 2014

By Megan Ryan, CPA

Beginning in calendar year 2015, certain employers must comply with the Affordable Care Act requirement to offer health insurance to full time employees. In conjunction with this requirement, employers are required to report to both employees and the Internal Revenue Service specific information related to the health insurance made available to employees. Such reporting requirements begin in early 2016, as it relates to the 2015 calendar year.

Which Employers Must Comply?

In 2015, the employer mandate and related health insurance reporting requirements will apply only to those employers with more than 99 full-time equivalent employees. In 2016, these rules expand to apply to employers with 50 or more full-time equivalent employees. Note that under the original law, the employer mandate would apply to this latter group in 2015. The Treasury Department announced in February of 2014, a one-year delay for mid-size employers (those with 50 to 99 full-time equivalent employees).

What Information Must Be Reported?

Tax law requires the following information to be reported to employees and the Internal Revenue Service:

Name, date, and employer identification number (EIN) of the employer;
Name and phone number of a contact person of the employer;
The calendar year the reporting relates to;
A statement certifying whether the employer offers its full-time employees and their dependents the opportunity to enroll in minimum essential coverage (discussed here) through an employer-sponsored health plan, by calendar month;
If such coverage is offered, provide the following information:
- The length of any waiting period before an employee is eligible to enroll in an employer-sponsored health plan;
- The months of the calendar year in which coverage was available;
- The employee’s share (self only) of monthly premiums for the lowest cost option in each enrollment category under the plan; and
- The employer’s share of the total allowed cost of benefits provided under the plan.

The number of full-time employees for each month during the calendar year; and
The name, address, and taxpayer identification number (TIN) for each full-time employee employed during the calendar year and the months (if any) during which the employee and any dependents were covered under employer-sponsored health plans.

How Will the Information Be Reported to Employees and the IRS?

Employers will report health insurance information in a similar manner to Forms W-2/W-3 and 1099/1096. Each employee should receive Form 1095-C, which provides details relevant to that specific employee as outlined above. Employers should file all Form 1095-Cs with the IRS, along with Form 1094-C, which is a transmittal form similar to Form W-3 and Form 1096.

Form 1095 has not been released by the IRS as of the publication of this article.

What Are the Due Dates for Filing?

Employers must provide Form 1095-C to employees by January 31st following the coverage year. For the 2015 calendar year, the due date to provide Form 1095-C to employees is January 31, 2016.

Forms 1094-C and 1095-C must be provided to the Internal Revenue Service by February 28th if filing on paper or March 31st if filing electronically. For calendar year 2015, that means the IRS deadline falls on one of those dates in 2016.

What additional reporting is expected of self-insured employers?

Beginning with the 2015 coverage year, health insurance issuers are required to issue Form 1095-B. For employers who offer fully-insured group health plans, the insurance company will issue Form 1095-B. Employers offering a self-insured group health plan are required to report in a similar manner, however self-insured employers use Form 1095-C to fulfill this requirement. Form 1095-C will contain two parts, one that applies to self-insured employers only and another that applies to all employers. Self-insured employers will complete both sections.

For a self-insured employer completing the self-insured section of Form 1095-C, the contents must include:

Name, address, and employer identification number (EIN) of the employer sponsoring the plan;
Name and phone number of a contact person of the employer;
For each employee, spouse, and dependent covered under the plan, provide the following:
- Name
- Address
- Taxpayer identification number (TIN), or date of birth if TIN is not available; and
- For each individual listed, the months during the calendar year that the individual was covered under the plan.

Issuers of Form 1095-B and 1095-C are only required to provide the form to the employee. There is no requirement to provide a copy of the form to the spouses and/or dependents listed on the form.

Employers with self-insured health plans should ensure, prior to the first January 31, 2016 reporting due date, that TINs are on file for spouses and dependents covered by the employer’s self-insured plan. Most employers likely have this information on file already; however, in the event they do not, it is important to plan ahead and request the information from employees.

The IRS will use a combination of Forms 1095-A (issued by health insurance exchanges), 1095-B, and 1095-C to determine whether employers are subject to the employer shared responsibility payment. These forms also will be used by the IRS to determine if individual taxpayers are subject to the penalty for lack of health insurance coverage.

Reminders

Mid-size employers (those with 50 to 99 full-time equivalent employees) do not need to comply with the employer mandate until 2016.In February, Treasury announced that large employers who must begin providing health insurance to employees in 2015 may do so for only 70% of its full-time workers, delaying for one year (to 2016) the requirement to offer insurance to 95% of full-time workers.