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Questions and Answers about Information Reporting by Employers on Form 1094-C and Form 1095-C

Employers subject to section 4980H of the Internal Revenue Code (“Code”), generally meaning employers with 50 or more full-time employees (including full-time equivalent employees) in the preceding calendar year, use Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, and Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, to report the information required under section 6056, about offers of health coverage to full-time employees (and family members), and under section 6055, about enrollment in health coverage by employees (and family members) for employers that sponsor self-insured health plans. (These Q&As also address reporting for certain former employees. See Reporting Offers of COBRA Continuation Coverage and Post-Employment Coverage.)

Form 1094-C is used to report to the IRS summary information for each employer and to transmit Forms 1095-C to the IRS.  Form 1095-C is used to report information about each employee.

The information reported on Form 1094-C and Form 1095-C is used in determining whether an employer is potentially liable for a payment under the employer shared responsibility provisions of section 4980H, and the amount of the payment, if any. Form 1095-C is also used by the IRS and the employee in determining the eligibility of the employee (and the employee's family members) for the premium tax credit under section 36B. For employers that are subject to section 4980H and that sponsor self-insured health plans, Form 1095-C is also used by the IRS and individuals to verify employees' and family members' enrollment in minimum essential coverage under the self-insured health plan for purposes of the individual shared responsibility provisions of section 5000A.

These Q&As provide additional information about completing Form 1094-C and Form 1095-C for calendar year 2017 that are to be filed in 2018. The Q&As may be used in conjunction with the Instructions for Forms 1094-C and 1095-C, which provide detailed information about completing the forms.

For information about the reporting requirements under section 6056, including information on who is required to report, see Reporting of Offers of Health Insurance Coverage by Employers (section 6056). Generally, employers subject to section 4980H are required to report and are referred to in these Q&As  as Applicable Large Employer (ALE) Members.

For details about additional reporting requirements applicable to sponsors of self-insured health plans under section 6055, see Questions and Answers on Information Reporting by Health Coverage Providers (section 6055).

For information on the employer shared responsibility provisions, see Employer Shared Responsibility Q&As (section 4980H).

Basics of Employer Reporting

1. What forms must an ALE Member file with the IRS to report the required information under sections 6055 and 6056?

The section 6056 regulations provide that, under the general method of reporting, an ALE Member must file a separate Form 1095-C for each of its full-time employees, and must file a transmittal (Form 1094-C) for all of the returns filed for a given calendar year. An ALE Member may file one or more Forms 1094-C, but regardless of the number of Forms 1094-C the ALE Member files, the ALE Member must file one (and only one) Form 1094-C that is an Authoritative Transmittal, reporting summary information about the ALE Member and its employees. These forms must be filed whether or not the ALE Member offers coverage, or the employee enrolls in any coverage offered.

To meet the section 6055 requirement, an ALE Member that offers health coverage through a self-insured health plan must report information about enrollment in the coverage on Form 1095-C, Part III, for any employee who is enrolled in coverage (and any enrolled family members).

A more complete discussion of the information that must be reported to the IRS (including simplified methods of reporting) can be found in the final section 6056 regulations, the final section 6055 regulations, and the Instructions for Forms 1094-C and 1095-C, which include a definition of ALE Member.

2. For which employees must an ALE Member file Form 1095-C?

Generally, an ALE Member must file Form 1095-C for each employee who was a full-time employee of the ALE Member for any month of the calendar year, including any employee who was treated as a full-time employee for one or more months of the calendar year under the look-back measurement method for determining full-time employee status under the employer shared responsibility provisions. (See later questions in Basics of Employer Reporting for exceptions.) For guidance on how to determine who is a full-time employee, including rules on the look-back measurement method, see Identification of Full-Time Employee sections in the Employer Shared Responsibility Q&As.

Also, an ALE Member that sponsors a self-insured health plan must generally file Form 1095-C for each employee who enrolls in the self-insured health coverage or enrolls a family member in the coverage, regardless of whether the employee is a full-time employee for any month of the calendar year.

3. What information must an ALE Member furnish to its employees?

An ALE Member must furnish a completed Form 1095-C to each employee who was a full-time employee of the ALE Member for any month of the calendar year (that is, the same group of employees for whom the ALE Member is required to file a Form 1095-C with the IRS). The parts of the form that relate to section 6056 (Parts I and II) must be completed and furnished regardless of whether the ALE Member offers coverage, the employee enrolls in any coverage offered, or the employee waived any coverage offered. Also, an ALE Member that sponsors a self-insured health plan must furnish Form 1095-C with Part III completed for each employee and family member who enrolls in the self-insured health coverage, regardless of whether the employee is a full-time employee for any month of the calendar year.

See Reporting Offers of Coverage and other Enrollment Information below for further information about simplified employee statements that may be used under the Qualifying Offer reporting method.

