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Are you in compliance with the Affordable Care Act (ACA) provisions that went into effect in 2015?

EMPLOYER MANDATE (PAY OR PLAY)

Effective January 1, 2015, employers with 100 or more full-time employees and full-time equivalent employees must offer full-time employees a certain level of health coverage or be subject to a penalty.

• Detailed guidance about complying with the employer mandate is available here
• An overview of key ACA provisions for employers with 50 or more employees is available here.

Additional information about the employer requirements under ACA can be found on ABC’s Health Care Law Employer Toolkit.

EXCEPTIONS

Employers with 50 to 99 full-time employees and full-time equivalents are not required to comply with the employer mandate until 2016 (provided they meet certain IRS certification requirements). However, such employers are subject to the information reporting requirements under Internal Revenue Code (IRC) sections 6055 and 6056 effective for the 2015 calendar year (refer to New Reporting Requirements section below).

An overview of key ACA provisions for employers with 50 or more employees is available here.

Employers with fewer than 50 full-time employees and full-time equivalents do not have to comply with the employer mandate. However, small employer health plans are required to cover “essential health benefits” (effective 2014). Further, effective for the 2015 calendar year, small employers that self-insure are subject to IRC section 6055 (refer to New Reporting  Requirements section below). 

An overview of key ACA provisions for employers with up to 50 employees is available here.

An overview of key ACA provisions for employers with fewer than 25 employees is available here.

NEW REPORTING REQUIREMENTS

ACA also includes onerous employer reporting requirements under IRC sections 6055 and 6056. ACA’s reporting requirements apply to employers with 50 or more full-time employees and full-time-equivalent employees, as well as employers of any size that self-insure. Effective for the 2015 calendar year, employers are required to collect certain information about the health coverage they offer and, in the first quarter of 2016, report such information with the Internal Revenue Service (IRS). In addition to filing information returns with the IRS, an employer must provide a related statement to each full-time employee under section 6056 and to each covered individual under 6055.

Applicable large employers (50 or more full-time employees and full-time-equivalent employees) can learn more about section 6056, here. 

• 2015 draft form 1095-C Employer-Provided Health Insurance Offer and Coverage
• 2015 draft form 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns
• 2015 draft instructions for forms 1094-C and 1095-C.

Self-insured employers can learn more about 6055, here. Self-insured employers that are applicable large employers are subject to the reporting requirements of both section 6055 and section 6056 and are required to use Form 1095-C and transmittal Form 1094-C. Self-insured employers, with fewer than 50 full-time or full-time equivalent employees, should use Form 1095-B and transmittal Form 1094-B.

• 2015 draft form 1095-B Health Coverage
• 2015 draft form 1094-B Transmittal of Health Coverage Information Returns
• 2015 draft instructions for forms 1094-B and 1095-B

*Employers are encouraged to consult counsel and/or their insurance brokers about complying with ACA in 2015 and beyond.