If you're an employer of a medium to large business, you're no stranger to the Affordable Care Act. If you're in HR or Payroll, you've probably spent a lot of time learning about the ACA provisions. According to the Employer Shared Responsibility provisions of the ACA, any Applicable Large Employer (ALE) who
Has your organization met all the requirements? With so much to consider, how do you know you've covered it all? How can you determine if you are compliant with all ACA regulations? We’ve put together this comprehensive online guide to help walk you through the important components of tracking and reporting on ACA compliance. Be confident in your compliance and know when the time comes, you played and won't pay.
As an HR professional, you need to know the ins and outs of the employer provisions so you can proactively manage ACA compliance in your organization. That starts with knowing your ACA vocabulary—what do all those acronyms mean anyway?
Affordable coverage: According to ACA provisions, your employer health plan must offer affordable coverage. An employer health plan offers affordable coverage as long as no employee pays more than 9.5% of their family income on premiums.
Administrative period: The administrative period is time for an employer to calculate the average hours worked by an employee during the measurement period to determine the employee’s benefits eligibility. The administrative period allows employers up to 90 days to complete the calculations (though you can complete this in minutes with an integrated HR system and ACA module). Most companies will align this with their open-enrollment period.
Applicable Large Employer (ALE): According to the IRS, an employer who has 50 or more full-time employees or full-time equivalent employees on average for the previous year is an ALE. ALE status updates each calendar year. ALEs are subject to the Employer Shared Responsibility and Reporting provisions of the ACA.
Consolidated Omnibus Budget Reconciliation Act (COBRA): Under certain qualifying events, a person may elect COBRA coverage. This mainly occurs when employment ends and former employees may temporarily keep the health coverage under the employer health plan. Another instance includes losing coverage as a dependent of a covered employee. When someone does elect COBRA coverage, they will pay 100% of the premium (including whatever share the former employer originally covered), plus an administrative fee.
Employer health plan: Also referred to as a job-based health plan, this is the coverage offered to an employee by his/her employer.
Employer shared responsibility and reporting: These are the ACA provisions that require all ALEs offer affordable healthcare coverage plans to eligible employees and their dependents. ALEs must also report these offers of coverage to the IRS and provide employees with similar information and statements. This is also referred to as the “employer mandate” or “pay or play provisions” referring to the financial consequences employers face for noncompliance.
Essential Health Benefits: These are the minimum requirements for benefits health insurance plans must cover. There are ten categories of essential health benefits:
Form 1094-C: ALEs must use Form 1094-C to report required information about whether or not the employer offered affordable minimum essential health coverage (MEC) and enrollment in MEC for eligible employees. Form 1094-C will transmit forms 1095-C to the IRS.
The IRS will use Forms 1094-C and 1095-C to determine whether an employer will be penalized for noncompliance. This penalty will require payment under the Employer Shared Responsibility provisions under section 4980H. These forms will also determine employees’ eligibility for the premium tax credit.
Form 1095-C: This form provides important information employees need to complete their individual tax returns. On Line 61 of individual tax returns, employees must show whether they or their family members had minimum essential coverage. ALEs must prepare a Form 1095-C for each employee whose hours of service equaled 130 or more hours in a month. This even applies to those who did not take part in the employer-sponsored health plan. Employers must prepare a Form 1095-C for any part-time employee enrolled in the employer-sponsored plan. Employers do not need to prepare Form 1095-C for any part-time employees not enrolled in the employer-sponsored plan.
Form 8809: To apply for an extension to file information return forms with the IRS (like Form 1094-C), submit a Form 8809 on or before the due date of the return for an automatic extension. This form does not require a signature. For an additional 30-day extension, the filer or an authorized agent must sign the form.
Full-time Equivalent Employee (FTE): An employee is considered full-time equivalent if he/she worked (or expects to work) on average 30 hours or more a week for more than 120 days in a year.
Grandfathered Health Plan: A Grandfathered Health Plan is a health plan that already existed during the enactment of the Affordable Care Act in March 2010. Some grandfathered plans are exempt from certain ACA mandates. If your company's health plan is a grandfathered plan there are a few things to note:
Measurement period: Also called the “look-back period,” the measurement period is the set period of time an employer records the hours worked by a variable hour employee. This measurement period must be between three and 12 consecutive months (designated by the employer).
