Don't ya love do-overs?

Well, if you're nervous about doing the new ACA reporting right, at least you get to do a test run, and do it over if you make some mistakes.

The IRS has recently opened up its Affordable Care Act Assurance Testing system which allows employers to see
if their reporting software is correctly filling out the 2014 Forms 1094 and 1095. In November, the testing system will be cued up with the 2015 reporting forms.

The IRS submission requirements for using the ACA Assurance Testing system advise to:
“read the instructions carefully prior to preparing the submission.”

“Code definitions for Offer of Coverage Codes and Safe Harbor Codes are defined in the instructions and are not
provided in the narrative but must be included within your submission where appropriate,” the IRS cautions.

Good Faith Effort

In addition to a test run, for 2015, employers who file will have protection even if your filing is incorrect or incomplete, as long as you show you made good faith efforts to comply with the ACA reporting requirements. Michael Weiskirch, a principal at EmployeeTech Inc. says a “good-faith effort” is defined as an employer simply attempting to complete the forms.

But the good-faith effort for 2015 tax year will disappear in 2016 and penalties will apply for incorrect information after that.

Test runs begin in November, but hopefully, you've been already collecting the necessary information.  Having the ability to track and manage the required data should be happening now, according to Weiskirch. He says the requirements “have put benefit advisers and their clients
at a crossroads and have created a small panic in selecting the ‘just right’ solution.”

Over the last two years, a flood of ACA reporting solutions have entered the market, some stand-alone some
that are to be integrated with your existing HR, payroll or benefit systems.

Reporting Requirements

Whatever method you choose, here's what  is required by the IRS:

• Beginning next year, applicable large employers (ALEs), (generally meaning employers with 50 or more full-time employees in the preceding year), must report whether: a) an individual is covered by minimum essential coverage; b) and that an offer of minimum essential coverage that provides minimum value was made to each full-time employee.
• ALEs use Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, and Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, to report the information required.
  
  

“The IRS will use these forms to enforce the employer penalties, individual mandate and tax credit eligibility rules under the Affordable Care Act,” the Wagner Law Group cautions.

“With mandatory reporting for ALEs beginning in 2016, understanding the reporting requirements is critical. Accordingly, employers should give careful attention to this and all future IRS guidance as the reporting deadline rapidly approaches,”  the group adds.

In addition to the test run, the IRS issued a Q&A notice to clarify for employers what's coming:

"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 IRS list of questions and answers about reporting requirements for employers, see their Reporting Offers of Health Insurance Coverage by Employers page on IRS.gov/aca.


Sources: Melissa A Winn, IRS allows employers to test run ACA reporting | Benefit News http://ebn.benefitnews.com/news/health-care-reform/irs-allows-employers-to-test-run-ACA-reporting, 9/9/15, 11:32 AM

Questions and Answers to Help Your Organization Understand ACA Reporting Requirements
IRS Health Care Tax Tip 2015-56, September 16, 2015
http://www.irs.gov/Affordable-Care-Act/Employers/Questions-and-Answers-to-Help-Your-Organization-Understand-ACA-Reporting-Requirements

IRS Clarifies ACA Reporting Requirements for Large
Employers, 6-9-15, http://www.benefitnews.com/news/health-care-reform/irs-clarifies-aca-reporting-requirements-for-large-employers-2746619-1.html
 

As you prepare your health benefit package for 2016, you need to make sure you're up-to-date with current Affordable Care Act and other developments that impact your organization going forward.

According to a recent survey, here are the top ten compliance issues employers should address in planning:

1) Employer shared-responsibility (ESR) strategy

• "50 or more full-time equivalent employees will need to file an annual information return reporting whether and what health insurance they offered employees. In addition, they are subject to the Employer Shared Responsibility provisions.
• Regardless of size, all employers that provide self-insured health coverage to their employees must file an annual return reporting certain information for each employee they cover." (http://www.irs.gov/Affordable-Care-Act/Employers)

• In order to avoid paying ESR assessments for 2016 coverage, make sure your efforts are supported by coverage offers, administrative and record-keeping processes, and benefit documents.

