6056 Reporting - Tool Kit
6056 Reporting – Tool Kit

IRS 6055 and 6056 Employer Reporting Requirements
for ACA Obamacare

The Affordable Care Act (ACA) added Section 6056 to the Internal Revenue Code (IRC) requiring annual information reporting to the Internal Revenue Service (IRS) by applicable large employers with fully insured plans relating to the health insurance that the employer offers (or does not offer) to full-time employees and their dependents.

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Section 6055 requires annual information reporting to the IRS by health insurance issuers, employers with self-insured plans, government agencies, and other providers of health coverage.

IRS Website on ACA Reporting Requirements

irs.gov/Questions-and-Answers Section-6056

Health Net Bulletin on 6055 MEC Minimum Essential Coverage

Kaiser Permanente 6 page pdf on Minimum Essential Reporting 8.2015

Word & Brown Webinar on 6056 Reporting

Our Webpage on 1095 C form to be give to employees

Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage

Questions and Answers to Help Your Organization
Understand ACA Reporting Requirements

IRS Questions and Answers that helps employers

The health care law requires applicable large employers to file information returns with the IRS and provide statements to their full-time employees about the health insurance coverage the employer offered.  An applicable large employer is an employer that employed an average of at least 50 full-time employees on business days during the preceding calendar year.

Here are three questions and answers that address specific situations that might apply to your organization.

Is an ALE member that sponsors a self-insured health plan required to file Form 1094-C and Form 1095-C
if the ALE member has no full-time employees?

Generally, yes.  An ALE member that sponsors a self-insured health plan in which any employee or employee’s spouse or dependent has enrolled is required to file Form 1094-C and Form 1095-C, whether or not that employer has any full-time employees and whether or not that individual is a current employee or a full-time employee. For an individual who enrolled in coverage who was not an employee in any month of the year, the employer may file Forms 1094-B and 1095-B for that individual.

Is an employer that is not an ALE member required to file under the Affordable Care Act
if the employer sponsors a self-insured health plan that provides minimum essential coverage?

No; however, such an employer is subject to the reporting obligations under the Affordable Care Act. An employer that is not an ALE member that sponsors a self-insured health plan in which any individual has enrolled is not subject to the reporting requirements of ACA. Such an employer will generally satisfy its reporting obligations by filing Form 1094-B and Form 1095-B.

Is an ALE member required to report under the Affordable Care Act
with respect to a full-time employee who is not offered coverage during the year? 

Yes.  An ALE member is required to report information about the health coverage, if any, offered to each of its full-time employees, including whether an offer of health coverage was – or was not – made. This requirement applies to all ALE members, regardless of whether they offered health coverage to all, none, or some of their full-time employees.  For each of its full-time employees, the ALE member is required to file Form 1095-C with the IRS and furnish a copy of Form 1095-C to the employee, regardless of whether or not health coverage was or was not offered to the employee. Therefore, even if an ALE member does not offer coverage to any of its full-time employees, it must file returns with the IRS and furnish statements to each of its full-time employees to report information specifying that coverage was not offered.

For the full list of questions and answers about reporting requirements for employers, see our Reporting Offers of Health Insurance Coverage by Employers page on IRS.gov/aca. The IRS website is also the place to find questions and answers for a wide range of ACA topics for individuals, employers and other organizations.

For more information, see the Instructions for Forms 1094-C and 1095-C and these additional Questions and Answers.

Affordable Care Act Information Reporting (AIR) Program page on IRS.gov and in Publications 5164 and 5165.

 

Health Coverage Providers: Understanding Minimum Essential Coverage

The Affordable Care Act requires any person or organization that provides minimum essential coverage, including employers that provide self-insured group health plans, to report this coverage to the IRS and furnish statements to the covered individuals.

These reporting requirements affect:

  • Health insurance issuers or carriers
  • The executive department or agency of a governmental unit that provides coverage under a government-sponsored program
  • Plan sponsors of self-insured group health plan coverage
  • Sponsors of coverage that the Department of Health and Human Services has designated as minimum essential coverage

For purposes of reporting by applicable large employers, minimum essential coverage means coverage under an employer-sponsored plan.

Minimum essential coverage does not include fixed indemnity coverage, life insurance or dental or vision coverage.

Minimum essential coverage does include:

Government-sponsored programs

  • Medicare part A, most Medicaid programs, CHIP, most TRICARE, most VA programs, Peace Corps, DOD Non-appropriated Fund Program

Employer sponsored coverage

  • In general, any plan that is a group health plan under ERISA, which includes both insured and self-insured health plans. Importantly, employer plans that cover solely excepted benefits, such as stand-alone vision or dental plans, are not MEC

Individual market coverage

  • Includes qualified health plans enrolled in through the federally facilitated and state-based marketplaces and most health insurance purchased individually and directly from an insurance company

Grandfathered plans

  • Generally, any plan that existed before the ACA became effective and has not changed

Miscellaneous MEC

  • Other health benefits coverage recognized by the Department of Health and Human Services as MEC

For more information, see our Questions and Answers on Information Reporting by Health Coverage Providers on IRS.gov/aca.

 

Health Coverage Providers:
Understanding Minimum Essential Coverage

The Affordable Care Act requires any person or organization that provides minimum essential coverage, including employers that provide self-insured group health plans, to report this coverage to the IRS and furnish statements to the covered individuals.

These reporting requirements affect:

  • Health insurance issuers or carriers
  • The executive department or agency of a governmental unit that provides coverage under a government-sponsored program
  • Plan sponsors of self-insured group health plan coverage
  • Sponsors of coverage that the Department of Health and Human Services has designated as minimum essential coverage

For purposes of reporting by applicable large employers, minimum essential coverage means coverage under an employer-sponsored plan.

Minimum essential coverage does not include fixed indemnity coverage, life insurance or dental or vision coverage.

Minimum essential coverage does include:

Government-sponsored programs

  • Medicare part A, most Medicaid programs, CHIP, most TRICARE, most VA programs, Peace Corps, DOD Non-appropriated Fund Program

Employer sponsored coverage

  • In general, any plan that is a group health plan under ERISA, which includes both insured and self-insured health plans. Importantly, employer plans that cover solely excepted benefits, such as stand-alone vision or dental plans, are not MEC

Individual market coverage

  • Includes qualified health plans enrolled in through the federally facilitated and state-based marketplaces and most health insurance purchased individually and directly from an insurance company

Grandfathered plans

  • Generally, any plan that existed before the ACA became effective and has not changed

Miscellaneous MEC

  • Other health benefits coverage recognized by the Department of Health and Human Services as MEC

For more information, see our Questions and Answers on Information Reporting by Health Coverage Providers on IRS.gov/aca.

Related Pages in Employer Mandate Section

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