The ACA is full of tricky IRS requirements that are difficult to keep organized. There are two important factors to consider when figuring out which forms (if any) to complete: the size of your business, and whether your health care plan is fully-insured or self-insured. To determine your company size, be sure to use your average monthly full-time equivalent count for the preceding calendar year (i.e. for 2018 size, use 2017 counts). If you are unsure whether your plan is fully-insured or self-insured (self-funded), click here to learn more or contact your plan administrator.
Use the information below to help determine your specific reporting requirements.
REPORTING FORM REQUIREMENTS
2-49 Full-Time Equivalents (Small Employer)
- Fully-Insured Plan – No Reporting requirement.
- Self-Insured Plan – File a Form 1095-B for each subscriber to your medical plan (include all dependents covered under that subscriber in Part IV).
- Form 1094-B – All transmittals to the IRS must also include this Employee-Level Transmittal Form.
50+ Full-Time Equivalents (Applicable Large Employer)
- Fully-Insured Plan – File a Form 1095-C for each employee who was full-time at any point during the reporting year; only complete Parts I and II.
- Self-Insured Plan – File a Form 1095-C for each employee who was full-time at any point during the reporting year and for each subscriber to your medical plan. Fill out Parts I and II for all full-time employees and subscribers. Complete Part III for each subscriber enrolled in your medical plan and all dependents covered under that employee or subscriber.
- Form 1094-C – All transmittals to the IRS must also include this Employer-Level Transmittal Form.
REPORTING REQUIREMENTS FOR
ALE – aka AGGREGATED LARGE EMPLOYER or CONTROLLED GROUP – MEMBERS
If your controlled group has an aggregate of 50+ full-time equivalent employees, you must file as an ALE, even if your entity has fewer than 50 full-time equivalents. Regardless of controlled group status, you are only responsible for reporting on the full-time employees who were employed under your EIN. All members of your Aggregated ALE Group, however, must be disclosed in Part IV on your Form 1094-C, which is the Employer-Level Transmittal Form.
Employer Shared Responsibility Penalties
- Failure to Offer Health Coverage to 95% of Full-Time Employees – $2,320 per Full-Time Employee
- Failure to Offer Affordable Coverage – $3,480 per Employee Receiving Premium Tax Credit
Incorrect Information on Returns
- Inaccurate or Late Filing – $260 per return; not to exceed $3,178,500 per year
- Intentional Disregard – $520 per return; no maximum