Paper or Digital? Ensuring Compliance When Furnishing 1095 Statements Under ACA
Heather Garcia, Partner ETC Companies
Under the Affordable Care Act (ACA), Applicable Large Employers (ALEs) and Health coverage providers for fully insured plans must furnish a copy of Form 1095 (either 1095-B or 1095-C) to the responsible individual to document the health coverage provided by the IRS published due date annually.
- For 1095-B, or 1095-C non-employee forms, the “responsible individual” is the person who, based on a relationship to the covered individuals, the primary name on the coverage, or some other circumstance, should receive the statement.
- For 1095-C employee forms, the form should follow the W-2.
In general, statements must still be furnished on paper, by USPS or by hand, unless a recipient affirmatively consents to receive the statement I an electronic format. If mailed, use the employees last known address. Employers furnishing Form 1095-B statements to responsible individuals may take advantage of the alternative manner to furnish these statements if the following conditions are met:
- The provider must provide clear and conspicuous notice, in a location on its website that is reasonably accessible to all responsible individuals, stating that a form copy is available upon request. The notice must also include an email address, a [physical address to which a request for a statement may be sent, and a telephone number that responsible individuals may use to contact the provider with any questions.
- The provider must post this notice on its website by March 3, 2025, and retain it in the same location on its website through October 15, 2025.
- If requested, employers must furnish a copy of Form 1095-B within 30 days of the date a request is received from a responsible individual.
For example, a provider’s website provides a clear and conspicuous notice if it (1) includes a statement on the main page—or a link on the main page, reading “Tax Information,” to a secondary page that includes a statement—in capital letters, “IMPORTANT HEALTH COVERAGE TAX DOCUMENTS”; (2) explains how responsible individuals may request a copy of Form 1095-B, Health Coverage (or, for an applicable large employer member that sponsors a self-insured group health plan and makes a return in accordance with Regulations section 1.6055-1(f)(2)(i), explains how non-full-time employees and nonemployees who are enrolled in the plan may request a copy of Form 1095-C, Employer-Provided Health Insurance Offer and Coverage); and (3) includes the provider’s email address, mailing address, and telephone number.