Minimum Essential Coverage (MEC): The minimum amount and type of health coverage individuals must obtain and report to the IRS. Individuals may receive this coverage through employers for themselves and their dependents. ALEs must provide MEC plans to eligible employees and their dependents, including COBRA and retiree coverage.
Minimum Value Coverage (MVC): Employer health plans must cover at least 60% of the total allowed cost of benefits expected to be incurred under the health plan.
Non-discriminatory coverage: Your employer health plan must offer fair and equal coverage to all eligible employees. Do not offer different eligibility or health benefits to any employees. This includes employee differences based on age, years of service, or compensation.
Stability period: Also called the “hold period,” the stability period is the period when employees who have been determined to be full time in the administrative period become eligible and must remain eligible for health coverage. This hold period allows employees to maintain the status determined in the measurement period for the designated amount of time in the stability period. The stability period can be between six and 12 months. With the exception of the first year, the stability period cannot be longer than the measurement period.
An employer who has (on average) 50 or more full-time employees or full-time equivalent employees for a calendar year qualifies as an Applicable Large Employer (ALE).
How many full-time equivalent employees did you have in the prior year? Use this full-time employee calculator to calculate your number of FTEs. (Remember: if the number of hours worked is not a whole number, round down to the nearest whole number.)
What am I required to do as an ALE? According to ACA provisions in the Employer Mandate, ALEs are responsible for offering affordable healthcare coverage plans to eligible employees and their dependents. Report these offers of coverage to the IRS and provide employees with similar information/statements.
Use ACA Measurement and Stability Periods to measure time worked and benefits eligibility before an employee becomes eligible for coverage. The time worked during this period determines the status for another specified period of time even if the worker’s hours change in order to create some kind of predictability in benefits eligibility.
Be sure to set up your measurement and stability periods the correct way according to ACA regulations. Check for the following in your organization's time periods:
Let’s look at who is eligible for coverage and how to avoid ACA penalties from offers of coverage.
Employees reach full-time status when hours of service equal 30 plus hours in one week or 130 hours in one month. Tracking time for full-time employees may seem simple. Tracking time for seasonal or variable-hour workers can get complicated.
If you miscalculate an employee’s hours of service, you may mark that employee as a part-time.
If you misclassify an employee as part-time instead of full time, you could miss a coverage offer.
If you miss a coverage offer, you face financial penalties with the IRS.
Miscalculating hours of service equals IRS penalties.
Don't miss a key phrase in full-time employee qualification. A full-time employee is any employee whose hours of service equals 30 or more hours in one week.
Hours of service and hours of work are not the same thing. Hours worked equals actual hours clocked by an employee. Hours of service can include paid vacation and holidays and unpaid leave days like FMLA leave.
Failure to include certain paid and unpaid days away from work, could exclude eligible employees from coverage. This violates the ACA and results in more compliance penalties.
Your organization's definition of full time may differ from how the ACA defines it. Offer coverage to employees that meet the ACA’s definition of full-time employees. Measure hours of service, not just hours worked, to include paid and unpaid leave in hour counts.
If you do fail to offer coverage to a full-time employee for any other reason, the employee may seek coverage through other means. Doing so could still lead to financial penalties for employers.
If you don't offer MEC to any of your full-time employees, and they qualify for a federal subsidy at the Health Insurance Marketplace, you pay. The annual penalty is a nondeductible fee of $2000 for every full-time employee, even those enrolled in coverage. Exclude the first 30 employees (first 80 employees in 2015) when calculating the penalty. Penalties assessments occur on a monthly basis.
Offer Minimum Essential Coverage to at least 95% of your full-time employees and avoid this penalty. Track employee time the right way, and skip the risk of missing any benefits-eligible employees.
Don't shrug off the financial repercussions of noncompliance with the ACA. These numbers could mean huge expenses for your business. Take charge of your ACA strategy. Get on board with software that will keep you confident about your ACA compliance.
Have a question about ACA reporting? Review our list of frequently asked questions employers and HR professionals have about ACA reporting to be sure you’re prepared when the next ACA reporting deadlines roll around. We'll answer your questions about ACA reporting deadlines, filing penalties, and form specifics for Form 1094-C and Form 1095-C.