2) ESR reporting

• Make sure you arrange data sources, systems and administrative processes to capture all vital information about your enrollees with minimum essential coverage (MEC), full-time employees, and all coverage offers needed for 2016 coverage reporting.  Also make sure you create a process for correcting any incorrect IRS filings and personal statements.

3) Preventive care

• Certain preventive care services must be covered free without your employees having to pay a co-payment or co-insurance or meet their deductible.  Click here for the list: http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html

• If you offer a "non-grandfathered" group health plan, make sure it complies with the final ACA rules and recent guidance on cost-free preventive services.

4) Additional ACA reporting and disclosure requirements

• Summary of Benefits and Coverage (SBC).  Hopefully you began providing SBCs to your employees at the first open enrollment that occurred after September 23, 2012. (http://www.dol.gov/ebsa/faqs/faq-aca8.html)
• Make sure you review your SBC delivery ongoing and watch for revised SBC templates. 
• ACA Reinsurance Fee.  If your company is self-insured, "Section 1341 of the Affordable Care Act establishes a transitional Reinsurance Program to help stabilize premiums for coverage in the individual market during the years 2014 through 2016. The statute requires all health insurance issuers and third-party administrators on behalf of self-insured group health plans to make contributions under this program to support payments to individual market issuers that cover high-cost individuals (payment-eligible issuers)."(http://www.irs.gov/uac/Newsroom/ACA-Section-1341-Transitional-Reinsurance-Program-FAQs)
• Prepare for round two of online submission and payment of ACA's reinsurance fee.
                                                       

5) Mid-year changes to cafeteria plan elections

• You need to decide whether to permit mid-year changes to cafeteria plan elections for either or both of the status-change events in IRS Notice 2014-55.

6) ACA’s out-of-pocket (OOP) maximum

• "For plan or policy years beginning in 2016, the maximum annual limitation on cost sharing is $6,850 for self-only coverage and $13,700 for other than self-only coverage...the self-only maximum annual limitation on cost sharing applies to each individual, regardless of whether the individual is enrolled in self-only coverage or in coverage other than self-only." (http://www.dol.gov/ebsa/pdf/faq-aca27.pdf)


• You need to verify that self-only and other (e.g., family) coverage tiers in “non-grandfathered” plans meet ACA’s 2016 out-of-pocket limits for in-network care. You also need to confirm that family coverage also satisfies ACA’s self-only OOP limit for each enrollee.  For example, if a family member incurs $20,000 in health care expenses, that family member is only responsible for $6,850, with self-insured employers or insurers required to pay the balance, even though the family maximum is not met.  The HHS reasons that an individual in a family plan should not be required to pay more than an individual in an individual plan.
  

7) Same-sex marriages and domestic partnerships

• You need to assess how the U.S. Supreme Court’s Obergefell v. Hodges ruling that legalizes same-sex marriage nationwide impacts your benefit programs and employment policies.  Also consider if there are indirect implications for domestic partner coverage.

8) Mental Health Parity and Addiction Equity Act (MHPAEA)

• You need to check that your plan designs and operations provide parity between medical/surgical and mental health/substance use disorder (MH/SUD) coverage. Federal audits of health plans now evaluate compliance with the final Mental Health Parity and Addiction Equity Act (MHPAEA) rules that took effect in 2015. In addition, check on continuing state legislative activity and litigation around parity issues .

9) EEOC Rules - Wellness

• You need to review your employee wellness program in light of the proposed Equal Employment Opportunity Commission (EEOC) rules requiring voluntary participation and restricting incentives for completing health risk assessments and/or biomedical screenings. Be prepared to make changes after EEOC finalizes these rules for nondiscriminatory wellness plans under the Americans with Disabilities Act.

10) ACA Excepted Benefits

• You need to review any fixed-indemnity and supplemental health insurance policies you offer to ensure they qualify as "excepted benefits" under the ACA and the Health Insurance Portability and Accountability Act (HIPAA).

Sources:
All embedded sources, plus: http://ebn.benefitnews.com/gallery/eba/top-10-compliance-issues-for-employers-2747296-1.html?utm_content=bufferce5ea&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer