ACA Requirements for Employers

There’s a lot of information going around about the Affordable Care Act. With all the insurance and filing requirements now in place for individuals, employers, and insurance providers, it can be hard to keep up with what you need to do to keep your business compliant.

Well rest easy, you’ve found ExpressACAForms and we’ve brought you the Employer Shared Responsibilities straight from the horse’s mouth!

(This horse, of course, is the IRS.)


The Employer Shared Responsibility Provisions
So the first thing to know about employer shared responsibility is that it applies to Applicable Large Employers (ALEs), or employers with 50 or more full-time employees. So the vast majority of employers aren’t liable for these provisions, but they are:

• ALEs must offer minimum essential coverage (MEC) of affordable health insurance that provides minimum value OR
• Make an employer shared responsibility payment to the IRS.

These provisions went into play January 1, 2015, so you may be a little familiar with one or the other already.

Avoiding the Payment by Meeting the Provisions
There are two ways an ALE can be made to pay an employer shared responsibility payment:

1. If the employer does not offer MEC to at least 95% of its full-time employees and their dependents, and
2. If at least one full-time employee receives the premium tax credit for purchasing coverage through a Health Insurance Marketplace.

The reasoning behind the first way to incur a payment is a little obvious; you’re directly disobeying the ACA and IRS’s rules about providing health insurance.

The second way’s reasoning is a little more nuanced. You see, even if you offer insurance to your employees, you still have to make sure it meets all the ACA’s minimum value and affordability requirements. If it doesn’t, when your employees go to a Health Insurance Marketplace to get more coverage, they become eligible for and receive a premium tax credit. This alerts the IRS that you become eligible for and receive an employer shared responsibility payment for not meeting ACA requirements.

Employer Reporting Requirements
So not only do you as an ALE have to provide affordable health insurance that meets all these MEC and minimum value requirements, but you have to report you did all that to the IRS each year as well with Forms 1094-C and 1095-C.

Think of them as W-2s for your employees’ health insurance coverage. You use these forms to report the coverage you offered them, the coverage they accepted, and their (and their dependents) basic information. And in January each year, you send a copy to each of your employees so they can use it for their records, and in March you e-file a copy with the IRS to show your compliance.

By the way, one of the easiest, most secure, and most accurate ways to e-file these forms is right here with ExpressACAForms! And if you’re worried about staying ACA compliant throughout the year, check out our sister product ACAwise; it tracks your compliance, alerts you of any discrepancies, and e-files your return each year for you!

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What is a Health Care Marketplace?

With all this Affordable Care Act talk going around, you’ve probably heard the term “Health Care Marketplace,” or maybe even “ObamaCare Marketplace,” dropped once or twice. But just what is this mythical marketplace?

Is it an actual place where insurance salesmen hawk different insurance packages all wrapped up in paper and string? Sort of! But not exactly.

The Health Insurance Marketplace is your state’s price comparison website for subsidized health insurance. Each year during the annual open enrollment period, you can enroll in a plan, switch plans, or apply for cost assistance.

If you don’t receive insurance from your employer, the Health Insurance Marketplace is where you can go to be sure you’re getting health insurance that meets minimum essential coverage and minimum value. And those are things you want to make sure you have, otherwise, you'll have to pay a pretty hefty fine.

As we mentioned earlier, each state has a different marketplace. And you’ll want to make sure you’re on the right website for your state. If you’re in:

• Arkansas, use the Arkansas Health Connector,
• California, use Covered California,
• Colorado, use the Connect for Health Colorado site,
• Connecticut, use Access Health CT,
• District of Columbia, use the DC Health Link,
• Hawaii, use the Hawaii Health Connector,
• Idaho, use Your Health Idaho,
• Kentucky, use Kentucky’s Healthcare Connection,
• Maryland, use the Maryland Health Connection,
• Massachusetts, use the Health Connector,
• Minnesota, use MNsure,
• Nevada
• Individuals: HealthCare.gov
• Employers shopping for employee health plans: Nevada Health Link
• New Mexico, use BeWellNM,
• New York, use the New York State of Health,
• Oregon
• Individuals: HealthCare.gov
• Individuals applying for Medicaid and CHIP: Cover Oregon
• Rhode Island, use HealthSourceRI,
• Utah
• Individuals: HealthCare.gov
• Small businesses and their employees: Avenue H
• Vermont, use the Vermont Health Connect, and
• Washington, use the Washington Healthplanfinder.

If you live in any other state, you’ll use the official Health Insurance Exchange Marketplace website, www.HealthCare.gov. If you live in one of the US territories (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, or the Virgin Islands), you’re not eligible to use the Marketplace to apply for health insurance and should check with your territory’s government offices to learn about your options.




While our software is designed to help employers and third party providers e-file ACA returns, we’re also committed to providing accurate, up-to-date ACA information, so stay tuned for more from ExpressACAForms!

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What is Minimum Value?

Last week we went over minimum essential coverage (MEC) and how it’s important to offer coverage that meets it. Another requirement of Affordable Care Act compliant coverage is that it also meet a minimum value.

What is Minimum Value?
Minimum value is a standard of minimum coverage that applies to health plans employers offer. If the plan you offer meets this standard as well as the MEC standard, you’re considered ACA compliant in the coverage you offer.

A health plan meets the minimum value requirement if:

• It’s set up to pay at least 60% of the total cost of medical services for a standard population and
• Its benefits include substantial coverage of physician and inpatient hospital services.

Reporting Minimum Value
Don’t forget that you have to report the coverage you offer that meets MEC and minimum value requirements on Forms 1094 and 1095! And ExpressACAForms can help you e-file those forms quickly, easily, and securely!

If you’re looking for something a little more in-depth (think features to help make sure your coverage meets minimum requirements and is offered on time) in your ACA reporting, try out our sister product, ACAwise! You can sign up for a free demo today over at www.ACAwise.com or by calling (704) 954-8420.

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What is Minimum Essential Coverage?

A phrase that pops up a lot with Affordable Care Act compliance is “Minimum Essential Coverage,” MEC for short. But just what does it mean?

Minimum Essential Coverage
One of the main points of the Affordable Care Act was to make sure all taxpaying Americans have affordable health insurance that meets certain criteria. Obviously, one bit of this criteria had to be that all types of insurance offered as ACA compliant offer a certain amount of coverage.

Starting to get an idea of where this is going?

But, just to make sure everyone’s up to speed: minimum essential coverage is the type of coverage that meets at least all of the basic ACA requirements for health insurance.

Applicable Large Employers, insurance providers, and anyone else required to provide offers of coverage, must offer insurance that meets MEC or pay a fine. And, trust us, you don’t want to pay the fine.

Types of Minimum Essential Coverage
As a rule of thumb, the following types of health insurance meet minimum essential coverage:

• Employer-sponsored coverage, which includes COBRA and retiree coverage
• Coverage from the Health Insurance Marketplace/Affordable Insurance Exchange
• Medicare Part A
• Medicare Advantage plans
• Most Medicaid coverage
• Children’s Health Insurance Program (CHIP) coverage
• Certain coverage administered by the Veterans Administration
• TRICARE
• Coverage provided to Peace Corps volunteers
• Non-appropriated Fund Health Benefit Program coverage
• Refugee Medical Assistance supported by the Administration for Children and Families

If you need a plan for reporting the minimum essential coverage you offered your employees/recipients this year, check out ExpressACAForms! It’s simple, fast, and secure! If you have any questions, just give us a call at (704) 839-2270 or send us an email to support@ExpressACAForms.com.

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Affordable Care Act Transmittal Forms 1094-B and 1094-C

Did you know that there’s more to your Affordable Care Act return than just Form 1095-B or 1095-C? That’s right: your ACA forms must be sent with a transmittal return, either Form 1094-B or 1094-C, each year.

Form 1094-B
Submitted with Forms 1095-B is Form 1094-B, Transmittal of Health Coverage Information Returns. The majority of Form 1094-B consists of basic information about the filer, including name, EIN, and contact information. On Form 1094-B, the filer also needs to report the number of Forms 1095-B submitted with the transmittal form.

Form 1094-B also requires the filer’s signature, title, and date before it can be submitted with the complete ACA return.

Form 1094-C
Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, which is submitted with 1095-C Forms, is a bit more complex than Form 1094-B. Because it requires more information, Form 1094-C is split into three parts:

• Part I: Applicable Large Employer Member (ALE Member)
• Part I includes all the basic information about the ALE whose ACA report this 1094-C belongs to, including the name, EIN, address, and person of contact.
• Lines 9-16 of Part I are filled out if the filer is a Designated Governmental Entity (DGE) filing on behalf of an employer. So in some instances, these lines will need to be left blank.
• On line 18 of Part I, the total number of 1095-C forms accompanying the 1094-C is included.
• And lastly, if this Form 1094-C is the authoritative transmittal for an ALE member in a group return, the box on line 19 should be checked. There can only be one authoritative transmittal filed for each employer.
• Part II: ALE Member Information
• In Part II of Form 1094-C, the filer will provide information on whether or not they’re a member of an Aggregated ALE Group. They’ll also need to include the total number of 1095-C forms filed by and/or on behalf of the ALE member and indicate if they apply for any Certifications of Eligibility.
• If the filer has multiple returns, they only need to fill out Part II on the authoritative transmittal Form 1094-C (as indicated by line 19).
• Part III: ALE Member Information - Monthly
• In Part III, filers indicate how many full-time employees and total employees they had each month of the year.
• Part IV: Other ALE Members of Aggregated ALE Group
• If the filer is a part of an Aggregated ALE Group and checked “Yes” on line 21 of Form 1094-C, they’ll need to complete Part IV.
• In Part IV, the filer lists the names and EINs of other ALE members of the Aggregated ALE Group.

Questions?
So there you have it: Forms 1094-B and 1094-C. If you have any further questions about these forms or how to e-file them, don’t hesitate to contact us here at ExpressACAForms! You can give us a call (704-839-2270) or send us a live chat Monday through Friday, 9:00 a.m. to 6:00 p.m. ET. Can’t make it then? Just send us an email to support@ExpressACAForms.com and we’ll get back with you as soon as possible!

