ACA Reporting

The Affordable Care Act (ACA) contains a list of healthcare coverage requirements that must be met, or organizations could face substantial penalties. Unfortunately, compliance can be very challenging as the rules are difficult to understand and prone to change.

ACA Reporting: The Basics

Form 1095 is a collection of forms that the IRS uses to administer the Employer Shared Responsibility Provisions (ESRP) of the Affordable Care Act and to determine the premium tax credit eligibility of each employee.

These forms must be filed by their respective deadlines to avoid penalties. Employers and employees who do not meet the healthcare coverage requirements under the Affordable Care Act will be subjected to fines. Failing to file Form 1095 can currently result in a penalty of $260 per return, which is capped annually at $3 million, but these figures are subject to increase.

eBen’s ACA Reporting Services

Our team was one of the first to build its own capability to do reporting, spearheaded by our industry-leading understanding of the ACA reporting requirements under Sections 6055 and 6056, and we offer a comprehensive range of reporting services, including:

• Identifying employees who fall under the ACA requirements
• Producing, printing, and distributing IRS Form 1095
• Preparing and electronically filing IRS Form 1094
• Automated code generation for IRS Form 1095-C

We also offer tracking, measurement, and verification services, including:

• Tracking and determining full-time and part-time status of workers
• Monthly tracking for variable employees
• Look-back tracking
• Alerting employees of changes to their eligibility status
• Support for exchange notice appeals
• Support for Premium Tax Credit appeals
• Audit support

State Coverage Mandates

Several states have passed their own mandates and now require their residents to have insurance, which means employers and health plans in these states must comply with ACA reporting at the state level. At eBen, we can determine your state’s status and handle e-filing on your behalf.

Customized Service

We offer a full ACA service with everything an organization needs to ensure full compliance with the requirements, with affordability determinations, full-time and part-time tracking, 1095-C code generation, printing and distribution, Form 1094-C filing and preparation, and the support of experienced consultants.

For organizations that do not require a full suite of services, we can offer a tailored package that focuses solely on the areas where you need the most support, such as a reporting-only service that includes the printing, distribution, preparation, and filing of Forms 1094-C and 1095-C, plus all the expert support that has made eBen a top benefits consultancy.

Handle ACA Reporting Requirements With Ease

The Affordable Care Act (ACA) requires employers with 50 or more full-time equivalent employees to offer health insurance coverage. If they don’t, they may be subject to fines. In order to determine which employers are subject to the fines, the IRS requires employers to report on their employees’ health insurance coverage. This is done through Sections 6055 and 6056 of the ACA.

Section 6055 and 6056 Requirements

Section 6055 requires employers with 50 or more full-time equivalent employees to report on the health insurance coverage they offer their employees. This report is called the Employer Coverage Report. The Employer Coverage Report asks for information about the employer’s plan, including the name of the insurer, the policy number, and the dates of coverage.

Section 6056 requires all large employers (employers with 50 or more full-time equivalent employees) to report on the health insurance coverage they offer their employees. This report is called the Employee Coverage Report. The Employee Coverage Report asks for information about each employee’s coverage, including whether or not they are enrolled in a plan and what plan they are enrolled in.

What is the Purpose of these Requirements?

The purpose of these reporting requirements is to help the IRS determine which employers are subject to fines for not offering proper health insurance coverage options for their employees. The reporting requirements also allow the IRS to track whether or not employees are receiving health insurance coverage through their employer.

The reporting requirements can be confusing and difficult to understand. That’s why it’s important to work with an experienced team of benefits consultants who can help you identify which employees are required to receive these notices.

How eBen Can Streamline the ACA Reporting Process

At eBen, we have pioneered new processes that make ACA reporting and compliance easier than ever. We have developed an industry-leading understanding of the Section 6055 and 6056 reporting requirements and developed tools to help you easily identify employees who are required to receive the applicable notices.

Failing to adhere to these requirements can result in a penalty exposure of up to $260 per employee, as well as employer shared responsibility penalties for each full-time employee. In order to avoid these penalties, it is important to take a proactive approach. eBen can help to provide industry-leading tools that help to streamline this process.

For more information, reach out to our team of experts today at 910-518-9338 or reach out to us directly by submitting a form.

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^{Revised as of October 23rd, 2024.}