4. May an ALE Member furnish a substitute statement to the recipient and file a substitute return with the IRS?

Yes, a substitute Form 1095-C may be furnished to the recipient, and if the ALE Member is filing with the IRS using paper, substitute Forms 1094-C and 1095-C may be filed with the IRS. The substitute form must include all of the information required on Form 1094-C and Form 1095-C, as applicable, and satisfy all form and content requirements as specified by the IRS.  A substitute Form 1095-C may be furnished to the recipient in a portrait format.  However, substitute Forms 1094-C and 1095-C filed with the IRS must be in landscape format. (The same rules apply if the ALE Member sponsors a self- insured health plan and is filing a return to satisfy section 6055.) For more information, see Publication 5223, General Rules and Specifications for Affordable Care Act Substitute Forms 1095-A, 1094-B, 1095-B, 1094-C, and 1095-C.

5. What are the due dates in 2018 for furnishing to the recipient and filing with the IRS calendar year 2017 Forms 1094-C and 1095-C?

Furnishing: For reporting in 2018 (for offers of coverage and coverage in 2017), an ALE Member must furnish the Form 1095-C to each full-time employee on or before March 2, 2018.  This due date reflects a 30-day extension from the general due date (that is, January 31 of the year immediately following the calendar year to which the information relates); the extension was provided by the IRS in Notice 2018-06 on December 22, 2017.

The extension applies automatically and does not require the submission of any request or other documentation to the IRS.  In view of this automatic extension, the rules allowing the IRS to grant extensions of time of up to 30 days to furnish Form 1095-C will not apply to the extended due date.  Also, because the 30-day extension of the due date to furnish applies automatically and is as generous as the permissive 30-day extensions of time to furnish 2017 information statements under section 6056 that have already been requested by some reporting entities in submissions to the IRS, the IRS will not formally respond to those requests.

Under Notice 2018-06, the extended furnishing due date also applies for purposes of section 6055 reporting for 2017 (Forms 1094-B and 1095-B).

Filing:  Generally, Forms 1094-C and 1095-C must be filed by February 28 if filing on paper (or March 31 if filing electronically) of the year following the calendar year to which the return relates. The requirement to file Forms 1094-C and 1095-C is met if the forms are properly addressed and mailed on or before the due date. If the due date falls on a weekend or legal holiday, then the due date is the following business day. A business day is any day that is not a Saturday, Sunday or legal holiday.   Regulations under section 6081 address extensions of time to file information returns.

Although the IRS extended the due date for furnishing Form 1095-C for 2017, the due date for filing Forms 1094-C and 1095-C with the IRS was not extended. But note that Notice 2018-06 does not affect the normal provisions regarding automatic extensions of time for filing information returns, which can be obtained by submitting a Form 8809, Application for Extension of Time To File Information Returns, and it also does not affect the provisions regarding additional extensions of time to file.

6. For which employees is an ALE Member not required to file or furnish a Form 1095-C?

Form 1095-C is not required for the following employees (unless the employee or the employee’s family member was enrolled in a self-insured plan sponsored by an ALE Member):

    • an employee who was not a full-time employee in any month of the year; or
    • an employee who was in a limited non-assessment period for all 12 months of the year (for example, a new variable hour employee still in an initial measurement period). For more information, see the definition of limited non-assessment period in the Instructions for Forms 1094-C and 1095-C.

7. Is an ALE Member required to file or furnish a Form 1095-C for a full-time employee who has coverage under TRICARE or a Department of Veterans Affairs (VA) health program?

Yes, a Form 1095-C must be filed for (and furnished to) every full-time employee, including a full-time employee who has coverage under TRICARE or a VA health program.  The rule that employees covered under TRICARE or a VA health program are not counted in determining whether an employer is subject to the employer shared responsibility provisions, otherwise known as an applicable large employer, does not change the rule that if an employer is an applicable large employer or ALE Member, a Form 1095-C must be filed for and furnished to every full-time employee.  For more information, see Employer Shared Responsibility Q&As.

8. How does an ALE Member complete the Authoritative Transmittal?

Although an ALE Member may file multiple Forms 1094-C to transmit Forms 1095-C to the IRS, each ALE Member must file one (and only one) Authoritative Transmittal with the IRS reporting summary information about that ALE Member and its employees.  When filing its Authoritative Transmittal, Form 1094-C, the ALE Member reports its name, address, EIN and contact information on Form 1094-C lines 1-8, and on line 19 the ALE Member checks the box to indicate that this is its Authoritative Transmittal.  The ALE Member then continues to complete Parts II, III, and IV of the Form 1094-C, as applicable.  For additional details on completing Forms 1094-C, see the Instructions for Forms 1094-C and 1095-C.

9. Do ALE Members that are combined to form a single employer (an “Aggregated ALE Group”) file one Authoritative Transmittal reporting summary information for all ALE Members in the Aggregated ALE Group?

No. Even though employers that have a certain level of common or related ownership are treated as a single employer for purposes of determining status as an applicable large employer, the requirement to file Forms 1094-C and to file and furnish Forms 1095-C applies separately to each ALE Member in the Aggregated ALE Group. Therefore, each ALE Member in the Aggregated ALE Group must file its own Authoritative Transmittal and file and furnish Forms 1095-C for its own full-time employees.  Each ALE Member in the Aggregated ALE Group must have its own Employer Identification Number (EIN) and no Authoritative Transmittal should be filed for an Aggregated ALE Group.