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Understanding ACA Form 1095-B

When we talk about the information returns associated with Affordable Care Act, we tend to get hung up on Form 1095-C. It makes sense: Form 1095-C is the form Applicable Large Employers file and they’re the “insurance providers” going through the most changes thanks to the ACA. (And “most change” tends to mean “most attention.”)

That’s why we’re taking this post to talk exclusively about Form 1095-B!

Purpose of the Form
Form 1095-B, Health Coverage, is used to report information to the IRS and taxpayers about the minimum essential coverage of health insurance provided by the filer.

And in case you need a reminder: minimum essential coverage (or MEC) is the least amount of coverage legally required for taxpayers to have each year. While it’s the individual taxpayer’s responsibility to make sure they have coverage that meets MEC, it’s also the responsibility of insurance providers to offer MEC plans as set by the ACA.

Who Needs to File Form 1095-B
Generally, every person that provides MEC to individuals during the calendar year must file Form 1095-B to report the coverage. This does exclude certain employers (ALEs) and government employers who are subject to the employer shared responsibility provisions and therefore must file Form 1095-C.

In other words, health insurance issuers and carriers for most health insurance coverage, including individual market coverage and insured coverage sponsored by employers, as well as small employers need to file Form 1095-B for each covered individual each year.

When to File
If you need to file Form 1095-B with the IRS, you must do so at the beginning of the year following the year you offered coverage. And how you plan to file determines when you’ll need to file.

If you’re sending in paper copies to the IRS, you must submit Form 1095-B, along with its transmittal form, Form 1094-B, by February 28 (or 29). If you plan to e-file, you have until March 31. Keep in mind that if your due date ends up falling on a weekend or legal holiday, the deadline is automatically extended to the next business day.

And speaking of “automatically extended,” you can get an automatic 30-day extension of time to file your 1095-B forms if you file Form 8809 with the IRS by your original deadline.

And How to File
The more traditional way to file your ACA return is to mail it in each year. While the IRS recommends everyone e-file, you really only have to if you have more than 250 forms to file. So if you’re planning for traditional, mail Form 1094-B and your 1095-B forms by your deadline to:

• Department of the Treasury, Internal Revenue Service Center, Austin, TX 73301
• If your principal business is in: Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, Virginia, or West Virginia
• Department of the Treasury, Internal Revenue Service Center, Kansas City, MO 64999
• If your principal business is in: Alaska, California, Colorado, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Utah, Washington, Washington, D.C., Wisconsin, or Wyoming

Of course, if you’re looking for a faster, easier, more secure way to file, then you should e-file with ExpressACAForms! With ExpressACAForms, you don’t have to fill out each individual form by hand before mailing it in, which can leave you susceptible to human error and at the mercy of the postal system. Instead, just upload the the ACA information you have using our bulk upload spreadsheet or one of your own, review the forms our program creates for you, and securely e-file them directly with the IRS.

If you have any other questions regarding Form 1095-B or e-filing your ACA return, give us a call! We’re always happy to help. We’re available at (704) 839-2270 and through live chat on our website Monday through Friday, 9:00 a.m. to 6:00 p.m ET and we offer 24/7 customer assistance via email at support@ExpressACAForms.com!

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ACA Form 1095-C Updated for 2016 Filing

Even when it’s not filing season, the IRS makes sure to keep itself busy. Just last month, they released draft Forms 1094-C and 1095-C and published draft instructions for completing them for the 2016 tax year.

While these updates are just drafts, there are already a few changes between the forms you filled out for your 2015 ACA return and the ones you’ll complete for your 2016 return. These changes are likely to stick, however, and once the Forms 1094-C and 1095-C are finalized, they must be e-filed by March 31, 2017.


Form 1094-C Changes

• Box B of Line 22 is designated “Reserved.” The Qualifying Offer Method Transition Relief is not available for 2016.
• In Part III, column (b), “Section 4980H” was added before “Full-Time Employee Count for ALE Member.” This was included to remind filers that “full-time employee,” as defined by section 4980H, applies for purposes of this column. ALE Members may not use another definition of FTEs to complete this column.

Form 1095-C Changes
Underneath the title of Form 1095-C, the reminder, “Do not attach to your tax return. Keep for your records.” was added to inform recipients not to file Form 1095-C with their personal return.

Code Changes

• Code 1I on Form 1095-C, line 14, and Code 2I for line 16 are no longer applicable for the 2016 filing year.
• New codes for addressing conditional offers of spousal coverage, 1J and 1K, have been added for use on Form 1095-C, line 14, if applicable.

Transition Relief Changes
Only limited transition relief will continue for the 2016 tax year. Because several forms of transition relief were available to employers for the 2015 tax year only, references to these forms of relief have been removed from Forms 1094-C and 1095-C.

E-filing with ExpressACAForms
It’s never too early to set up your ACA e-filing account with ExpressACAForms! As an IRS-authorized e-file provider, we guarantee the most up-to-date and secure software in ACA filing. If you have any questions or need help getting started, just give us a call. Or send us an email! We’re happy to help any way we can!

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