IMA Compliance Alert

Reminder – 2018 ACA Reporting

With Affordable Care Act IRS reporting due soon, we know the requirements can be a tad confusing to keep straight, so below we’d like to provide some clarity on which entities are responsible for which forms.

First it’s important to know whether an employer is an “applicable large employer” (ALE).  If an employer’s average employee count over calendar year 2017 totaled 50 or more full-time and equivalents (FTEs), then that employer was an ALE for all of calendar year 2018.  If an employer was in a “controlled group” or “affiliated service group” with other employers, then all the employers within that family of companies must combine their 2017 employee counts to determine ALE status for 2018.

If an employer was an ALE for 2018 (either because it’s own 2017 counts averaged 50+ FTEs or the combined family of companies 2017 counts averaged 50+ FTEs), then the employer must complete 1095-C statements for all FT employees and provide all of those to the IRS along with a 1094-C transmittal cover sheet.  Please note that insurers and TPAs do NOT complete these “C” forms for ALEs.  If the health plan was insured, then the insurer will complete different forms that serve a different purpose, the 1094-B and 1095-B forms; but if the health plan was self-funded at any point in 2018, then the employer has additional requirements since there’s no insurer to provide “B” forms.

Non-ALEs with insured plans do not have to complete ACA reporting, but non-ALEs with self-funded plans will have to complete 1095-B forms for individuals enrolled in their self-funded plan and submit those forms to the IRS with a 1094-B transmittal cover sheet.  Even partially self-funded plans, such as level-funded or graded-preferred type plans, are subject to this reporting requirement.  Some insurers and TPAs might be willing to complete the “B” forms on behalf of non-ALEs, you just need to ask to confirm.

The 1095-B or -C forms must be postmarked to individuals by Monday, March 4, 2019. All those forms must be submitted to the IRS along with the corresponding 1094-B or -C cover sheet by either Thursday, February 28, 2019 if filing by paper, or by Monday, April 1, 2019 if filing electronically (note that e-filing is required if the employer has 250 or more forms).

Please let your IMA Benefits team know if you have any questions; we will continue to monitor regulator guidance and offer meaningful, practical, timely information.