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August 5, 2014

HRB 99 - Implementation Updates

Released August 5, 2014  |  Download as a PDF 

IRS Releases Draft Section 6055 and 6056 Reporting Forms

The Affordable Care Act (ACA) imposes new reporting requirements on health insurers, as well as on certain employers.  These reporting requirements are imposed by IRC Sections 6055 and 6056 (see CBIZ Health Reform Bulletin, IRS Final Rules – IRC Sections 6055 and 6056, 3/14/14). These reporting requirements are for the purpose of helping the government discern who might be entitled to premium assistance, as well as discern what employers might be subject to the employer shared responsibility excise tax.  This bulletin will focus primarily on the employer’s reporting obligation. 


The first report will be required for the 2015 calendar year, due in 2016.  There is a report due to participants which must be provided by January 31st of each year; the first report would be due January 31, 2016.  The report to the government will be due by February 28th of each year if filed by paper; by March 31st if filed electronically. 


The IRS released the following draft reporting forms on July 24, 2014:

w  Form 1094-B Transmittal of Health Coverage Information Returns

w  Form 1095-B Health Coverage

w  Form 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns

w  Form 1095-C Employer-Provided Health Insurance Offer and Coverage


It is important to note that these are draft forms only and are subject to change.  It expected that the related draft instructions to these forms will be issued sometime this month, and the final instructions and forms will be issued thereafter. 


Generally, the C series of these forms will be used by employers subject to the shared responsibility requirement, i.e., those employing 50 or more employees.  The Form 1095-C is the statement to be provided to each plan participant.  The Form 1094-C is the transmittal form used to submit the Form 1095-C to the government.


In addition, self-funded plans will complete certain parts of these forms to reflect whether the coverage qualifies as minimum essential coverage (MEC).  Generally, insurers will complete the B series, Form 1094-B being the transmittal form and the Form 1095-B being the statement to insured indicating whether the coverage provided qualifies as MEC.



Our CBIZ Employee Services will be hosting another webinar on October 21st, Report Overload! Are You Meeting Your Requirements?  Hopefully, the final forms and instructions will be available by then and we’ll include a discussion of the new forms at that time. 


In the meantime, particularly for employers subject to the ACA’s shared responsibility requirement, organizations will want to take a look at the draft forms and begin developing a system to collect the requisite information.  In particular, note that Social Security numbers will need to be provided.  If the employer does not have the Social Security number for individuals for whom reporting is required, they will want develop a system to collect them.  If the employer cannot obtain a Social Security number, the individual’s date of birth could be used. 


Basically, the forms require the employers to report on whether health coverage was offered for each month of the year and if coverage was not offered, then the employer would be required to provide the reason for not offering coverage, such as in the instance where the employer was not in business during the reporting timeframe, an employee works part-time or an employee was in a waiting period. 


As a reminder, employers subject to the shared responsibility requirement will be obligated to prepare the forms for the 2015 calendar year, even if the risk of an excise tax is delayed due to one of the transition rules (see “Transition Relief Rules” in the CBIZ HRB, Exploring the Final Employer Shared Responsibility Regulations, 3/10/14)


Again, these are draft forms only.  As soon as the final forms and instructions are available, we will provide more detail.


2015 Affordability Standards for Minimum Essential Coverage

In Revenue Procedure 2014-37, the IRS released the 2015 contribution percentages for purposes of determining affordable minimum essential coverage standards under the shared responsibility requirement, as follows:


q  Employer Shared Responsibility Requirement.  Employers subject to the ACA’s shared responsibility requirement must offer minimum essential coverage (MEC) that meets an affordability standard and a minimum value standard or risk a penalty. Generally, MEC includes the type of coverage available under most insured and self-funded employer-sponsored group health plans, without regard to grandfathered status.  MEC is deemed affordable to a particular employee if the employee's required contribution to the plan does not exceed 9.5% (9.56% in 2015) of the employee's household income for the taxable year, based on the cost of single coverage in the employer’s least expensive plan. 


q  Individual Shared Responsibility.  Beginning this year, all U. S. residents must maintain MEC or risk a shared responsibility penalty.  There are currently 9 categories of individuals exempt from the requirement to maintain MEC.  Specifically, an individual who cannot afford coverage because the premium cost exceeds 8% (8.05% for 2015) of his/her household income would be exempt from the individual mandate. 


In addition, this Revenue Procedure includes a revised “Applicable Percentage Table” for purposes of calculating an individual's premium tax credit for tax years beginning in 2015.


In related guidance (Rev. Proc..2014-46), the IRS released the 2014 monthly national average premium for qualified health plans that is used in determining the maximum individual shared responsibility penalty.  For 2014, the potential penalty for failure to maintain MEC is the greater of $95 per adult and $47.50 per child (up to $285 for a family); or 1.0% of family income.  The total amount of penalty is capped based on the average cost under a bronze level plan offered through the marketplace.  For 2014, the monthly average bronze level plan premium is $204 per individual; $1,020 for a family with five or more members.


Disclosure Requirement for Reduction or Elimination in Preventive Services

In response to the Supreme Court’s decision in the Hobby Lobby case (see CBIZ HRB, Preventive Services - Contraceptive Mandate, 7/2/14), the Department of Labor’s Employee Benefit Security Administration issued an FAQ reminding plan sponsors about the requirements to comply with certain ERISA disclosure requirements. 


Specifically, if a closely held corporation is eligible to claim the religious objection to providing contraceptive coverage to its employees under a group health plan, and if it wishes to remove these benefits from the plan, this would be a material reduction in benefits requiring a modification to the summary plan description.  This change in benefits can be provided to plan participants in the form of a summary of material modification (SMM). 


The SMM must be provided to participants as soon as possible, but in no event later than 60 days from the date the plan sponsor adopts the change.


















About the Author:  Karen R. McLeese is Vice President of Employee Benefit Regulatory Affairs for CBIZ Benefits & Insurance Services, Inc., a division of CBIZ, Inc.  She serves as in-house counsel, with particular emphasis on monitoring and interpreting state and federal employee benefits law.  Ms. McLeese is based in the CBIZ Leawood, Kansas office.


The information contained herein is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations. The information contained herein is provided as general guidance and may be affected by changes in law or regulation. The information contained herein is not intended to replace or substitute for accounting or other professional advice. Attorneys or tax advisors must be consulted for assistance in specific situations. This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.

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