For example, if Company A and Company B together make up an Aggregated ALE Group, Company A must file one Form 1094-C Authoritative Transmittal, reporting its name, address and EIN on lines 1-8, and reporting on line 19 that it is the Authoritative Transmittal.  Company A would then complete Parts II, III and IV, as applicable, reporting information only about Company A and its employees.  Company A would also complete Forms 1095-C for full-time employees of Company A. In addition, if Company A sponsors a self-insured health plan, it would also complete Form 1095-C, including Part III for any employees, whether or not they are full-time employees, and family members enrolled in the coverage.

Company B must file a separate Form 1094-C, Authoritative Transmittal, reporting its name, address, and EIN on lines 1-8, reporting on line 19 that it is the Authoritative Transmittal, and completing the remainder of the Form, as applicable.  Company B would also complete Forms 1095-C for full-time employees of Company B.  In addition, if Company B sponsors a self-insured health plan, it would also complete Form 1095-C, including Part III for any employees, whether or not they are full-time employees, and family members enrolled in the coverage.

For more information on the terms Aggregated ALE Group, ALE Member, and applicable large employer, see Reporting of Offers of Health Insurance Coverage by Employers (section 6056).

10. Which ALE members should complete Part III of Form 1095-C?

An ALE Member that sponsors a self-insured health plan should complete Part III of Form 1095-C for employees and family members who enroll in the self-insured coverage. An ALE Member that sponsors a health plan that includes self-insured options and insured options should complete Part III of Form 1095-C only for employees and family members who enroll in a self-insured option. An employer who participates in a multiple employer welfare arrangement (MEWA) is considered to offer that coverage to its employees, so if the employer participates in a self-insured MEWA, that employer would be required to complete Part III for its employees and family members who enroll in the MEWA. For information on how to complete Form 1095-C for an employee who is enrolled in self-insured coverage but who is not a full-time employee, see the Instructions for Forms 1094-C and 1095-C.

An ALE Member that offers coverage to an employee other than under its own self-insured health plan or a self-insured MEWA, such as through an employer-sponsored insured health plan or a multiemployer health plan, should NOT complete Part III.  Instead, information about the coverage will be filed with the IRS and furnished to employees on Form 1095-B, Health Coverage, by the insurance provider or the sponsor of the plan providing the coverage.

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Reporting Offers of Coverage and other Enrollment Information

11. How should an ALE Member report whether an offer of coverage was made to an employee for a month?

The ALE Member uses line 14, Offer of Coverage, in Part II of Form 1095-C to report whether an offer of coverage was made to an employee for each month of the year. An offer of coverage is considered to have been made for a month only if the coverage offered would provide coverage for every day of that month (see Offer of Coverage section in the Employer Shared Responsibility Q&As and the Instructions for Forms 1094-C and 1095-C for more information on when an employer is, and is not, considered to have made an offer of coverage). The ALE Member should enter the applicable indicator code to report whether coverage was offered and, if so, the type of coverage that was offered to the employee for that month (for example, employee-only coverage, employee and dependents coverage, employee, spouse and dependents coverage, etc.). However, see later questions in Reporting Offers of Coverage and other Enrollment Information for information about reporting offers of coverage for the months in which an employee is hired or terminated, and see Reporting Offers of COBRA Continuation Coverage and Post-Employment Coverage below, for additional information.  For more information about completing line 14 and the use of the indicator codes, see the Instructions for Forms 1094-C and 1095-C.

12. How should information about an offer of coverage for the month in which an employee is hired be reported on Form 1095-C?

For the first month of employment, in Part II of Form 1095-C, the ALE Member should report that the employee was not offered coverage for that month by entering code 1H, No offer of coverage, on line 14 (unless the employee was offered coverage and the offer of coverage extended to every day of that month).  For example, if a newly-hired employee starts employment on the 10th of a month, with the offer of coverage (if accepted) providing coverage also starting on the 10th of the month, the ALE Member should report that the employee was not offered coverage for that first month.

If an employee’s first day of employment is a day other than the first day of the month, then the first month of employment is a limited non-assessment period and the ALE Member will not be subject to a payment under section 4980H for that employee’s first month of employment. In that case, the ALE Member should enter code 2D, Employee in a section 4980H(b) Limited Non-Assessment Period, on line 16 for that month. For more information see the definition of limited non-assessment period in the Instructions for Forms 1094-C and 1095-C.

The rules are different for Part III of Form 1095-C. In Part III of Form 1095-C, an ALE Member that sponsors a self-insured health plan should report an individual as having coverage under the plan for the month if the individual was covered for any day of the month.  Accordingly, if the employee enrolls in the plan and obtains coverage for any day during the month of hire, the employee (and any family members who obtained coverage through the employee’s enrollment) should be reported as having coverage for that month in Part III of Form 1095-C.

13. How should information about the offer of coverage for the month in which an employee terminates employment be reported on Form 1095-C

An ALE Member reports that an employee was offered coverage for a month in Part II of Form 1095-C only if the offer of coverage would provide coverage for every day of the month. Accordingly, if an employee terminates employment with an ALE Member on any day other than the last day of a month and the coverage or offer of coverage expires upon termination of employment, the ALE Member should report that the employee was not offered coverage for that final month of employment by entering code 1H, No offer of coverage, on line 14.

