ACA

On March 23, 2010, President Obama signed the Affordable Care Act. The law put in place comprehensive health insurance reforms that put consumers back in charge of their health care.  This act also required employers to provide certain information to their employees, IRS and/or DOL.

Marketplace Coverage Model Notice – The Affordable Care Act (ACA) requires that all current full-time employees must receive this notice from their employer; new hires will also receive this notice in the future within 14 days of their hire. The notice is a brief overview of the new online Health Insurance Marketplace.

 


 

Employer Shared Responsibility – The Affordable Care Act added section 6055 to the Internal Revenue Code, which provides that every provider of minimum essential
coverage will report coverage information by filing an information return with the IRS and furnishing a statement to individuals.  The Affordable Care Act added section 6056 to the Internal Revenue Code, which requires applicable large employers to file information returns with the IRS and provide statements to their full-time employees about the health insurance coverage the employer offered. An applicable large employer is an employer that employed an average of at least 50 full-time employees on business days during the preceding calendar year. A full-time employee generally includes any employee who was employed on average at least 30 hours of service per week and any full-time equivalents.

Medical Plan’s Responsibility:
The Plan will be responsible for filing Form 1095-B. Form 1095-B is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage and therefore are not liable for the individual shared responsibility payment.

Employer’s Responsibility:
The applicable large employer is responsible to complete Form 1095-C.  Employers that do not meet the definition of an applicable large employer are not required by the IRS to furnish a Form 1095-C to their employees.

Form 1095-C:
The employer is only responsible for completing Parts I & II, but not Part III.  Since, under the rules the plan will be filling out 1095-B.

Interim Guidance Regarding Multiemployer Arrangements: An employer is treated as offering health coverage to an employee if the employer is required by a collective bargaining agreement or related participation agreement to make contributions for that employee to a multiemployer plan that offers, to individuals who satisfy the plan’s eligibility conditions, health coverage that is affordable and provides minimum value, and that also offers health coverage to those individuals’ dependents, or is eligible for Section 4980H transition relief regarding offers of coverage to dependents. For more information, see Section XV.E of the Preamble to the final Section 4980H regulations.
An Applicable Large Employer (“ALE”) relying on the interim guidance reports on the Forms 1094-C and 1095-C in the following manner:

  • On the Form 1094-C, Part III, column (a), which reports whether the employer offered minimum essential coverage to at least 70% of its full-time employees (95% after 2015), for the month(s) in which the employer is eligible, employees for whom the employer is contributing to the multiemployer plan should be treated as having been offered minimum essential coverage (even if not actually offered coverage) for the months in which the employer is eligible to use the interim guidance.
  • However, on the Form 1095-C, Part II, line 14 (detailing offers of coverage), ALE members should not enter a code for health coverage the employer is treated as having offered (but did not actually offer), even if the employee is included in the count of full-time employees offered coverage on Form 1094-C, Part III, column (a). Rather, although the language in the instructions is somewhat unclear it appears that line 14 must reflect the coverage actually offered to the employee.
  • Similarly, for the 1095-C, Part II, line 15 (Employee Share of Lowest Cost Monthly Premium for Self-Only Minimum Value Coverage), it appears that the ALE must obtain the lowest-cost self-only coverage premium amount applicable to each employee from the multiemployer plan for Form 1095-C, line 15 reporting purposes.
  • On August 6, 2015 the IRS provided new guidance.  The new draft instructions provide additional guidance on how contributing employers would prepare the Form 1095-C for full-time employees for whom they contribute to a multiemployer plan.  Previously, the IRS had informally stated that multiemployer plans would be required to provide information to contributing employers concerning whether each participant had become eligible/enrolled in the fund.
  • The new guidance states that for reporting offers of coverage for 2016, an employer relying on the multiemployer arrangement interim guidance should enter code 1A on line 14 for any month for which the employer enters code 2E on line 16 (indicating that the employer was required to contribute to a multiemployer plan on behalf of the employee for that month and therefore is eligible for multiemployer interim rule relief). For reporting for 2016, Code 1A may be entered without regard to whether the employee was eligible to enroll in coverage under the multiemployer plan. For 2016 and future years, reporting for offers of coverage made through a multiemployer plan may have different guidelines.

 

Additional Links:

Full instructions for 1094 and 1095 C – http://www.irs.gov/pub/irs-pdf/i109495c.pdf

Additional Information is provided at – http://www.irs.gov/Affordable-Care-Act/Employers/Questions-and-Answers-on-Reporting-of-Offers-of-Health-Insurance-Coverage-by-Employers-Section-6056

 


 

Data Provided by Medical Plan

The Medical cannot provide contribution data to the employer, as this would be a HIPAA violation.

We will provide additional information as clearer guidance is received from the federal government.

 


 

Additional Plan Information:

Fund Name: Greater Pennsylvania Carpenters’ Medical Plan
EIN: 23-7007718
Plan No.: 501
Plan Year: January 1 – December 31

Dependent coverage and spousal coverage of the Greater Pennsylvania Carpenters’ Medical Plan meet the requirements of the ACA. The Plan covers dependents of members, including biological children, adopted children, and step-children under age 26, and disabled children over age 26. Additionally, coverage is offered to spouses (opposite sex and same sex) of members.

The Plan does offer Minimal Essential Coverage (MEC) to Members, Members’ Children, and the Spouses of Members, and the coverage offered to Members is of Minimum Value, which was verified by an Actuary of The Segal Company. The Employee share of lowest cost, monthly premium, for self-only Minimum Value coverage is $0.00.

The Plan is a Self-Funded ERISA Plan.

Coverage is offered to all “full-time” bargaining unit employees.

Coverage offered does not exceed a 90 day limitation or waiting period.