6055 / 6056 Reporting
Certain employers will be required to report information about their employees’ and their health care coverage to both employees and the IRS each year.
Internal Revenue Code (Code) Section 6055 requires every entity that provides Minimum Essential Coverage (MEC) to file an annual return reporting specific information for each covered individual. The 6055 reporting is applicable to insurers of insured major medical plans and plan sponsors of self-funded plans. Employers of any size that sponsor Minimum Essential Coverage must submit this report. As a general matter, only major medical coverage is considered Minimum Essential Coverage. Statements must also be provided to each individual whose name and information are reported on the annual return.
Under Code Section 6056, every employer that employed on average at least 50 full-time equivalent employees on business days during the preceding calendar year (“large employers”) must file a return that reports the terms and conditions of the health care coverage provided to the employer's full-time employees during the year. In addition, the report is required to include and certify detailed and specific information on the employer's full-time employees, including those who received the coverage and when they received it.
Large employers are responsible for the Section 6056 reporting regardless of whether the health care coverage is fully insured or self-funded. All employers in a controlled or affiliated service group are combined for purposes of deciding if the employer is “large”, but each employer in the group must file the Section 6056 report separately.
Under both 6055 and 6056, the first reporting will be for calendar year 2015 (regardless of plan year), and will be due in 2016. They are due to covered individuals by January 31 and to the IRS by February 28, or March 31 if filed electronically. Insurers will be responsible for the reporting requirements for insured plans under Section 6055 via Form 1095-B. Employers sponsoring insured plans will be responsible for the reporting under Section 6056 via Form 1095-C. Large employers that sponsor self-funded plans are required to report the information required under both Section 6055 and 6056 on a single combined form using Form 1095-C. Final regulations along with draft forms and instructions (available in the Additional Resources box below) have been published for review and comment.
6055/6056 Reporting Hot Topics & FAQs
- Need Assistance with the ACA Employer Reporting?
The Patient Protection and Affordable Care Act (ACA) requires large employers and employers that sponsor self-funded medical plans to report extensive and detailed data for the calendar that began January 1, 2015. A large employer for this purpose must have 50 or more full time equivalent employees across the control group.
If you have not already done so, now is the time to make a plan for how to complete the IRS Forms 1094/1095 that must be distributed to employees by January 31st each year except in 2016, it is due February 1, 2016 since the 31st is a Sunday. Note that customers who signed up for our WorxTime reporting service do not need to participate in this webinar. The webinar would be helpful for customers who use the WorxTime tracking, but not reporting, service.
Please click here to register.
- 2015 ACA Forms
The Internal Revenue Service (IRS) has released final 2015 Patient Protection and Affordable Care Act (ACA) Forms 1094-C and 1095-C. The 1094-C and 1095-C forms are mandatory filings by employers with 50 or more full-time equivalent employees to enforce section 4980H of the Internal Revenue Code (IRC) Employer Mandate. Employers are required to report 2015 tax year information to both employees and the IRS. The 1095-C form is due to employees by February 1, 2016, and the 1094-C e-filing is due to the IRS by March 31, 2016 (February 29, 2016 for paper filing). Failure to comply with the reporting requirements could result in a fine of $250 for each return for which such failure occurs (up to $3,000,000).
The final forms are generally consistent with the drafts released earlier this year. However, there are some modifications to the instructions in completing the forms to reflect various scenarios.
- ACA Reporting Penalties to Increase
Congress recently passed the Trade Preferences Extension Act of 2015. The Act significantly increases penalties for reporting failures under several sections of the Internal Revenue Code, including the Patient Protection and Affordable Care Act (ACA) reporting using Internal Revenue Service Forms 1094 and 1095.
As employers are well aware, the ACA requires all large employers to report detailed information concerning their workforce and group health plan coverage offerings. These reports are due in early 2016, and cover the 2015 calendar year. Penalties may be imposed for incomplete, incorrect or failed reporting.
Penalties for ACA reporting failures (such as failing to file by the deadline, failing to provide required information, or failing to provide correct information) will increase from $100 to $250 per return. The yearly cap on total penalties will also increase, from $1.5 million to $3 million. "Intentional disregard" of the filing requirement may result in a penalty of $500 per return, and the cap on total penalties will not apply.