The rules are different for Part III of Form 1095-C. In Part III of Form 1095-C, an ALE Member that sponsors a self-insured health plan should report an individual as having coverage under the plan for the month if the individual was covered for any day of the month.  Accordingly, if an employee who terminates employment with an ALE Member had coverage for any day during the month of termination, the employee (and any family members who had coverage through the employee’s enrollment) should be reported as having coverage for that month in Part III of Form 1095-C.

Also, if the coverage or offer of coverage would have continued if the employee had not terminated employment during the month, the ALE Member will be treated as having offered coverage to that employee for purposes of section 4980H for that employee’s last month of employment. In that case, the ALE Member should enter code 2B, Employee not a full-time employee, on line 16 for that month. In addition, the ALE Member can treat the employee as having been offered coverage for the month for purposes of Form 1094-C, Part III, column (a). For information about reporting offers of coverage in months after the date of termination, see Reporting Offers of COBRA Continuation of Coverage and Post-Employment Coverage below.

14. How is the amount of the Employee Required Contribution that is to be reported on line 15 of Form 1095-C computed?

An amount is entered on line 15 only if the Offer of Coverage reported on line 14 includes an offer of minimum value coverage to the employee.  In that case, the Employee Required Contribution is the employee’s share of the monthly cost for the lowest-cost self-only minimum essential coverage providing minimum value that is offered to the employee by the ALE Member. The Employee Required Contribution may not be the same amount as the premium the employee pays for coverage if, for example, the employee chooses to enroll in more expensive coverage, such as family coverage. In addition, the Employee Required Contribution may not be the same amount as the premium the employee pays for coverage if the employer, in addition to or in conjunction with the coverage, offers other arrangements that could affect the employee’s cost of coverage, including certain HRA contributions, wellness program incentives, flex credits, and opt-out payments. For additional rules on determining the amount of the Employee Required Contribution, see Notice 2015-87 (questions 7-12) and the proposed regulation on the premium tax credit.

For purposes of these Q&As, minimum essential coverage refers to health coverage under an eligible employer-sponsored plan. For more details on minimum essential coverage, see Publication 974, Premium Tax Credit (PTC). For more information on when coverage provides minimum value see, Employer Shared Responsibility Q&As.

15. Is an ALE Member required to enter a code on line 16, Section 4980H Safe Harbor and Other Relief, of Form 1095-C?

No. An ALE Member is not required to make an entry on line 16 of Form 1095-C. However, an ALE Member may use line 16 to indicate that the ALE Member qualifies for an exception from a potential assessable payment under section 4980H(b) for a given month. Thus, an ALE Member should enter the appropriate code on line 16 if any applies. If no code is applicable for a given month, line 16 should be left blank. For more information about using line 16, see the Instructions for Forms 1094-C and 1095-C.

16. What code is entered on Form 1095-C, line 14, Offer of Coverage and Form 1095-C, Line 16, Section 4980H Safe Harbor and Other Relief, when a full-time employee who is offered coverage either does not enroll or waives the coverage?

There is no specific code that is entered on either line 14 or line 16 of Form 1095-C to indicate that a full-time employee is offered coverage but did not enroll.  As discussed in questions above in Reporting Offers of Coverage and other Enrollment Information, if a full-time employee has an offer of coverage, the ALE Member enters the applicable indicator code on line 14 to report what type of coverage the employee was offered. The ALE Member may use line 16 to report that it qualifies for an exception from a potential assessable payment under section 4980H(b) for a given month.  The Instructions for Forms 1094-C and 1095-C explain when an ALE Member may enter a code on line 16.  For more information about using lines 14 and 16, see the Instructions for Forms 1094-C and 1095-C.

It is important to note that there is no exception from a potential assessable payment under section 4980H(b) for cases where the employee waived, declined or did not enroll in coverage.  However, the ALE Member may nevertheless not be subject to a potential assessable payment for other reasons, for example if the employer offered the employee affordable coverage that provided minimum value, and should enter the appropriate code on line 16, if any applies.  For more information, see Employer Shared Responsibility Q&As.

17. How should an ALE Member report enrollment information for self-insured health plan coverage provided to an individual who was not an employee on any day of the calendar year, such as a non-employee COBRA beneficiary?

An ALE Member that sponsors a self-insured health plan may use Form 1095-C to report enrollment information for individuals who were not employees on any day of the calendar year by entering code 1G, “Offer of coverage for at least one month of the calendar year to an individual who was not an employee for any month of the calendar year or to an employee who was not a full-time employee for any month of the calendar year...” If applicable, an ALE Member should enter code 1G on line 14 of Form 1095-C in the “All 12 Months” column or in each separate monthly box (for all twelve months) and complete Part III of Form 1095-C. (Note, however, that Form 1095-C requires the recipient’s Social Security number (SSN) on line 2, so Form 1095-C cannot be used for covered individuals reported on line 1 who have not provided a SSN to the employer regardless of whether the employer has requested the information.)

The non-employees who are enrolled in coverage might include a former employee receiving COBRA continuation coverage who terminated employment in a previous calendar year, a retired employee who terminated employment in a previous calendar year, a non-employee director, or a family member (including a surviving spouse or dependent) of such an individual if the family member is receiving coverage independent of the individual, such as by electing individual COBRA continuation coverage. All family members of an individual who are covered individuals due to that individual’s enrollment (for instance, a spouse of a retiree who is enrolled in the plan because the retiree elected self plus spousal coverage) should be included on the same Form 1095-C as the individual who enrolls in the coverage.

For the option to use Form 1095-B as an alternative to Form 1095-C for an individual who was not an employee on any day of the calendar year, see the Instructions for Forms 1094-C and 1095-C. See Reporting Offers of COBRA Continuation Coverage and Post-Employment Coverage below for information on the choices an employer that sponsors a self-insured health plan has for reporting coverage of spouses and other family members of an employee in cases in which the spouse and/or family member separately elect to receive COBRA continuation coverage.

18. How does an ALE Member complete its Authoritative Transmittal and Form 1095-C if the ALE Member is eligible to use the Qualifying Offer method?

If an ALE Member has made a Qualifying Offer for all 12 months of the year to one or more full-time employees (and the employee did not enroll in an employer-sponsored self-insured health plan), the ALE Member may use an alternate reporting method for those employees who received a Qualifying Offer for all 12 months of the year.  A “Qualifying Offer” is an offer that satisfies all of the following criteria:

  • It is an offer of minimum essential coverage that provides minimum value;
  • The employee cost for employee-only coverage for each month does not exceed 9.5% (as adjusted) of the mainland single federal poverty line divided by 12; and
  • An offer of minimum essential coverage is also made to the employee’s spouse and dependents (if any).

On the Form 1094-C, line 22, Certifications of Eligibility, the ALE Member should check box A, Qualifying Offer Method. On Form 1095-C, line 14, the ALE Member should enter code 1A, Qualifying Offer, for each employee receiving a Qualifying Offer for all 12 months of the year. When an employee receives a Qualifying Offer, no entry is required in line 15, Employee Required Contribution, and no entry is required in line 16, Section 4980H Safe Harbor and Other Relief.

Form 1095-C must be filed with the IRS; however, as an alternative to furnishing the employee with a copy of Form 1095-C filed with the IRS, the employer may furnish a statement containing certain information and stating that because the employee received a Qualifying Offer for all 12 months of the year, the employee is not eligible for the premium tax credit. However, an employer that sponsors a self-insured health plan may not use this alternative for any employee who has enrolled in the coverage under that plan because the employer is required to report that coverage on Form 1095-C.  In that case, the employer must furnish the employee with a copy of the Form 1095-C as filed with the IRS, which will include enrollment in coverage information (Part III) as well as offer of coverage information (Part II).

For information on the alternate method for completing Form 1095-C, line 14, for an employee who received a Qualifying Offer for at least one month, but not necessarily all 12 months of the calendar year, see the Instructions for Forms 1094-C and 1095-C.

For additional details on the reporting rules for a Qualifying Offer, including the contents of the alternative statement, see the Instructions for Forms 1094-C and 1095-C and the section 6056 regulations.  For more information on how the 9.5% of the mainland single federal poverty line is adjusted over time, see Notice 2015-87 (question 12).

19. How does an ALE Member complete its Form 1094-C Authoritative Transmittal and the accompanying Forms 1095-C, if the ALE Member is using the 98% offer method?

If an ALE Member, taking into account all months during which the individuals were employees of the employer and were not in a limited non-assessment period, has offered affordable health coverage providing minimum value to at least 98% of its employees for whom it is filing a Form 1095-C, and offered minimum essential coverage to those employees’ dependents, the ALE Member may qualify for simplified reporting procedures. (For this purpose, the health coverage is affordable if the ALE Member meets one of the section 4980H affordability safe harbors.) Note that for purposes of the 98% offer method, an offer to an employee’s spouse is not required.

If an ALE Member is using this method, it should check box D, 98% Offer Method, on line 22 of Form 1094-C. The ALE Member is not required to determine whether all of the employees for whom it is filing were full-time employees and therefore, is not required to complete Form 1094-C, Part III(b), Section 4980H Full-Time Employee Count for ALE Member, on its Authoritative Transmittal.  However, the ALE Member is required to file Forms 1095-C on behalf of all its full-time employees who were full-time employees for one or more months of the calendar year.

For further details on the 98% offer method, see the section 6056 regulations and the Instructions for Forms 1094-C and 1095-C.

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Reporting for Governmental Units

20. How does a governmental unit that has been designated to report on behalf of another governmental unit that is an ALE Member complete Form 1094-C and Form 1095-C?

A governmental unit (defined as the government of the United States, any state or political subdivision thereof, or any Indian tribal government (as defined in section 7701(a)(40)) or subdivision of an Indian tribal government (as defined in section 7871(d)), may report under section 6056 on its own behalf or may designate another person or persons to report on its behalf.  A person may be designated to file the return and furnish the statements under section 6056 on behalf of the ALE Member if the person is part of or related to the same governmental unit as the ALE Member. A government entity that is appropriately designated to file for another governmental unit is referred to as a Designated Government Entity (DGE).

If a DGE is designated to report on behalf of an ALE Member, all of the reporting rules for Forms 1094-C and 1095-C provided in these Questions and Answers apply to the DGE, including reporting coverage information for employees and family members in Part III of Form 1095-C for an ALE Member that sponsors a self-insured health plan.

