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 (IRC) section 6055 requires every entity that provides Minimum Essential Coverage (MEC) to file an annual return reporting specific information for each covered individual. The section 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 IRC 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. Statements must also be provided to each full-time employee, regardless of whether an offer of coverage was made to that employee or not.
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 section 6055 and section 6056, the first reporting period was calendar year 2015 (regardless of plan year), with filings due in 2016. Statements are due each year to covered individuals and/or full-time employees 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. Large 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 IRS forms and instructions (available in the Additional Resources box) have been published.