Low Risk, maybe, but is it Accurate?
Heather Garcia, Partner ETC Companies
Under the Affordable Care Act (ACA), the IRS mandates that the 1095 form should accurately reflect the entity providing Minimum Essential Coverage (MEC) for health insurance. Typically, this is the employee’s legal employer, who issues the W-2. Misreporting (e.g., listing the health plan sponsor instead of the legal employer) can cause discrepancies in tax documentation and potentially trigger IRS audits or penalties for both the employer and the individual enrolled in coverage.
Per the latest IRS instructions (Draft 2024), any entity providing MEC must file an information return for covered individuals. Non-ALEs (Applicable Large Employers) may use the 1095-B form, while ALEs must use the 1095-C form. ALEs sponsoring self-insured health plans, including individual coverage HRAs (ICHRAs), should generally report using Part III of the 1095-C rather than a 1095-B. Non-ALEs and employers covering non-employees (retirees, independent contractors, COBRA participants without W-2 wages) may use the 1095-B.
On page 2 of the instructions, it states: “Health insurance issuers or carriers will file Form 1095-B for all insured employer coverages. Plan sponsors are responsible for reporting self-insured employer coverage.” Any inaccurate reporting by the issuer or carrier could result in employer penalties, as ultimate ACA compliance responsibility lies with the plan sponsor, not the carrier.
Plan sponsors for self-insured employer medical coverage include:
- Each participating employer (for its covered individuals) in a multi-employer plan.
- The association, committee, or joint board of trustees maintaining a multiple-employer plan.
- The employee organization for plans is maintained solely by employee groups/organizations.
- Each participating employer for its employees in multiple-employer welfare arrangements.
The Key Question: How close is “close enough”? If you choose to have your carrier provide 1095-B forms for your level-funded (self-insured) plan, ensure they are properly configured to align forms with the W-2 employer. Also, if choosing to use a 1095-B form, confirm that your organization is not an ALE.
Note: An ALE is determined based on the prior tax year’s full-time equivalent employee count, using the IRS formula. It is unrelated to the number of plan enrollees or the “small” or “large” group classification of the plan.
There are numerous “technology” solutions in today’s market to transmit this data to the IRS. Take the time to follow their tutorials and training aids and stay diligent—check your compliance efforts! Failure to do so can expose your organization to costly penalties for failure to file and furnish accurate forms, which are generally $330 per form in 2024, or trigger an employer shared responsibility payment (ESRP) for ALEs whose coverage is reported inaccurately.
If you are more of the mindset of “I don’t have time, I just need this to be done for me”, let ETC help. Contact ETC at info@etctracking.com.