If a DGE is designated to file returns on behalf of more than one ALE Member, the DGE must file a separate Form 1094-C for each ALE Member for which the DGE is reporting.  On lines 9-14 of Form 1094-C, Part I, the DGE would report its name, address and EIN, and on lines 1-6 it would report the name, address, and EIN of the ALE Member for which it is reporting. Contact names and telephone numbers must be provided for both the ALE Member and the DGE. For additional information, see the Instructions for Forms 1094-C and 1095-C and Notice 2015-87 (question 19).

21.What forms do a DGE and the designating governmental unit use to report the required information?

A governmental unit and a DGE should use Form 1094-B, Transmittal of Health Coverage Information Returns and Form 1095-B or Form 1094-C and Form 1095-C, as follows:

(A) An ALE Member with an insured employer-sponsored health plan (or options under the employer-sponsored health plan that are insured) that has delegated to a DGE the responsibilities for reporting the offer of coverage (section 6056) information.

In this case, the DGE must report the offer of coverage information using a Form 1094-C and a Form 1095-C for each employee for whom the governmental unit has delegated the reporting to the DGE.

(B) An ALE Member that sponsors a self-insured health plan (or options under the group health plan that are self-insured) that has delegated to the DGE the responsibilities for reporting the offer of coverage (section 6056) information and the enrollment in coverage (section 6055) information.

In this case, the DGE must report the offer of coverage information and the enrollment information using a Form 1094-C and a Form 1095-C for each employee for whom the governmental unit has delegated the reporting to the DGE.

(C) An ALE Member that sponsors a self-insured health plan (or options under the group health plan that are self-insured) that has delegated to the DGE the responsibilities for reporting the enrollment in coverage (section 6055) information but not the offer of coverage (section 6056) information.

In this case, the DGE will report the enrollment information on Form 1094-B and Form 1095-B.   Because the governmental unit did not delegate its responsibilities for reporting the offer of coverage information, the governmental unit must report the offer of coverage information on Form 1094-C and Form 1095-C for each full-time employee; however, it should not complete Form 1095-C, Part III (since the enrollment information will be provided by the DGE on Form 1095-B).  For additional details, see the Instructions for Forms 1094-C and 1095-C and Notice 2015-87 (question 19).

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Reporting Offers of COBRA Continuation Coverage and Post-Employment Coverage

22. How should an ALE Member complete Part II of Form 1095-C for a full-time employee who terminates employment during a calendar year and receives an offer of COBRA continuation coverage?

An offer of COBRA continuation coverage that is made to a former employee due to termination of employment is not reported as an offer of coverage in Part II of Form 1095-C.  If the ALE Member is otherwise required to complete a Form 1095-C for the former employee (because, for example, the individual was a full-time employee for one or more months of the year before terminating employment), the ALE Member should use code 1H, No offer of coverage, on line 14 for any month that the former employee was offered COBRA continuation coverage.  For those same months, the ALE Member should use code 2A, Employee not employed during the month, on line 16 for each month in which the individual is not an employee (regardless of whether the former employee enrolled in the COBRA continuation coverage).  Note, however, that an ALE Member that provides COBRA continuation coverage through a self-insured health plan generally must report that coverage for any former employee or family member who enrolls in that COBRA continuation coverage in Part III of the Form 1095-C. Also, the ALE Member  may report the coverage on a Form 1095-B for any individual who was not an employee during the year and who separately elected the COBRA continuation coverage.

An offer of COBRA continuation coverage that is made to an active employee due to a reduction in hours is reported differently than an offer of COBRA continuation coverage to a former employee. See the next question for more details.

23. How should an ALE Member complete Part II of Form 1095-C for an active employee who receives an offer of COBRA continuation coverage due to a reduction in hours?

An ALE Member making an offer of COBRA continuation coverage to an active 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 continuation coverage as an offer of coverage in Part II of Form 1095-C. In this instance, the code entered on line 14 for the months in which an offer of COBRA continuation coverage is made should reflect only the individuals who received an offer of COBRA continuation coverage (which generally will be only the individuals enrolled in the non-COBRA coverage at the time of the reduction in hours) or the individuals who received an offer of other coverage at the same time the COBRA continuation coverage is offered. This is because only the individuals who received an offer of COBRA continuation coverage (or of other coverage at the same time) are potentially ineligible for the premium tax credit for coverage through the Marketplace due to the offer of COBRA continuation coverage (or other coverage).

For example, assume a full-time employee who has been offered spouse and dependent minimum value coverage elects self-only coverage as the original (non-COBRA) coverage. Further assume the employee becomes part-time and receives an offer of COBRA continuation coverage that provides minimum value, but neither the employee’s spouse nor dependents are offered COBRA continuation or other coverage at that time. In that case, the ALE Member should enter code 1B, Minimum essential coverage providing minimum value offered to employee only, on line 14 for each month for which the COBRA continuation coverage offer applies.