AFAS and WorxTime Can Help!
American Fidelity Administrative Services, LLC (AFAS), an American Fidelity Corporation affiliate, offers a WorxTime service to assist with this reporting. WorxTime will capture the necessary information, create the required forms, and distribute the information directly to each employee and to the IRS. Note: The deadline to request a statement of work is August 31, 2015 in order for us to assist with the reporting due in early 2016.
Some products and services may be provided by third party contractors or affiliated companies.
Neither AFA or AFAS provide tax or legal advice and, given the complexity of federal health and welfare plan rules, we always recommend working with your own legal counsel to discuss how your plans could be affected and to review any guidance provided by us.
- IRS Releases Final Forms and Instructions for Employer Reporting Under the Affordable Care Act
The Internal Revenue Service (IRS) has released final versions of the forms that will be used to meet the Patient Protection and Affordable Care Act's (ACA) information reporting requirements under Internal Revenue Code sections 6055 and 6056. Sections 6055 and 6056 require insurers, including employers that sponsor self-insured plans, and large employers to file information returns with the IRS and also provide statements to employees. Reporting is mandatory for the 2015 calendar year regardless of an employer's plan year effective date in 2015. Information for 2015, including the actual months of coverage and dependent social security numbers, is required to be reported in early 2016.
Insurers and employers that sponsor self-insured health plans will use IRS Forms 1094-B and 1095-B to report under section 6055 on individuals enrolled in minimum essential coverage. Large employers (as defined by the ACA, those employing 50 or more full-time equivalents) will use IRS Forms 1094-C and 1095-C to report under section 6056 on offers of health coverage and enrollment in employer-provided plans. Employers that sponsor self-insured plans and that are also applicable large employers will use IRS Forms 1094-C and 1095-C to file a combined report under both section 6055 and section 6056.
- New Reporting Instructions Released
On August 28, 2014, the Internal Revenue Service (IRS) released draft instructions for completing and filing Forms 1094-B and 1094-C as well as forms 1095-B and 1095-C for reporting of health care coverage by insurers and employers as required by the Patient Protection and Affordable Care Act (ACA) under Internal Revenue Code Sections 6055 and 6056. Earlier this year, on July 24, the IRS released the draft forms that would be filed with the IRS and provided to employees annually.
Section 6055 and 6056 require insurers and employers to report information to the IRS and employees to manage the administration of the Individual Mandate, the Employer Mandate, and Premium Tax Subsidies. Although the first reports will not be due until early 2016, the reported data will be for the 2015 calendar year (regardless of the employer’s plan year). Employers will want to consider the data requirements now before the start of 2015 to make sure they have a process to capture the required information.
- Agencies Issue FAQ on Summary of Benefits and Coverage Requirements
On July 24, the Internal Revenue Service (IRS) released draft forms to be used by employers and insurers for reporting information regarding health care coverage and "minimum essential coverage" (MEC) as required under Health Care Reform. Final regulations were issued earlier in the year implementing the MEC reporting (Section 6055 of the Internal Revenue Code) and the reporting of health coverage (Section 6056). Instructions to the form have not yet been published. The reports are required for the 2015 calendar year regardless of plan year effective date and the first reporting will be due in early 2016. Learn more about the IRS reporting on our website.
- Employer Reporting White Paper
- Final Section 6055 Regulations
- Final Section 6056 Regulations
- Form 1095-B: Health Coverage Employee returns to report Section 6055 information
- Form 1094-B: Transmittal of Health Coverage Information Returns To transmit employee Section 6055 information returns to the IRS
- Form 1095-C: Employer Provided Health Insurance Offer and Coverage Employee returns to report Section 6056 information
- Form 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return To transmit employee Section 6056 information returns to the IRS
- Comparison of the Requirements of Section 6055 and Section 6056
- Final 2015 Instructions for Forms 1094-B and 1095-B
- Final 2015 Instructions for Forms 1094-C and 1095-C
American Fidelity Assurance Company does not provide tax or legal advice.