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Questions and Answers on Information Reporting by Health Coverage Providers (Section 6055)

Information reporting under section 6055 is required for health coverage providers. More information is available on the information reporting for providers of minimum essential coverage page.

Basics of Provider Reporting

1.  What are the information reporting requirements for providers of health coverage?

The Affordable Care Act added section 6055 to the Internal Revenue Code, which requires every provider of minimum essential coverage to report coverage information by filing an information return with the IRS and furnishing a statement to individuals. The information primarily is used by the IRS to administer – and by individuals to show compliance with – the individual shared responsibility provision in section 5000A.

2. When did the information reporting requirements go into effect?

The information reporting requirements were first effective for coverage provided in 2015. Health coverage providers are required to file information returns with the IRS and furnish statements to individuals each year to report coverage information for the previous calendar year. For information on transition relief, see Extended Due Dates and Transition Relief.

3. Where can I find more information about the information reporting requirements for health coverage providers?

The regulations under section 6055 and proposed regulations under section 6055 provide further guidance on the information reporting requirements for health coverage providers. Employers that are health coverage providers (for example, employers with self-insured health plans) may also be interested in reviewing regulations under section 6056 and our questions and answers regarding information reporting requirements for certain large employers and our questions and answers about Forms 1094-C and 1095-C.

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Who is Required to Report

4. Who is required to report under section 6055?

Any person that provides minimum essential coverage to an individual must report to the IRS and furnish statements to individuals, including the following:

  • Health insurance issuers, or carriers, for insured coverage (but see below regarding certain limited exceptions),
  • Plan sponsors of self-insured group health plan coverage, and
  • The executive department or agency of a governmental unit that provides coverage under a government-sponsored program.

5. What is minimum essential coverage?

Minimum essential coverage means health coverage under any of the following programs:

  • Eligible employer-sponsored coverage
  • Individual market coverage, including qualified health plans offered by the Health Insurance Marketplace, health insurance provided through a student health plan, catastrophic coverage, or coverage under an expatriate health plan for non-employees
  • Medicare Part A coverage and Medicare Advantage plans
  • Most Medicaid coverage
  • Children's Health Insurance Program (CHIP) coverage
  • Most types of TRICARE coverage
  • Comprehensive health care programs offered by the Department of Veterans Affairs
  • Health coverage provided to Peace Corps volunteers
  • Department of Defense Nonappropriated Fund Health Benefits Program
  • Refugee Medical Assistance
  • Coverage through a Basic Health Program (BHP) standard health plan
  • Certain coverage provided to business owners who aren’t employees
  • Coverage recognized by HHS as minimum essential coverage

More information about minimum essential coverage is provided in section 5000A(f), in regulations under section 5000A, and in our section 5000A questions and answers

6. What is eligible employer-sponsored coverage? 

Eligible employer-sponsored coverage is:

  • Group health insurance coverage for employees under –
    • a plan or coverage offered in the small or large group market within a state,
    • a plan provided by a governmental employer, such as the Federal Employees Health Benefit program, or
    • a grandfathered health plan offered in a group market,
  • A self-insured health plan for employees,
  • COBRA coverage,
  • Retiree coverage, or
  • Coverage under an expatriate health plan for employees and related individuals.

7. Is an employer required to report under section 6055 if it sponsors a health plan that provides coverage by purchasing insurance from a health insurance issuer?

No. An employer that sponsors an insured health plan (a health plan that provides coverage by purchasing insurance from a health insurance issuer) will not report as a provider of health coverage under section 6055. The health insurance issuer or carrier is responsible for reporting that health coverage. However, if the employer is subject to the employer shared responsibility provisions in section 4980H, it is responsible for reporting information under section 6056 about the coverage it offers to its full-time employees. For further information about the employer shared responsibility provisions under section 4980H and the reporting requirements under section 6056, see the section 4980H regulations and our section 4980H questions and answers, the section 6056 questions and answers and the Forms 1094-C and 1095-C questions and answers.

8. For self-insured group health plan coverage, who is the plan sponsor that must to report under section 6055?

  • For a self-insured group health plan maintained by a single employer, the plan sponsor is the employer.  For a plan maintained by more than one employer that is not a multiemployer plan (as defined in ERISA) the plan sponsor is each participating employer. For purposes of identifying the employer, the section 414 employer aggregation rules do not apply. 
  • For a plan that is a multiemployer plan (as defined in ERISA), the plan sponsor is the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the plan.
  • For a plan maintained solely by an employee organization, the plan sponsor is the employee organization.
  • For any plan for which a plan sponsor is not identified above, the plan sponsor is the person designated by plan terms or, if no person is designated, each entity that maintains the plan.