Notwithstanding the preceding instructions for completing line 14 of Form 1095-C, for purposes of section 4980H(a), an ALE Member will be treated as having made an offer to a full-time employee’s dependents (for purposes of section 4980H, a dependent does not include a spouse) for an entire plan year if the ALE Member provided the employee an effective opportunity to enroll the employee’s dependents at least once for the plan year, even if the employee declined to enroll the dependents in the coverage and, as a result, the dependents later did not receive an offer of COBRA coverage. This treatment of the initial offer as an offer of coverage to the dependents for purposes of section 4980H(a) would include the period after that employee had a reduction in hours, lost eligibility under the plan, and was offered self-only COBRA continuation coverage; however, this treatment applies only if the employer would also have offered the dependents COBRA continuation coverage if they had been enrolled in the plan at the time of the reduction in hours.

The following examples illustrate how employers should report offers of COBRA continuation coverage for active employees on Form 1095-C.

Example 1: ABC Corporation is an ALE Member, and its health plan has a calendar year plan year. James was a full-time employee of ABC Corporation and received an offer of coverage under its health plan, providing minimum value, including an offer of minimum essential coverage for his spouse and dependents. James enrolled in self-only coverage from January 1, 2017 through October 31, 2017. The employee required contribution for the lowest cost self-only coverage providing minimum value available under the plan was $150 per month. On November 1, 2017, James transferred to a part-time position and was no longer eligible for coverage under the terms of the ABC Corporation health plan. James received an offer of COBRA continuation coverage due to the transfer to the reduced-hours position, with an employee required contribution of $250 per month for self-only coverage providing minimum value. James elected to enroll in the COBRA continuation coverage for the months of November and December 2017.

ABC Corporation should complete Part II of Form 1095-C for James as follows:

January - October

        Line 14 – Enter code 1E (Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) and spouse)
        Line 15 – Enter $150 as the employee required contribution
        Line 16 – Enter code 2C (Employee enrolled in coverage offered)

November – December

         Line 14 – Enter code 1B (Minimum essential coverage providing minimum value offered to employee only)
         Line 15 – Enter $250 as the employee required contribution
         Line 16 – Enter code 2C (Employee enrolled in coverage offered)

Example 2: The same facts as Example 1, except James elects not to enroll in the COBRA continuation coverage.  ABC Corporation should complete line 14 and line 15 in the same manner as in Example 1.  However, the applicable code, if any, for line 16 for November and December is determined as it would be for any other active employee. Thus, for any month in which James is treated as a full-time employee under the look-back measurement method, the employer may not use code 2B, Employee not a full-time employee, on line 16.  In that case, the employer may enter another code from Code Series 2 (Section 4980H Safe Harbor and Other Relief), if applicable.  For guidance on how to determine who is a full-time employee, see Identification of Full-Time Employees section in the Employer Shared Responsibility Q&As.

ABC Corporation should complete Part II of Form 1095-C for James as follows:

January – October

        Line 14 – Enter code 1E (Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) and spouse)
        Line 15 – Enter $150 as the employee required contribution
        Line 16 – Enter code 2C (Employee enrolled in coverage offered)

November – December

        Line 14 – Enter code 1B (Minimum essential coverage providing minimum value offered to employee only)
        Line 15 – Enter $250 as the employee required contribution
        Line 16 – Enter, if applicable, a code from Code Series 2 (Section 4980H Safe Harbor Codes and Other Relief for Employers)

For Examples 1 and 2, when ABC Corporation completes its Authoritative Transmittal, Part III – ALE Member Information – Monthly, Lines 23-35, ABC Corporation can treat James and his dependents as if they had an offer of coverage for the whole 2017 plan year, including November and December, when determining whether ABC corporation offered minimum essential coverage to at least 95% of its full-time employees and their dependents.  
 

Example 3: The same facts as Example 1, except from January 1, 2017, James enrolled in family coverage providing minimum value covering himself, his spouse, and his dependents. On November 1, 2017, when James transferred to a part-time position and lost eligibility for coverage under the terms of the plan, an offer of COBRA continuation coverage was made to James, his spouse, and his dependents. ABC Corporation should complete line 14 and line 15 in the same manner as in Example 1, except that for November and December, code 1E, Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) and spouse, should be entered on line 14.

ABC Corporation should complete Part II of Form 1095-C for James as follows:

January – October

        Line 14 – Enter code 1E (Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) and spouse)
        Line 15 – Enter $150 as the employee required contribution
        Line 16 – Enter code 2C (Employee enrolled in coverage offered)

November – December

        Line 14 – Enter code 1E (Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) and spouse)
        Line 15 – Enter $250 as the employee required contribution
        Line 16 – Enter code 2C (Employee enrolled in coverage offered)
 

24. How should an employer that sponsors a self-insured health plan report coverage of spouses and dependents of employees who separately elect to receive COBRA continuation coverage?

In some circumstances, for example if the employee is deceased or elects not to enroll in COBRA continuation coverage, a current or former employee’s spouse and dependents may be offered COBRA continuation coverage and be entitled to make an independent election to enroll in COBRA continuation coverage.  An employer that sponsors a self-insured health plan may choose to report coverage of each non-employee spouse and dependent who separately elects COBRA continuation coverage on a Form 1095-B or on Form 1095-C.

