Information Reporting by Providers of Minimum Essential Coverage (MEC) (§6055)

The Affordable Car Act and Section 6055 Information Reporting Requirements

An overview of the provision, details on the various types of minimum essential coverage, reporting requirements, and an introduction to the IRS forms used in reporting health coverage information. The provisions of the Affordable Care Act requires health insurance issuers, certain employers, providers of government-sponsored coverage, and others who provide minimum essential coverage, which is commonly referred to as MEC, to file an annual information return with the IRS, reporting coverage information for the calendar year and to furnish a copy of that return, which is referred to as a statement to an individual.

Health Insurance and the IRS

Recipients use this information when completing their tax returns, and the information is used by the IRS to validate compliance with the individual shared responsibility provision, which requires all non-exempt individuals to either have minimum essential coverage or pay the individual shared responsibility payment. Final regulations for information reporting of minimum essential coverage were issued as treasury decision 9660 on March 10th, 2014.

 

What is Minimum Essential Coverage?

There are several different types of government-sponsored programs that qualify as MEC, including Medicare Part A, most Medicaid programs, the Children’s Health Insurance Program, or CHIP, most Tricare, most VA programs, Peace Corps, and coverage for DoD nonappropriated fund employees. Employer-sponsored coverage, commonly called ESI, is also MEC. ESI includes insured or self-insured group health plans which many individuals may receive through their employment or the employment of a family member. ESI can also include grandfathered plans. In general, a grandfathered plan is any plan that was in existence before the ACA became effective and has not changed since then. Grandfathered rules may also apply to certain individual plans generally if the individual was enrolled in the policy on March 23rd, 2010. Over time, it is expected fewer and fewer plans will retain grandfathered status as various changes to plan designs take effect. Cobra and retiree coverage are also group health plans and MEC. Individuals may also enroll in a qualified health plan through the marketplace for obtaining individual coverage directly from an insurer.

The ACA and IRS Enforcement

Under the ACA, the Department of Health and Human Services has authority to recognize other plans or programs providing health coverage as MEC, for purposes of Section 5000A. HHS has created a system under which plan sponsors can apply to HHS for recognition as MEC, thus this category will evolve over time. A list of miscellaneous MEC is available on irs.gov

 

Who must file a form related to Minimum Essential Coverage?

The very first question likely to be asked is who must report minimum essential coverage? The general rule is that every provider of MEC must file and furnish the required information return. However, there are some exceptions. Insurers are not required to file a return reporting qualified health plans obtained in the individual marketplace. The marketplace reports coverage obtained as the marketplace on form 1095A, Health Insurance Marketplace Statement. Also, reporting is not required for additional or supplemental coverage that is not MEC, such as a standalone dental plan offered by an employer.

Reporting of Minimum Essential Coverage

Reporting is also not required for MEC that is in addition to other MEC that is provided by the same plan sponsor or is supplemental to government-sponsored coverage. An example of coverage provided by the same plan sponsor is a health reimbursement arrangement provided by an employer that also provides a primary health-care plan. An example of coverage that is supplemental, the government-sponsored coverage, is a Medicare or Tricare supplemental plan. So who is an MEC provider? . For insured coverage the MEC coverage is the health insurance issuer or carrier. Also, the government agencies that provide government-sponsored coverage such as Medicare or Medicaid, are required to report. Medicare will report Medicare coverage. For Medicaid and CHIP coverage, the state agency that administers the program is responsible for reporting. If the Medicaid or CHIP coverage is obtained through an issuer, the issuer is not required to report. Instead, coverage is reported by the state’s Medicaid or CHIP agency. DOD will report for Tricare and coverage under the non-appropriated fund health benefits program, the Department of Veterans Affairs for VA benefits, and the Peace Corps for coverage for Peace Corps volunteers. Finally, the sponsored entity of coverage that HHS has designated as MEC is required to report. Now we will discuss who is required to report coverage that is provided through a self-insured group plan and that is not provided by an applicable large employer. We will address coverage offered by an applicable large employer in a later slide.

 

Plan Sponsor Reporting of Minimum Essential Coverage (MEC)

As a general rule, the plan sponsor is required to do the reporting. For a self-insured plan maintained by a single employer, the employer is the plan sponsor and is responsible for information reporting. If a selfinsured plan is maintained by more than one employer and is not a multi-employer plan, the plan sponsor is each participating employer. If members of a control group are not applicable large employers, then each employer may report separately, or one entity may report for the whole group. For multi-employer plans, the plan sponsor required to report is either the Joint Board of Trustees, association, committee or similar body that establishes and maintains the multi-employer plan. If the coverage is through a MultiEmployer Welfare Arrangement or MEWA, each participating employer must report for its employees. Finally, for any other self-insured employer-sponsored coverage, the plan sponsor is the person identified as the sponsor or administrator by the plan. If there is no entity designated then the plan sponsor is the employer. Government employers that sponsor self-insured health plans are permitted to designate a related government entity to be responsible for reporting. If the government employer designates a related government entity, the designated entity is the plan sponsor and must file and furnish the required returns.

 

What is Form 1095-B?

