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Information Reporting by Providers of Minimum Essential Coverage

Basic Information

  • Any person, including health insurance issuers, self-insured employers, government agencies, and other entities, that provide minimum essential coverage to an individual during a calendar year must report certain information to the IRS.

  • Providers of minimum essential coverage also must furnish, for each covered individual, a statement that includes the same information provided to the IRS.
     

  • Providers that file 250 or more information returns during the calendar year must file the returns electronically. See "How to File Electronically," below. For information on the communication procedures, transmission formats, business rules and validation procedures for returns transmitted electronically through the ACA Information Reports (AIR) system, review Publication 5165, Guide for Electronically Filing Affordable Care Act (ACA) Information Returns.
  • The information furnished and reported is used by individuals and the IRS to verify the months, if any, in which individuals were covered by minimum essential coverage and, therefore, have satisfied the individual shared responsibility requirement of section 5000A of the Internal Revenue Code.

  • Minimum essential coverage is defined in Internal Revenue Code section 5000A(f) and the regulations under that section.

When to Report

Providers of minimum essential coverage (other than self-insured ALE members) must file Form 1095-B, and Form 1094-B, Transmittal of Health Coverage Information Returns, with the IRS annually, no later than February 28 (March 31 if filed electronically) of the year immediately following the calendar year to which the return relates.  Reporting requirements of ALE members are discussed below under Self-Insured Employers.

Also, providers of minimum essential coverage are required to furnish a statement for each covered individual by January 31 of the year following the calendar year for which the information return must be filed with the IRS.

Transition relief provides that the first information returns filed with the IRS and statements furnished to individuals who are provided minimum essential coverage are not due until 2016, for coverage provided in 2015.  Thus, under this transition relief, the first statements furnished to covered individuals must be furnished by January 31, 2016, and the first information returns filed with the IRS must be filed by February 28, 2016 (March 31, 2016, if filed electronically).

Although the first information returns and statements to covered individuals are not required until 2016 for the 2015 year, voluntary compliance for the 2014 year is encouraged. Providers of minimum essential coverage may comply with these information reporting provisions for 2014 in preparation for the full application of the provisions for 2015. No penalties will be applied for failure to comply with these information reporting provisions for 2014.

Information to be Reported to the IRS

Information to be reported to the IRS includes the name and taxpayer identification number (TIN) of the responsible individual (the person who may be the primary insured or a related person, such as a parent or spouse who submitted the application for coverage) for each covered individual.

When a provider has been unable to obtain a TIN and has made reasonable efforts(Link to preamble discussion on reasonable efforts in final 6055 regulation and 6055 Q&A #18) to obtain it, the provider reports the covered individual’s date of birth.

Providers must report the months for which the individual was enrolled in coverage and entitled to receive benefits for at least one day.  Specific information to be reported to the IRS can be found in section 1.6055-1(e) of the regulations.

Information to be Furnished to Responsible Individuals

Information contained in the statement to be furnished to responsible individuals (the person who may be the primary insured or a related person, such as a parent or spouse who submitted the application for coverage) includes the name of the coverage provider and the name and telephone number of the provider’s designated contact.  Specific information to be furnished can be found in section 1.6055-1(g) of the regulations.

How to Report

Health insurance issuers, self-insured employers, government agencies, and others that provide minimum essential coverage to an individual during a calendar year must file an annual information return with the IRS.  In general, providers of minimum essential coverage report on Form 1095-B, which is accompanied by a single transmittal form, Form 1094-B, for all returns filed for a given calendar year. Providers file one Form 1095-B for all individuals covered together under a policy or program. 

A provider of minimum essential coverage can make the required statement to the responsible individual by furnishing a copy of the Form 1095-B filed with the IRS.  Alternatively, these returns and statements to responsible individuals may be made by using substitute forms. The regulations provide that a substitute form must include all of the information required to be reported on Forms 1094-B and 1095-B, and comply with applicable revenue procedures or other published guidance relating to substitute returns.

How to File Electronically

Form 1094-B and Form 1095-B are subject to the requirements to file returns electronically.  Providers that file 250 or more information returns (Forms 1095-B) must file Forms 1094-B and 1095-B electronically through the ACA Information Returns (AIR) program. For information on the communication procedures, transmission formats, business rules and validation procedures for returns transmitted electronically through the ACA Information Reports (AIR) system, review Publication 5165, Guide for Electronically Filing Affordable Care Act (ACA) Information Returns.  The 250-or-more requirement applies separately to each type of return and separately to each type of corrected return.  Providers that file fewer than 250 returns may file electronically or on paper.  For more information, see the Instructions for Forms 1094-B and 1095-B.

Providers that file Form 1095-B must furnish a copy to the person identified as the responsible individual on paper by mail, unless the recipient affirmatively consents to receive the statement in an electronic format.  The requirement to obtain affirmative consent to furnish a statement in electronic format ensures that statements are sent electronically only to individuals who are able to access them.  A recipient may consent on paper or electronically.  If consent is on paper the recipient must confirm the consent electronically. 

Self-insured Employers

Self-insured employers – that is, employers who sponsor self-insured group health plans – are subject to the information reporting requirements for providers of minimum essential coverage whether or not they are applicable large employers under the employer shared responsibility provisions. This means employers of any workforce size that self-insure must comply with these information reporting requirements.

Self-insured employers that are not applicable large employers use Form 1095-B and the transmittal Form 1094-B to meet the information reporting requirements for providers of minimum essential coverage.

Self-insured employers that are applicable large employers, and therefore are also subject to the information reporting requirements for offers of employer-sponsored health insurance coverage, must combine reporting under both provisions by filing a single information return, Form 1095-C, and transmittal, Form 1094-C.

Information Reporting Penalties

A provider of minimum essential coverage that fails to comply with the information reporting requirements may be subject to the general reporting penalty provisions under section 6721 (failure to file correct information returns) and section 6722 (failure to furnish correct payee statement).

  • The penalty for failure to file an information return generally is $100 for each return for which such failure occurs.  The total penalty imposed for all failures during a calendar year cannot exceed $1,500,000.
  • For returns required to be filed after December 31, 2015, the penalty for failure to file an information return generally is increased from $100 to $250 for each return for which such failure occurs.  The total penalty imposed for all failures during a calendar year after December 15, 2015 cannot exceed $3,000,000.
  • The penalty for failure to provide a correct payee statement is $100 for each statement with respect to which such failure occurs, with the total penalty for a calendar year not to exceed $1,500,000.
  • The penalty for failure to provide a correct payee statement is increased from $100 to $250 for each statement for which such failure occurs, with the total penalty for a calendar year not to exceed $3,000,000.  The increased penalty amount applies to statements required to be provided after December 31, 2015.
  • Special rules apply that increase the per-statement and total penalties if there is intentional disregard of the requirement to furnish a payee statement.

The waiver of penalty and special rules under section 6724 and the applicable regulations, including abatement of information return penalties for reasonable cause, may apply to certain failures under section 6721 or 6722.

More Information

More information about the information reporting requirements for providers of minimum essential coverage, including self-insured employers, is available in these Questions and Answers.  More information about the information reporting requirements for ALEs is available in these Questions and Answers. More information for ALE’s about the employer shared responsibility provision is available in these Questions and Answers

Employers or health coverage providers can access and review recorded webinars at anytime to better understand how the health care law may affect their organization. The following ACA video provides about 40 minutes of detailed information on the employer–sponsored health coverage information reporting requirements for applicable large employers.

The Department of the Treasury and the IRS have also issued the following legal guidance and information:

  • Regulations on the information reporting requirements for providers of minimum essential coverage
  • Notice 2013-45, announcing transition relief for 2014 from this annual information reporting
  • Publication 5215, Affordable Care Act: Reporting Responsibilities for Health Coverage Providers

More information is also available in this fact sheet issued by the U.S. Department of the Treasury.

Page Last Reviewed or Updated: 16-Jun-2016