9. How do the reporting requirements under section 6055 apply to reporting entities that are part of a controlled group?

Plan sponsors in a controlled group that is not an applicable large employer member (ALE Member) under section 4980H, and coverage providers (such as issuers) that are not reporting as employers, may report under section 6055 as separate entities, or may have one entity report for the controlled group. See our section 6056 questions and answers and Forms 1094-C and 1095-C questions and answers for additional information on reporting by ALE Members that are providers of self-insured group health plan coverage.

10. Must a government employer report under section 6055 if it maintains a self-insured health plan?

Yes. However, unless prohibited by other law, a government employer that maintains a self-insured group health plan may designate a related governmental unit, or an agency or instrumentality of a governmental unit, as the person to file the returns and furnish the statements for some or all individuals covered under that plan. 

11. For a government-sponsored program, who must  report under section 6055?

  • For Medicaid and CHIP coverage, the state agency that administers the program must report. For Medicare, TRICARE, benefits administered by the Department of Veterans Affairs, and benefits for Peace Corps volunteers, the executive department or agency of the governmental unit that provides the coverage must report. However, Medicaid and CHIP agencies in U.S. possessions are not required to report their Medicaid or CHIP coverage.
  • For health insurance coverage under a government-sponsored program (such as Medicaid, CHIP, or Medicare) obtained through an issuer, the executive department or agency of the governmental unit that provides the coverage and not the issuer must report.
  • For the Nonappropriated Fund Health Benefits Program, the Secretary of Defense may designate the Department of Defense components that must report.

12. Should a health insurance issuer report under section 6055 for coverage in a qualified health plan in the individual market enrolled in through a Marketplace?

No. An issuer should not report on coverage under a qualified health plan in the individual market enrolled in through a Marketplace. The Marketplaces will separately report information on enrollments in a qualified health plan to the IRS and individuals under section 36B(f)(3).  Under Notice 2017-41, issuers of catastrophic plan coverage may, but are not required to, report on catastrophic plan coverage enrolled in through the Marketplace for 2015, 2016, and 2017. The Treasury Department and the IRS encourage issuers to voluntarily report on catastrophic plan coverage enrolled in though the Marketplace.

13. Must a health coverage provider report under section 6055 for arrangements that provide benefits in addition or as a supplement to an arrangement that is minimum essential coverage?

If the additional or supplemental benefits are not minimum essential coverage (for example, if they are excepted benefits like coverage at an on-site medical clinic), no reporting is required for the additional or supplemental benefits. In addition, no reporting is required under section 6055 for additional or supplemental benefits that are minimum essential coverage if the primary and supplemental coverages have the same plan sponsor or the coverage supplements government-sponsored coverage such as Medicare. 

14. Must a health coverage provider report under section 6055 if some or all of its covered individuals may be exempt from the individual shared responsibility provision?

Yes. A health coverage provider may not have the information necessary to determine whether an individual is exempt from the shared responsibility provision. To ensure complete and accurate reporting, providers must report under section 6055 for all their covered individuals.

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What Information Must Providers Report

15. What information must a health coverage provider report to the IRS?

The information that a provider must report to the IRS includes the following: 

  • The name, address, and employer identification number (EIN) of the provider;
  • The responsible individual’s name, address, and TIN, or date of birth if a TIN is not available. If the responsible individual is not enrolled in the coverage, providers may, but are not required to, report the TIN of the responsible individual (see How and When to Report the Required Information for more information on who is a responsible individual);
  • The name and TIN, or date of birth if a TIN is not available, of each individual covered under the policy or program and the months for which the individual was enrolled in coverage and entitled to receive benefits; and
  • For coverage provided by a health insurance issuer through a group health plan, the name, address, and EIN of the employer sponsoring the plan and whether the coverage is a qualified health plan enrolled in through the SHOP and  the SHOP's  identifier.

16. Will a health coverage provider collect TINs from individuals, including dependents, covered under its plan or policy?

Yes. Reporting of TINs for all covered individuals is necessary for the IRS to verify an individual’s coverage without the need to contact the individual.

If health coverage providers are unable to obtain a TIN after making a reasonable effort to do so, the covered individual’s date of birth may be reported in lieu of a TIN.

17. If a health coverage provider does not furnish a TIN, will it be subject to penalties?

Information reporting under section 6055 is subject to the penalty provisions of sections 6721 and 6722 for failure to file timely a correct information return or failure to furnish timely a correct statement to the individual. However, those penalties may be waived if a health coverage provider demonstrates that it made a reasonable effort to obtain an individual’s TIN but did not receive it. Specifically, a health coverage provider will not be subject to penalties for failure to report a TIN if it does all of the following:

  • Makes an initial TIN solicitation when an account is opened. An account is considered open when a health coverage provider receives a substantially complete application for coverage (including an application to add an individual to existing coverage) from or on behalf of an individual for whom the coverage provider does not already provide coverage.
  • Makes the second solicitation on or before the 75th day after the date on which an account is opened (or, in the case of retroactive coverage, the 75th day after the determination of retroactive coverage is made).
  • Makes the third solicitation by December 31 of the year following the year the account is opened.

18.  What information must a health coverage provider furnish to individuals?

In addition to the information it reported to the IRS for each covered individual listed on the information return, a health coverage provider must include a phone number for the provider’s designated contact person (if any) that the recipient of the statement can contact with questions about information on the statement. 

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How and When to Report the Required Information

19. When must a health coverage provider file the information return with the IRS?

A health coverage provider generally must file the information return and transmittal form with the IRS on or before February 28 (March 31 if filed electronically) of the year following the calendar year in which it provided minimum essential coverage to an individual.  Because Notice 2013-45 provides transition relief for section 6055 reporting for 2014, the first section 6055 returns required to be filed are for the 2015 calendar year and must be filed no later than February 29, 2016, or March 31, 2016, if filed electronically. However, see Extended Due Dates and Transition Relief regarding an extension of these dates for 2015 reporting due in 2016. The due dates for filing for 2016 and 2017 were not extended.

Regulations under section 6081 address extensions of time to file information returns. Under these regulations, health coverage providers may claim an automatic 30-day extension of time for filing information returns by submitting a Form 8809, Application for Extension of Time To File Information Returns. Under certain conditions, providers may also request additional extensions of time to file. For additional information see the instructions for Forms 1094-B and 1095-B.

20. What type of return must a health coverage provider file with the IRS?

Generally, a health coverage provider must file Form 1094-B and Form 1095-B (or other form that IRS designates, or a substitute form). However, if the provider is also an ALE Member as defined in the employer shared responsibility provisions under section 4980H and provides coverage to its employees through a self-insured group health plan, the provider must file Form 1094-C and Form 1095-C (or other form that IRS designates, or a substitute form), instead of Forms 1094-B and 1095-B, to report information with respect to its employees. For further information about the employer shared responsibility provisions and who is an ALE member, see the section 4980H final regulations and our section 4980H questions and answers. For further information about the forms, see the instructions for Forms 1094-B and 1095-B, the instructions for Forms 1094-C and 1095-C and the questions and answers about Forms 1094-C and 1095-C.

21. Must a health coverage provider file the return with the IRS electronically?

A health coverage provider that is required to file 250 or more Forms 1095-B or 250 or more Forms 1095-C during the calendar year must file the returns electronically. The 250 return threshold applies separately to each type of return required to be filed. Only Forms 1095-B or 1095-C are counted in applying the 250 return threshold for section 6055 reporting.  However, if the 250 return threshold applies, Forms 1094-B and 1094-C also must be filed electronically. A provider that is required to file fewer than 250 Forms 1095-B or Forms 1095-C may file on paper or electronically.

22. To whom must a health coverage provider furnish the statement?

A health coverage provider must furnish the statement to a responsible individual. The responsible individual generally is the person who enrolls one or more individuals, which may include him or herself, in minimum essential coverage. The responsible individual may be the primary insured, employee, former employee, uniformed services sponsor, parent, or other related person named on the coverage application.

23. Must a health coverage provider furnish the statement to anyone who is not the responsible individual?

No. A provider is not required to provide a statement to any individual who is not the responsible individual. 

24. When must a health coverage provider furnish the statement to the responsible individual?

A health coverage provider generally must furnish the statement to the responsible individual on or before January 31 of the year following the calendar year in which minimum essential coverage is provided. If the provider applies to the IRS in writing and shows good cause, the IRS may grant an extension of time up to 30 days for the provider to furnish the statement.

However, see Extended Due Dates and Transition Relief regarding an extension of these dates for 2015, 2016 and 2017, for Forms 1095-B due in 2016, 2017, and 2018, respectively.

25. How must a health coverage provider furnish the statement to the responsible individual?

A health coverage provider generally must mail the statement to the responsible individual’s last known permanent address or, if no permanent address is known, to the individual’s temporary address. A provider’s first class mailing to the last known permanent address, or if no permanent address is known, the temporary address, discharges the provider’s requirement to furnish the statement. 

A health coverage provider also may furnish the statement electronically to the responsible individual if the responsible individual affirmatively consents to it.

26. Does an employer that must file returns under section 6055 as a provider of self-insured health coverage to its employees and under section 6056 as an applicable large employer file combined information returns and statements? 

Yes. An ALE Member, as defined in the employer shared responsibility provisions under section 4980H, that provides self-insured coverage is subject to the reporting requirements of both section 6055 and section 6056. To streamline and prevent duplication under each reporting requirement, ALE Members with self-insured coverage will combine section 6055 and section 6056 reporting. An ALE Member with self-insured coverage will report on Form 1095-C, completing separate sections to report the information required under sections 6055 and 6056. An ALE Member that provides insured coverage will complete only the section of Form 1095-C that reports the information required under section 6056. Entities reporting as health insurance issuers, sponsors of self-insured group health plans that are not applicable large employers, sponsors of multi-employer plans, and providers of government-sponsored coverage, will report under section 6055 on Form 1094-B and Form 1095-B.

For further information about the employer shared responsibility provisions under section 4980H and the reporting requirements under section 6056, see the section 4980H final regulations, our section 4980H questions and answers, the section 6056 final regulations, and our section 6056 questions and answers. For further information about the forms, see the instructions for Forms 1094-B and 1095-B, the instructions for Forms 1094-C and 1095-C and the questions and answers about Forms 1094-C and 1095-C.

27. May a health coverage provider hire a third party to fulfill the provider’s reporting responsibilities?

Yes. Reporting arrangements between health care providers and other parties are not prohibited.  However, entering into a reporting arrangement does not transfer the potential liability of the provider for failure to report information and furnish statements under section 6055. In addition, if a person who prepares returns or statements under section 6055 is a tax return preparer, that person will be subject to the requirements generally applicable to tax return preparers.

28. For information returns filed and furnished in 2017 for coverage provided in 2016 and later years, what penalties may apply if a health coverage provider fails to comply with the section 6055 information reporting requirements?

The penalty under section 6721 may apply to a provider that fails to file timely information returns, fails to include all the required information, or includes incorrect information on the return. The penalty under section 6722 may apply to a provider that fails to furnish timely the statement, fails to include all the required information, or includes incorrect information on the 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. See Extended Due Dates and Transition Relief for information on relief that applies with respect to these penalties for reporting and furnishing for 2015, 2016, and 2017.

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Extended Due Dates and Transition Relief

29. Were the due dates for filing and furnishing 2017 Forms 1094-B and 1095-B extended?

IRS has extended the 2018 due date for furnishing 2017 Forms 1095-B to individuals, but has not extended the due date for filing the 2017 Forms 1094-B and 1095-B with the IRS. Specifically, Notice 2018-06 extended the due date for furnishing the 2017 Form 1095-B to individuals, from January 31, 2018, until March 2, 2018.

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-B 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 6055 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 6056 reporting for 2017 (Forms 1094-C and 1095-C).

Although IRS has not extended the due date for filing 2017 Forms 1094-B and 1095-B with the IRS, 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.

30. For the 2017 information reporting requirements, did Notice 2018-06 affect the rules under sections 6721(b) and 6722(b) concerning the reduction of penalty amounts for reporting under section 6055 or 6056?

No. Notice 2018-06 did not affect the rules under sections 6721(b) and 6722(b) concerning the reduction of penalty amounts for 2017 reporting under section 6055 or 6056.

31. Were the due dates for filing and furnishing 2016 Forms 1094-B and 1095-B extended?

IRS extended the 2017 due date for furnishing 2016 Forms 1095-B to individuals, but has not extended the due date for filing the 2016 Forms 1094-B and 1095-B with the IRS. Specifically, Notice 2016-70 extended the due date for furnishing the 2016 Form 1095-B to individuals, from January 31, 2017, until March 2, 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-B will not apply to the extended due date.

Under Notice 2016-70, the extended furnishing due date also applies for purposes of section 6056 reporting for 2016 (Forms 1094-C and 1095-C).

32. For the 2016 information reporting requirements, did Notice 2016-70 affect the rules under sections 6721(b) and 6722(b) concerning the reduction of penalty amounts for reporting under section 6055 or 6056?