To effectuate the designation, the government employer and the designee must enter into a written agreement in which the designee agrees to file and furnish information returns for the employer. This designation transfers liability for the government employers’ requirements to do information reporting to the designee. The designee must be part of and related to a government employer. For example, a political subdivision of a state, such as a county may designate the state or another political subdivision to file returns on its behalf. The designation must be made or revoked prior to the following deadline, and a copy of the agreement should be retained for the government employer’s records. This slide shows the reporting procedures. Forms 1095B are submitted to the IRS with a form 1094B transmittal. And multiple forms 1095B can be submitted with a single transmittal.

 

Filing Form 1095-B?

Additionally, a copy of the 1095B must be furnished to a responsible individual. This is the lead person for the people enrolled who should get the statement. In some cases, the responsible individual may not be enrolled in the coverage. For example, when children are enrolled in CHIP, their parents are not enrolled in CHIP coverage, but the statement is sent to the parent. As shown on the slide, ALE members who are self-insured will use form 1095C to fill the requirements to report MEC coverage. If more than 250 information returns will be filed, the returns must be filed electronically with the IRS. Electronic filers should refer to the Affordable Care Act Information Return for (AIR) web page on irs.gov for information on electronic filing. There is a link to the AIR web page on our resources slide in the appendix. All filers are encouraged to use electronic filing.

 

Other Health Care Tax Forms

However, paper filing is available for filers with 250 or fewer returns. To determine whether electronic filing is required, you count only the number of forms 1095B that will be filed, and do not count forms W-2, or any other information returns the filer may file; for example, information returns in the Form 1099 series. The requirement to furnish the statement is satisfied if the filer mails the statement to the responsible individual’s last known address. Additionally, the form 1095B can be furnished electronically to the individual only if the individual affirmatively consents to electronic receipt. It is not sufficient consent to receive the statement electronically if the individual has previously consented to receive W-2s or other information returns electronically. If the coverage is an expatriate health plan the statement may be furnished electronically unless the statement recipient requests a paper statement.

 

Information Reporting for Section 6055

If the plan sponsored is an ALE member, that sponsor selfinsures coverage, the employer is required to combine information reporting for 6055 and 6056. ALE members that are subject to the employer shared responsibility provision are required by Code Section 6056 to report information about the coverage offered to full-time employees in Part Three of form 1095C. An ALE member that offers self-insured coverage must report that the coverage under Section 6055 for each employee and family member who enrolls. To minimize burdens on affected employers and require only one form to be filed, the form 1095C Part Three is used to report enrollment information which allows the employer to satisfy Section 6055. Note that in certain cases an ALE member is permitted to report self-insured coverage on form 1095B; for example, for non-employees such as retirees. Additional information about the use of the form 1095B can be found in the FAQs and instructions for form 1094C and 1095C.

 

Overview of Form 1095B

1095B. Remember that instructions and FAQs are available to provide assistance in completing the forms. The form 1095B has four parts. Part one includes the name and address of the responsible individual. The responsible individual may be the primary insured employee, former employee, parent, or other person enrolling individuals in coverage. A date of birth may be entered if the social security number or other tax identifying number is not available. However, if the responsible individual is not enrolled in the policy, neither an SSN or date of birth is required. On line eight in part one, the filer enters a letter identifying the type of coverage. The instructions to the form list the codes: A, small business health option program or SHOP; B, employersponsored coverage; C, government-sponsored programs; D, individual market insurance; E, multiple employer plan; and, F, miscellaneous minimum essential coverage. Line nine, which asks for the SHOP identifier will be left blank for the voluntary year and for 2015 coverage.

Part two, employer-sponsored coverage: Only issuers of insured health group plans, including coverage purchased at the shop, complete part two with information about the employer. The form instructions specify when part two must be completed. Part three, the issuer or other provider is completed with the information about the insurance company or the other provider of coverage. Part four is where the names and identifying information about the covered individuals and the months of the coverage are reported. Part four is the most important piece of the information for the covered individual when completing their Form 1040. Remember the one-day rule. An individual is reported as covered for the month even if he or she was covered for only one day in the month. This slide covers the due dates for filing returns with the IRS and furnishing the statements to the recipient.

 

Using 1095-B to Prepare Taxes

The form 1095B must be furnished to the individual no later than January 31st of the year immediately following the calendar year to which the return relates. We have completed our discussion of who must file, how to file, and what information must be reported. On the last few slides we will walk through two different examples of how the forms look when completed. Here we can see the Form 1094B, Transmittal of Health Coverage Information Return. As we discussed, the filer uses this form to transmit one or more forms 1095B. Lines one through eight provide identifying information about the filer, including the name, EIN, point of contact, and the address. On line nine the filer enters the total number of Forms 1095Bs submitted with the transmittal.

 

IRS Section 6055 Summary

To recap, Section 6055 requires every issuer or provider that provides minimum essential coverage, also known as MEC, to an individual to file an annual information reporting return with the IRS for which such coverage is provided. Subsequently, this information is used by the IRS to validate that individuals have satisfied the requirement of the individual shared responsibility provision. There are various types of MEC, including employer-sponsored coverage, government-sponsored coverage, individual marketplace plans, other coverage HHS designates as MEC. These information returns must be filed with the IRS and furnished to the individuals to assist in completing their tax returns. The new forms developed by the IRS to satisfy the requirement of Section 6055 are the Forms 1094B transmittal and the 1095B.