Under the Affordable Care Act and the ACA Employer Shared Responsibility Mandate, reporting on ACA compliance requires two forms:
Applicable Large Employers, often referred to as ALEs, with 50 or more full-time and full-time equivalent employees in the previous year must file Form 1094-C and a Form 1095-C for each employee who was a full-time employee for any month of the calendar year.
Remember, no matter how your company qualifies full-time employees for its own purposes, the ACA’s standards apply to all employers.
Under Code sections 6055 and 6056, ALEs must use Form 1094-C to report required information about whether or not they offered affordable minimum essential health coverage (MEC) and enrollment in minimum essential health coverage for eligible employees. Form 1094-C will transmit forms 1095-C to the IRS.
Forms 1094-C and 1095-C will be used to determine whether an employer will be penalized for noncompliance. This penalty will require payment under the Employer Shared Responsibility provisions under section 4980H. These forms will also determine employees’ eligibility for the premium tax credit.
Employers will report the following on Form 1094-C:
The IRS encourages all employers to file electronically if possible. But, if any employer must file 250 or more of a single type of form, the employer must file electronically. This requirement applies separately to each type of form. For example, if you’re filing 350 1094-C forms and only 100 forms of another type, only the 1094-C forms must be filed electronically. If an employer applies for and receives a hardship waiver, the electronic filing requirement is not applied.
If filing on paper, the employer should send the forms to the IRS in a flat mailing package. On each package, write the employer’s name, number the packages consecutively, and place Form 1094-C in package number one. According to postal regulations, these forms must be sent by First-Class Mail.
Before completing your 1094-C, make a detailed review of all instructions. Once you have completed the form, review these forms with thorough evaluation to ensure they are correct and complete. Incorrect or incomplete forms are subject to penalty.
Employers must file the paper Form 1094-C with the IRS by February 28, 2019.
Employers must file the electronic Form 1094-C with the IRS by April 1, 2019.
ALEs with 50 or more full-time equivalent employees need to furnish their employees with Form 1095-C and file Form 1095-C with the IRS. If a small business employer is a member of a controlled or affiliated service group that has 50 or more full-time equivalent employees in total, that employer is also responsible for furnishing and filing Form 1095-C.
Form 1095-C provides important information employees need to complete their individual tax returns. On Line 61 of individual tax returns, employees must show whether they or their family members had minimum essential coverage.
Employers should prepare a Form 1095-C for each employee whose hours of service equaled 130 or more hours in a month. This includes those employees who did not elect to enroll in the employer-sponsored health plan.
Employers should also prepare a Form 1095-C for any part-time employees enrolled in the employer-sponsored plan. Employers do not need to prepare Form 1095-C for any part-time employees not enrolled in the employer-sponsored plan.
Employers will need to report the following information on Forms 1095-C:
All employers must furnish Form 1095-C to their employees by January 31, 2019.
**The IRS has issued an extension for employers to furnish employees with Form 1095-C. for 2019 only. The extended 2019 deadline for Form 1095-C is March 4, 2019.
Unless an employee has given specific consent to provide this form electronically, furnish all Forms 1095-C to employees by mail or deliver by hand.
Employers must file copies of Form 1095-C with the IRS by February 28, 2019 if filing by paper or April 1, 2019, if filing electronically.
Information on Form 1095-C is arranged by three rows of coded information. This is arranged by month for each employee who reached full-time employment status for one or more months during the calendar year.
Line 14: Offer of Coverage
Use the code to identify whether the employer offered MEC to the employee and the employee’s dependents.
Line 15: Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage
Complete this line with the dollar amount that shows the employee’s share of the lowest-cost monthly premium for self-only minimum value coverage.
Line 16: Applicable Section 4980H Safe Harbor Code
Use the code to identify any other information that may used to determine if the employer is liable for shared responsibility payment.
Form 1095 software will help employers track and code this information for completing the forms.
Now, let’s cover some important questions your employees may have about Form 1095-C.
If you're an HR professional trying to help your employees understand Form 1095-C, try explaining it this way: similar to how your W-2 shows whether you owe taxes, Form 1095-C shows whether or not fines are owed for ACA noncompliance.
