Navigating the complexities of the Affordable Care Act (ACA) is a critical aspect of benefits administration for Applicable Large Employers (ALEs). As an administrator, you must ensure compliance by offering Minimum Essential Coverage (MEC) to at least 95% of full-time employees. This includes the distribution of Form 1095-C to eligible employees, a key document for both employer reporting and employee tax filings. For employees, Forms 1095-C and 1095-B serve as proof of health coverage for tax purposes. Accurate tracking and reporting of employees' hours to determine full-time eligibility are essential for ACA compliance. By managing these responsibilities effectively and providing clear guidance to employees, administrators can ensure compliance and support employees through the ACA process.
What is ACA?
- ACA = Affordable Care Act/Obama Care/Health Care Reform. Employers must offer MEC to at least 95% of their full-time employees. ALEs with 50+ full-time employees are required to provide 1095 forms to their eligible employees.
What is Form 1095-C?
- Form 1095-C is used by employers with 50 or more full-time employees to report information required under the ACA about offers of health coverage and enrollment in health coverage for their employees.
What is Form 1095-B?
- Form 1095-B is used as proof of MEC when filing your state and/or federal taxes. It should be kept with your other tax information in case the IRS requires it as proof of your health care coverage.
Why am I receiving Form 1095-C?
- You may receive Form 1095-C because:
- You are a full-time employee under the ACA, and your employer is considered an applicable large employer.
- You and/or your dependents have health coverage from your employer, and your employer is required to report that coverage on Form 1095-C.
- You were offered health coverage from your employer.
Why am I receiving Form 1095-B?
- You may receive Form 1095-B because:
- You and/or your dependents have coverage under your employerâs health plan, and your employer is required to report that coverage on Form 1095-B.
- You and/or your dependents have health coverage from an insurer/plan sponsor/coverage provider required to report that coverage on Form 1095-B.
What do the codes mean on Line 14 and 16, Form 1095-C?
- Line 14 codes specify the type of coverage offered to an employee, the employeeâs spouse, and the employeeâs dependents. For descriptions, visit the IRS instructions here. Line 16 codes provide information about why coverage was or was not offered. Descriptions are available here.
What is the dollar amount on Line 15, Form 1095-C?
- Line 15 shows the employee-share of the monthly cost for the lowest-cost, self-only minimum essential coverage providing minimum value that your employer offers.
I pay more for coverage than the dollar amount on Line 15. Is my Form wrong?
- The amount on Line 15 reflects the cost of the lowest-cost plan offered to you, not necessarily the amount you pay for coverage if you chose a more expensive plan.
My coverage is not showing on Part III of Form 1095-C?
- If you are covered by an insured health plan or if your coverage provider is acting as a plan sponsor/insurer, your coverage information will likely be on Form 1095-B.
What do I have to do with this 1095 form?
- Keep your Form 1095 as you do with other important tax records.
How do I enter compliance information/ACA hours?
- Log into MyEnroll.com with your Administrator User ID and Password. Select Employee Hours Entry from the Compliance Tab. Enter monthly hours by month/year for the selected measurement period. Step-by-step instructions are in the ACA Guide.
My form is wrong.
- Inform your location HR/Administrator who will send corrections to ACA-Services@basusa.com. A new form will be created.
How do I get my form?
- Receive a copy in the mail or log onto www.myenroll.com to print a copy from your homepage under ACA.
Do I have to attach my 1095 to my tax return?
- No, keep Form 1095 for your records.
Can you send me a copy of my 1095?
- Contact Client Services at 800-945-5513.
How do I enter an educational exception?
- Teachers or aides with a break from active employment for more than 6 consecutive weeks may qualify for an exception. Enter dates of the "Educational Exception" in MyEnroll to prevent these periods from reducing average hours. Step-by-step instructions are in the ACA Guide.
Standard Measurement Results?
- MyEnroll calculates eligibility status at the end of each measurement period based on entered hours. To be considered full-time, an employee must work a minimum of 30 hours per week or 130 hours per month on average. Step-by-step instructions are in the ACA Guide.