Employer Reporting Requirements

Employer Reporting RequirementsStarting in 2016, What You Need to Report to the IRS for ACA Compliance

Two Kinds of Reporting

The Affordable Care Act (ACA) requires two kinds of reporting under the tax code: Section 6055 Reporting – MEC Report

Used by the IRS to enforce the “individual mandate” provision of the ACA.Used by individuals when they file their taxes to show months during which they were covered

Section 6056 Reporting – Shared Responsibility Report Used by the IRS to enforce the “employer shared responsibility”

portion of the ACA Used by individuals to prove eligibility for premium subsidy

Final regulations combined the reports into a single report

Section 6055 (MEC) ReportingFor insurers (and employers with self-funded plans) to report who has minimum essential coverage (MEC)

Section 6055 (MEC) Reporting

Who Needs to File? Employers with self-funded medical plans Carrier will file for all insured medical plans


What Gets Reported? The IRS wants to know who was enrolled in

minimum essential coverage (MEC) to verify individual taxes for not having coverage

A penalty will apply to anyone who doesn’t have coverage (no more than a 3-month break is allowed), unless they qualify for an exemption.


What Gets Reported? Name, address, and EIN of insurer (or employer

offering self-funded coverage) Name, address, and Social Security number of each

employee who is enrolled at any time during the calendar year

Name, address, and Social Security number if available of each covered spouse and child

Each month for which the individual was enrolled in MEC or entitled to receive benefits for at least one day of the month.

Section 6056 (ALE) ReportingFor applicable large employers (ALEs) to report which employees were offered affordable, minimum-value coverage

Section 6056 (ALE) Reporting Who Needs to File?

Applicable Large Employers (ALEs) Employers with 50 or more full-time or full-

time equivalent employees.Note that ALEs with between 50 and 99 employees are not exempt from this requirement.

All ALEs must file whether they offer fully insured coverage, self-funded coverage, or no coverage.

Also includes aggregated groups (such as controlled groups) but each employer member of the group must file separately.

Section 6056 (ALE) Reporting What Gets Reported?

EMPLOYER INFO The name, address, and employer identification

number (EIN) of the employer A contact person for the employer (name and

telephone number) The calendar year for which the information is filed


EMPLOYEE INFO: Name, address, and Social Security number of each

employee who was offered coverage All the calendar months during which the employee was

offered group health coverage (and, if not, a code explaining the reason) - Codes may be used for :

“not employed” “waiting period” “part-time” “not eligible”

The number of full-time employees in each month


OTHER INFO Certification as to whether the employer offered

minimum essential coverage to full-time employees Whether coverage provides the required minimum

actuarial value (60%) Whether coverage was offered to the employee, the

employee’s spouse, and/or the employee’s dependents The employee’s monthly share for self-only coverage in

the least expensive plan offering a minimum actuarial value of 60%


The employer will also be required to report the name, address, and EIN of a third party filing on its behalf.

If the employer is a member of an aggregated group, it will need to report the names and EINs of any other aggregated group members.

The employer must also report if it is a contributing member to a multiemployer plan.

Section 6056 (ALE) Reporting Alternative Reporting Methods

There are two simplified reporting methods that can be used under certain circumstances: Certification of Qualifying Offers Report not Identifying Full-Time Employees

Section 6056 (ALE) Reporting Alternative Reporting:

Certification of Qualifying Offers Employer must certify that for all months in the calendar

year that the employee was full-time the following was true: The employer offered the employee minimum essential

coverage that provided coverage with a minimum actuarial value of 60%;

The annual cost to the employee for employee-only coverage did not exceed 9.5% of the federal poverty level for a single individual (in 2014, the cost could not be more than $1108.65 ($92.38 per month)); and

Employer offered minimum essential coverage to the employee’s spouse and children , if any.

For 2015, if employer made a qualifying offer to 95% of full-time employees , spouses and children

Report for employees receiving a qualifying offer for all 12 months will include Employee Name, SSN and Address along with code that qualifying offer was made

Section 6056 (ALE) Reporting Alternative Reporting:

No Individualized Reporting with 98% Coverage Employer offers coverage that is

minimum essential coverage affordable (using any of the affordability safe harbor

methods) and has a minimum actuarial value of 60% to “substantially all” (at least 98%) of its full-time employees, then the employer is not required to include the names of full-time employees or the exact number of full-time employees.

Form is expected to be released by the IRS soon.

Reporting MechanicsWhat you need to do

Section 6055 and 6056 Reporting What to File

Send the following to the IRS: One single transmittal form (1094-C) to

the IRS A separate return (1095-C) for each

covered and full-time or enrolled employee 6055 Section completed for enrolled

employees 6056 Section completed for full-time

employees Send a copy of the 1095-C to each individual

for whom the 1095-C was sent to the IRS.

Section 6055 and 6056 Reporting When and How to Provide to Employees

Copies to individuals due January 31st

Mailed to last known address of employee Electronic filing permitted if:

Employee consents Disclosure statement is provided with the

consent request Inform employee that paper copy is available

upon request (and procedures for obtaining) Indicate how long the consent lasts

Notice is provided if information is furnished on a website – “IMPORTANT TAX RETURN DOCUMENT AVAILABLE”

Statements on website until 10/15 of the year in which the statement is first made available

Section 6055 and 6056 Reporting

When and How to File with IRS Paper returns due to IRS by February

28th Electronic returns due to IRS by March

31stElectronic returns required for entities filing more than 250 returns.

Filing extension is permitted up to 30 days, if: Good cause Extension is applied for from IRS

Begin to Gather Data

Employer will need to gather data in 2015 for the 2016 reporting (unless an alternative method is available).

Determine whether a controlled group exists that must be aggregated

Determine whether benefits department or admin software will maintain data

Polestar Benefits, Inc.412 Jefferson Parkway, Suite 202Lake Oswego, OR 97035(855) 222-3358www.pole

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Employer Reporting Requirements