Example: Keri was a full-time employee of ABC Corporation, which is an ALE Member.  Effective for the plan year beginning January 1, 2017, Keri elected to receive self-and-spouse coverage under the self-insured ABC Corporation health plan for herself and her spouse, Gerald. On May 15, 2017, Keri and Gerald divorce and Gerald loses eligibility for coverage under the plan.  ABC Corporation makes an offer of COBRA continuation coverage to Gerald, who elects to enroll in the COBRA continuation coverage and remains enrolled from May 15, 2017 through December 31, 2017.

ABC Corporation should report Keri’s enrollment in Part III of Form 1095-C by reporting that Keri was enrolled in minimum essential coverage in January 2017 through May 2017, and that Gerald had coverage (due to Keri’s enrollment in coverage providing coverage to a spouse) for the months January through May 2017.

For the period June through December 2017, Keri and Gerald should receive separate forms reporting them as enrolled in minimum essential coverage under ABC Corporation’s self-insured health plan.  Keri’s enrollment information will be included on her Form 1095-C; ABC Corporation may report for Gerald on a separate Form 1095-C or 1095-B.

25. How should an ALE Member complete Part II of Form 1095-C for a full-time employee who terminates employment during a calendar year and receives an offer of post-employment (non-COBRA) coverage?

An offer of post-employment coverage that is made to a former employee upon termination of employment (such as at retirement) is not reported as an offer of coverage in Part II of Form 1095-C.  If the ALE Member is otherwise required to complete a Form 1095-C, Part II for the former employee (because, for example, the individual was a full-time employee for one or more months of the year before terminating employment), the ALE Member should use code 1H, No offer of coverage, on line 14 for any month that the former employee was offered post-employment coverage. For those same months, the ALE Member should use code 2A, Employee not employed during the month, on line 16 for each month in which the individual is not an employee (regardless of whether the former employee enrolled in the post-employment coverage).

Note, however, that an ALE Member that provides post-employment coverage through a self-insured health plan must report that coverage for any former employee or family member who enrolls in that coverage in Part III of the Form 1095-C for the calendar year in which the employee terminated employment.  For subsequent calendar years in which an individual who was not an employee for any month enrolls in post-employment coverage provided through the self-insured health plan, the ALE Member may report that coverage on Form 1095-B or Form 1095-C. See Reporting Offers of Coverage and other Enrollment Information above for additional information on completing Form 1095-C.

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Reporting Coverage under Health Reimbursement Arrangements (Form 1095-C, Part III)

26. Should an ALE Member report coverage under a Health Reimbursement Arrangement (HRA) for an individual who is enrolled in both the HRA and the employer’s other self-insured major medical group health plan?

An HRA is a self-insured group health plan that is minimum essential coverage.  Therefore, enrollment in an HRA must be reported under section 6055 in the same manner as enrollment in other minimum essential coverage, unless an exception applies. Under one exception, if an individual is covered by two or more plans or programs that are minimum essential coverage and that are provided by the same reporting entity, reporting is required for only one of them for that month.  For information on how to identify the section 6055 reporting entity for employer-sponsored coverage, see the Section 6055 Q&As.

Thus, if, for a month, an individual is enrolled in an employer’s self-insured major medical group health plan and also has an HRA from the same ALE Member, the ALE Member is not required to report enrollment in coverage under the HRA (Form 1095-C, Part III or Form 1095-B, as applicable) for the individual.

If an employee is covered under both arrangements for some months of the year but drops coverage under the non-HRA group health plan and is covered only under the HRA, the employer must report coverage under the HRA for the months after the employee drops the non-HRA coverage.

For more information, see the Instructions for Forms 1094-C and 1095-C and proposed regulations section 1.6055-1(d)(2) and (3).

27. Should an ALE Member report coverage under an HRA for an individual who is eligible for the HRA because the individual is enrolled in the employer’s insured group health plan?

An HRA is a self-insured group health plan that is minimum essential coverage.  Therefore enrollment in an HRA must be reported under section 6055 in the same manner as enrollment in other minimum essential coverage, unless an exception applies.  Under one exception, if an individual is eligible for an HRA because the individual is enrolled in an employer’s insured group health plan for which section 6055 reporting is required, reporting generally is not required for the HRA.  For eligible employer-sponsored coverage, this exception applies only if both types of coverage (the HRA and the eligible employer-sponsored coverage for which 6055 reporting is required) are offered by the same employer. Thus, an ALE Member is not required to report enrollment in coverage under an HRA for an individual who is enrolled in both the employer’s HRA and the employer’s insured group health plan and who is eligible for the HRA only because the individual is enrolled in the employer’s insured group health plan, for which section 6055 reporting is required.

However, an ALE Member would be required to report HRA coverage for an employee who is enrolled in the HRA but not enrolled in another group health plan of the employer.  For example, the ALE Member must report on an employee enrolled in the HRA who is also enrolled in spousal coverage provided by another employer (rather than the employer’s other group health plan) or an employee who has ended enrollment in the employer’s major medical group health plan but retains the coverage under the HRA.  An ALE Member also would be required to report HRA coverage of a spouse and/or dependents if the employee enrolled in self-only coverage under the employer’s major medical group health plan (so that the spouse and/or dependents with coverage under the HRA were not enrolled in the employer’s major medical group health plan).

For more information, see the Instructions for Forms 1094-B and 1095-B, proposed regulations section 1.6055-1(d)(2) and (3), and Notice 2015-87 (question 4).

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