Here are some questions your employees may have about Form 1095-C and the answers you can give.
You will receive a 1095-C from your employer if your employer:
You will receive Form 1095 from the entity that provided you health insurance coverage for 2015.
Your insurance carrier may also send you Form 1095-B if you enrolled in a fully-insured employer-sponsored health plan.
Part I: Employee and Applicable Large Employer member information. You may truncate employee ID numbers and social security numbers in individual statements. Statements submitted to the IRS by the employer must include the full numbers.
Part II: Employee Offer and Coverage. Part II reports on health coverage offered and the affordability of that coverage. For reporting on 2015, the Plan Start Month box is optional, however the IRS anticipates it will be a requirement in the future. For information on indicator codes in this section, see the IRS code definitions.
Part III: Covered Individuals. This section reports on the individuals and dependents covered under the self-insured plan. Social security numbers are required for all dependents. As a reminder, spouses are not included in the definition of dependents under the ACA.
For more detailed instructions on Form 1095-C, visit the IRS instructions page.
Employers must furnish Form 1095-C to employees by January 31, 2019 (same as W-2). It is likely you will receive Form 1095-C a round the same time as your W-2.
**The IRS has issued an extension for employers to furnish employees with Form 1095-C. for 2019 only. The extended 2019 deadline for Form 1095-C is March 4, 2019. Therefore, you may not receive your Form 1095-C from your employer until a later date.
Most employees will not need to wait to receive their 1095-C to file their tax return, though you will want to save the form with your other tax records. The IRS has a list of documentation to keep in your records to verify your coverage.
Employees will need their 1095-C information to complete their individual tax return if the employee:
No, do not attach the form to your tax return documents. You may keep the form for your records and refer to the form as needed when completing federal tax documents. Your employer will file the statement with the IRS.
Unless the employee gives consent, employers must furnish Form 1095-C to employees by paper. Employees may offer consent by paper or electronically, but, any consent given on paper must be confirmed electronically.
Failure to file complete and accurate Forms 1094-C by the form deadline will result in penalties equal to $250 per form, not to exceed $3 million per year. Failure to file and furnish correct information on Form 1095-C could result in a $500 per form penalty for employers. That is not a cheap penalty to blow off. The best way to avoid these penalties is to report on ACA compliance using the proper forms and submitting them to the IRS by the deadline. If you need more time to gather data to complete the forms, file for an extension. We will discuss these steps in the nex questions.
To avoid penalties from the IRS, report on ACA compliance with the IRS using Forms 1094-C and 1095-C on or before the deadline. The ACA requires all ALEs to report health benefits coverage to the IRS through Form 1094-C and 1095-C. ALEs must furnish employees with a related statement of coverage using Form 1095-C. Employers must complete these forms for any employee who reached 130 hours in a month. Here are a few tips to complete ACA reporting forms without penalty:
The changes in filing extensions over the last few years have caused some confusion. There have been application requirements and general across-the-board extensions, so what should employers expect in 2018?
Things should go back to the original plan: the IRS gives set deadlines with the ability for employers to apply for extensions on an individual basis. To apply for an extension on 2018 ACA reporting forms, submit Form 8809 on or before the due date of the return for an automatic extension. This form does not require a signature. For an additional 30-day extension, the filer or an authorized agent must sign the form.
Be sure to retain copies of all forms and returns filed with the IRS for at least three years from the due date. If you do not keep copies, you should be able to reconstruct the data given in the returns in the event of an audit.
In years past, the IRS offered transition relief to certain qualifying organizations during the new implementation of the Affordable Care Act and the Employer Mandate. In 2019, for reporting on 2018, section 4980H transition relief is no longer available.
**UPDATE: On November 29,2018, the IRS issued an extension for good-faith transition relief through the 2018 tax year.
The ACA not only requires ALEs to offer health coverage to full-time equivalent employees, but also requires that health plan be affordable with at least 60% minimum value. According to the ACA, an “affordable” plan is one that costs no more than 9.5% of an employee’s total household income. But knowing an employee’s total household income involves knowing more than the salary your business pays them. Other factors like spouse’s income, variable hours, and pre-tax contributions can make a difference in an employee’s income. These ACA safe harbors help employers ensure the health insurance coverage they offer to their employees will meet the affordability requirements of the ACA.
