ACA REPORTING: IRS FORMs 1095-B & C
This IRS employee form is the responsibility of HEALTH COVER PROVIDERS — in other words, the insurance company [or other entities, including self-insured employers] paying the medical bills.
The provider must send this completed form to every covered employee detailing their coverage and thereby enabling them to report their own individual ACA compliance to the IRS.
FORM 1095-B includes information on all dependents & other individuals covered by a policy in addition to the employee as policy holder. It enables the IRS to determine who has MINIMUM ESSENTIAL COVERAGE & therefore is not liable for an individual shared responsibility payment.
This IRS employee FORM 1095-C is the responsibility of the employer as the health cover sponsor to complete and distribute to every full-time employee.
As part of their ACA reporting & compliance, APPLICABLE LARGE EMPLOYERS [ALEs] must send completed FORMS 1095-C to every eligible employee, detailing the offer of coverage they have received under the company’s sponsored plan. These forms are subsequently also filed by the employer [along with other required documentation] to the IRS.
For a comprehensive guide to the IRS CODES for completing LINES 14 & 16 of FORM 1095-C click here.
- NOTE: EMPLOYERS WITH FULLY-INSURED PLANS are the sponsor but not provider of health cover. The health plans sponsored by these employers are provided by an insurance company or other provider. The FULLY-INSURED employer is responsible only for FORM 1095-C.
- NOTE: EMPLOYERS WITH SELF-INSURED PLANS are both sponsor & provider of health cover. In other words, the plan is funded entirely by the employer, who pays for any employee health claims instead of an insurance company. These SELF-INSURED employer are accordingly responsible for both FORM 1095-B [as the provider] and FORM 1095-C [as the sponsor]. That said, SELF-INSURED employers can combine these forms into a single FORM 1095-C.
- NOTE: PART III OF FORM 1095-C must only to be completed by employers sponsoring selfinsured health cover; it includes in addition to the named employee. any dependents and other individuals covered by the plan.
If you have questions regarding FORMs 1095-B or C or any other aspect of ACA reporting & compliance, please contact BENEFITSCAPE , the leading ACA specialist.
BENEFITSCAPE provides best-in-class ACA services & intelligent FLAG & FIX DIAGNOSTICS to 1000s of employers of all sizes, in all sectors, and on all major HCMs.