Forms 1094/1095


Reference

 

Short Read

What You Need to Know

What You Need to Do

  1. The insurer files Forms 1094-B and 1095-B and distributes statements to individuals for all fully insured health plans.Tooltip A form 1095-B must be filed with the IRS for each individual to whom minimum essential coverage is provided and can be aggregated along with the transmittal form 1094-B. 1095-B is also distributed to the “responsible individual”. This is typically the covered employee or former employee.
  2. Small, self-insured employers (generally those with less than 50 employees) file Forms 1094-B and 1095-B and distribute statements to individuals.
  3. Large employers (generally those with 50 or more employees) file Forms 1094-C and 1095-C and distribute statements to individuals. This applies to large employers whether they offer insured plans, self-insured plans, or no health coverage.Tooltip Note that only ALEs with self-insured plans need to compete Part III of Form 1095-C.Employers filing 250 or more 1095 forms must file electronically.
  4. Review the reference material, which includes a complete list of all information that must be included on the report.
  5. Review the reporting forms as these will provide greater detail on the Section 6055 and 6056 requirements.

When Is It Due?

The 1094/1095 reporting forms are due to the IRS on or before February 28 (March 31 if filed electronically) of the year following the calendar year in which it provided minimum essential coverage to an individual.Tooltip An automatic 30-day extension of time to file is available if requested on or before the 1094/1095 due date. Filers may request an extension of time to file Forms 1094 & 1095 using Form 8809. Filers may request one additional extension, not to exceed 30 days, by submitting a second Form 8809 before the end of the first extension period. Note that this extension applies only to filing the 1094/1095 with the IRS. It does NOT extend the deadline for providing employee statements.

Why Comply?

 

Forms 1094-B and 1095-B

Purpose

Information that Must Be Reported

Filing the Report with the IRS

Filing Deadline

Distributing Statements to Individuals

Distribution Deadline

Forms 1094-C and 1095-C

Purpose

  • The information will be used to enforce the shared responsibility provisions of the ACA (play or pay) for applicable large employers (ALEs) and to determine who is eligible for premium credits in the exchange marketplace (Section 6056 reporting). The government needs to determine whether the ALE offered minimum essential coverage to full-time employees that was affordable and provided minimum value.
  • A Form 1095-C must be filed with the IRS for each employee (who was a full-time employee for any month of the calendar year) and can be aggregated along with the transmittal form 1094-C. 1095-C is also distributed to covered plan participants. Please note that employers who offer self-insured coverage must report on all individuals (regardless of full-time status) who received minimum essential coverage under the employer plan.
  • In general, an offer of COBRA continuation coverage that is made to a former employee due to termination of employment is reported as ‘No Offer of Coverage’. However, an ALE member making an offer of COBRA continuation coverage to an ongoing employee who loses eligibility for non-COBRA coverage due to a reduction in hours (for instance, a change from full-time to part-time status resulting in loss of eligibility under the plan) should report the offer of COBRA coverage as an offer of coverage.

Information that Must Be Reported

  • Generally, the report will list the type and cost of coverage offered and who did and did not receive the offer of coverage.
  • The reference material includes a complete list of all information that must be included on the report. Note that only ALEs with self-insured plans need to compete Part III of Form 1095-C.

Filing the Report with the IRS

  • ALEs will furnish information to the IRS using Form 1095-C and the IRS transmittal Form 1094-C.
  • Certain reporting rules apply to employers in MEWAs, controlled groups, employers with collectively bargained plans and governmental employers.
  • Employers who certify that they made a qualifying offer to one or more employees during the year may utilize alternative reporting methods that provide less detailed information to the IRS.
  • These forms must be filed regardless of whether the ALE member offers coverage, or the employee enrolls in any coverage offered.

Filing Deadline

  • Forms 1094-C and 1095-C must be filed with the IRS on or before February 28 of the year following the year the coverage is provided (March 31, if filed electronically). (Example: deadline for paper filing is February 28, 2017 for reporting information on the 2016 calendar year.)
    • An automatic 30-day extension of time to file is available if requested on or before the 1094/1095 due date. Filers may request an extension of time to file Forms 1094 & 1095 using Form 8809. Filers may request one additional extension, not to exceed 30 days, by submitting a second Form 8809 before the end of the first extension period. Note that this extension applies only to filing the 1094/1095 with the IRS. It does NOT extend the deadline for providing employee statements.
  • Note: Employers filing 250 or more 1095 forms must file electronically.

Distributing Statements to Individuals

  • Form 1095-C (or a similar statement) must be provided to each full-time employee identified on the return.
  • If mailed, the statement must be sent to the employee’s last known permanent address or, if no permanent address is known, to the employee’s temporary address. A reporting entity may furnish the statement electronically if specific requirements are satisfied.
  • Employers who certify that they made a qualifying offer to one or more employees during the year may utilize alternative reporting methods that provide less detailed information to full-time employees and responsible individuals.

Distribution Deadline

  • March 2Text-TooltipOr the next business day, if the 30th day falls on a Saturday, Sunday, or legal holiday of the year following the year the coverage is provided.
    • The regulations provide for an extension of time to furnish statements (up to 30 days) for a showing of good cause upon written application to the IRS. Note: unlike the extension request for filing Forms 1094/1095 with the IRS, requesting an extension of time to provide employee statements is not automatic.

WHAT IS THE RISK