There are three types of ACA safe harbors:
Using these safe harbors is optional. You can apply different safe harbors to different categories of employees, provided that you do so consistently for all employees in a particular category. Read more about ACA safe harbors here.
Yes. The IRS has already been issuing penalty notices to employers who have failed to comply with the ACA Employer Shared Responsibility Mandate in the past.
Managing ACA compliance is no simple task. Employers need to have the right system and strategy in place for successful compliance. Reliable ACA compliance software will track, integrate, and analyze data across time and attendance, core HR, benefits, and payroll. Because employers must complete a Form 1095-C for each full-time employee, the time and effort involved is consuming. Form 1095-C software allows employers to maximize efficiency for health care reform paperwork.
With ACA reporting software, employers can receive accurate visibility for hours of service including look-back and stability periods, for full-time, part-time, and variable-hours employees.
Additionally, this tool can automate benefits eligibility notifications and employee plan enrollment. With this information automatically updated and recorded, ACA management software allows employers to spend less time managing the hassles of paperwork and timesheets. Instead, they can focus on the bottom line for their businesses.
Unlike other information returns and forms like W-2s, the 1094 and 1095 forms can require information from multiple systems of record for one annual filing. This means employers need to gather tracked information from HR, payroll, benefits, and more. If you wait until just before the ACA reporting deadline in 2018 to act on tracking and reporting, it could be difficult to gather all the data and complete the forms in time. This could leave you to face steep financial penalties from the IRS.
Get a head start on ACA reporting for 2018:
Thursday, January 31, 2019
Deadline to furnish Form 1095-C to employees.
**The IRS has issued an extension for employers to furnish employees with Form 1095-C. for 2019 only. The extended 2019 deadline for Form 1095-C is March 4, 2019.
Thursday, February 28, 2019
Deadline to file Forms 1094-C/1095-C if filing by paper.
Monday, April 1, 2019
Deadline to file Forms 1094-C/1095-C if filing electronically.
Monday, April 15, 2019
Tax Day! Individual tax returns are due. Employees should include healthcare coverage information on their individual returns.
Keeping up with ACA compliance for your workforce is no simple task. You need multiple records from different departments or systems to keep everything in order. The best solution for HR managers is ACA compliance software.
ACA compliance software offers companies a way to execute and proactively manage their ACA compliance tracking across the entire workforce and minimize the risk of facing major financial consequences.
Fuse's ACA Compliance Module takes something complex and makes it easy, hassle-free, and reliable. Think of it as your go-to ACA compliance guide.
Management dashboards provide consolidated views of regular- and variable-hour labor pools and the ability to drill down into views for individual employees.
ACA compliance alerts notify managers when an employee’s status changes to full time or part time, when an employee is approaching benefits eligibility, and when an employee has scheduled hours that would put the worker over the eligibility limit.
Automated alerts can also be sent to employees to notify them of their eligibility for benefits. Additional rules can help you enforce schedules and maintain your preferred full-time/part-time employee mix.
View any employee’s current status or historical status by month with the ACA timeline view. Access both real-time and historical detail on ACA status measurements for both your company and individual employees.
Sure, this all sounds great, but does this mean you have to learn one more thing?
The ACA Compliance Module is available in the Fuse Platform Marketplace. Integration is already built in so the account admin can add the module to the system within the platform. Then you’re free to enjoy your ACA compliance strategy alongside the other digital, automated, and cloud-based features of workforce management—all in one place.
You’re not doing this alone. You’ll be armed with user guides, training videos, and the Fuse Support team to help walk you through the implementation process.
Fuse’s ACA Compliance Module is one of the only single-platform solutions for HR, benefits administration, time and attendance, and payroll. With a single record for each employee, you can streamline and automate the ACA compliance and benefits enrollment process as employees reach eligibility.
Discover a smarter solution for ACA reporting and compliance today.
All data seamlessly flows from one module to the next. Employee’s profile, benefits or HR – No problem, any data about all employees
isin a single location and you can easily see it all in an organized manner.
Aaron P. IT Director
Fuse has stayed on top of the ACA reporting requirements & has provided us with the required data for tracking our employees' benefits.
Kathy W. HR Director & Payroll Administrator