As we gather to gawk at the impending King v. Burwell piñata whacking, here’s a reminder to curb your enthusiasm. Even if your employer mandate dies this month, even if it is not resurrected by legislation or executive action, and even if you provide compliant coverage, most of you will have to report your 2015 coverage offers in early 2016 or face audit and significant penalties. He’s a short summary of the reporting requirements, arranged by simplicity.
Small employers with no group health plans and small employers with fully-insured group health plans are exempt from the coverage offer reporting requirements, because they apply to insurers (including self-insuring employers, under Code § 6055) and to “Applicable Large Employers” (Code § 6056, borrowing the § 4980H ALE definition).
As with the employer mandate, exemption of government employers is a well-busted myth.
Are you eligible for the 50 to 100 “bubble employer,” transitional relief from the 2015 employer mandate? Great, but that only adds to your coverage offer reporting, requiring your certification of eligibility on Form 1094-C. Relief is not automatic. You must report and request it.
Fully-Insured ALEs Use Forms 1094-C and 1095-C.
Do you have an EIN? Good, you’ll need one to file with the IRS a Form 1095-C for each person who was your full-time employee in any month of 2015, along with a Form 1094-C cover sheet for the whole set of Forms 1095-C. Your insurer will file Forms 1094-B and 1095-B. To the extent of overlap, they should agree. Expect the IRS to check your submissions against each other and against your W-2 filings.
Self-Insured Small Employers Use Forms 1094-B and 1095-B.
You’re not subject to 2015 plan year ALE reporting if you are small (based on 2014 employment) and not a member of an aggregated ALE group. But if you’re self-insured, you’re subject to insurer reporting.
Self-Insured Large Employers
Here’s where complexity starts. Code sections 6055 and 6056 apply fully to you. The § 6055 rules, § 6056 rules and instructions for the “C” Forms and for the ‘B” Forms offer less than complete relief from duplicative demands. Get help.
Yes, subject to current guidance and with retention of ultimate liability, an employer may report through an agent. A Governmental Unit may trust its reporting to a Designated Governmental Unit (“DGE”). But the IRS must receive a single “authoritative transmittal” for each ALE member, regardless of who files it. That Form must identify all other ALE members of the same aggregated group. If you expect another to carry your load, verify now that they are prepared to carry your load without dropping it.
Leased Employees and Multi-Employer Plans
Do you rely on employees leased in full-time status for less than one year? They may be your ACA responsibility for employer mandate and for coverage offer reporting purposes. Do you contribute to a multi-employer plan administered by someone else? In either case, get help.
Few employers who prepare in advance should need extreme lawyering. Most, however, will need months of help from plan administration consultants, the best of whom are in high demand right now, because they have bought, rented or developed IT tools to handle full-time employee tracking and coverage offer reporting. If you show up late and need to cut in line, expect to pay for that privilege.