No. Notice 2016-70 did not affect the rules under sections 6721(b) and 6722(b) concerning the reduction of penalty amounts for 2016 reporting under section 6055 or 6056.

33. Were the due dates for filing and furnishing 2015 Forms 1094-B and 1095-B extended?

Yes. In Notice 2016-4, IRS extended the 2016 due dates for the 2015 information reporting requirements, for both filing information returns with the IRS and furnishing statements to individuals, for insurers, self-insured employers, and other coverage providers under section 6055, and for ALE Members under section 6056.

Specifically, Notice 2016-4 extended the due date for furnishing to individuals the 2015 Forms 1095-B from January 31, 2016, until March 31, 2016, and extended the due date for filing with the IRS the 2015 Forms 1094-B, 1095-B, 1094-C, and 1095-C from February 29, 2016, to May 31, 2016, if not filing electronically, and from March 31, 2016, to June 30, 2016, if filing electronically.
These extensions applied automatically and were not longer than the 30-day extensions that could otherwise be obtained. Therefore, the IRS did not process any previously requested extensions of these deadlines for 2015 reporting in 2016. Employers or coverage providers that did not comply with the extended due dates in Notice 2016-4 may be subject to penalties under section 6722 or 6721 for failure to timely furnish and file.

34. For the 2015 information reporting requirements, did Notice 2016-04 affect the rules of sections 6721(b) and 6722(b) concerning the reduction of penalty amounts for reporting under section 6055 or 6056?

Yes. Because the deadlines under sections 6055 and 6056 for furnishing ACA statements to individuals and filing ACA information returns with IRS were extended as described above, the August 1, 2016 deadlines for reduction in penalty amounts to correct the failures described in sections 6721(a)(2) and 6722(a)(2) also were extended.

For statements furnished to individuals under sections 6055 and 6056, any failures that issuers correct by April 30 and October 1, 2016, respectively, will be subject to reduced penalties.  For returns filed on paper with the IRS under sections 6055 and 6056, any failures that issuers correct by June 30 or November 1, 2016, respectively, will be subject to reduced penalties.  For returns filed electronically with the IRS under sections 6055 and 6056, any failures that issuers correct by July 30 or November 1, 2016, respectively, will be subject to reduced penalties.

These extended dates have no effect on the penalty relief described below for incomplete or incorrect returns filed or statements furnished to covered individuals in 2016 for coverage provided in calendar year 2015.  However, the IRS has publicly stated in various forums that filers of Forms 1094-B, 1095-B, 1094-C, and 1095-C that missed the June 30, 2016, due date will not generally be assessed late filing penalties under section 6721 if the reporting entity made legitimate efforts to register with the AIR system and to file its information returns, and it continued to make such efforts and completed the process as soon as possible.  In addition, consistent with existing information reporting rules, filers that are assessed penalties may still meet the criteria for a reasonable cause waiver from the penalties.   

35. Is relief available from penalties for incomplete or incorrect returns filed or statements furnished to covered individuals in 2016 (for coverage in 2015), 2017 (for coverage in 2016), and 2018 (for coverage in 2017)?

Yes. In implementing new information reporting requirements, short-term relief from reporting penalties frequently is provided. This relief generally allows additional time to develop appropriate procedures for collection of data and compliance with the new reporting requirements. Accordingly, for reporting in 2016, 2017, and 2018 for coverage provided in 2015, 2016, and 2017, respectively, the IRS will not impose penalties under sections 6721 and 6722 on reporting entities that can show that they have made good faith efforts to comply with the information reporting requirements.

Specifically, relief is provided from penalties under sections 6721 and 6722 for returns and statements filed and furnished in 2016 to report coverage in 2015, and in 2017 to report coverage in 2016, and in 2018 to report coverage in 2017, for incorrect or incomplete information reported on the return or statement. For example, a group health plan insurer that makes a reasonable effort to obtain the EIN of the employer sponsoring the coverage will not be subject to penalties under sections 6721 or 6722 if the insurer fails to enter an EIN on line 11 of Form 1095-B for 2015 or enters an EIN that is found to be incorrect. No relief is provided in the case of reporting entities that cannot show a good faith effort to comply with the information reporting requirements or that fail to timely file an information return or furnish a statement. However, consistent with the existing information reporting rules, reporting entities that fail to timely meet the requirements still may be eligible for penalty relief if the IRS determines that the standards for reasonable cause under section 6724 are satisfied.

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