the post from yesterday congratulations! You are officially certified now as OCD - Obamacare Compliance Designation. If not, never fear, your favorite bloggers are here. For those with a more visual approach be sure to check out the bottom.
For individuals who purchase insurance through the Marketplaces you might use/receive the following regulations and forms:
Regulation 5000A - The rule that everyone must have minimum essential health care coverage. This also provides a listing of types of coverage that qualify under the ACA.
Section 1401 (which creates Section 36B of the Internal Revenue Code) - This authorizes tax credits for the purchase of qualifying health insurance in an exchange “established by the State under Section 1311″ of the Act. It was a vital part of the King vs. Burwell case. In final regulations under Code 36B, the Treasury Department and the IRS read the rules broadly, such that subsidized coverage are available irrespective of whether an exchange is state-based or Federally-facilitated.
1095-A - This is called the Marketplace Statement. It is provided by the Marketplace to confirm an individual has insurance that meets minimum coverage and allows that person to receive a premium tax credit. It shows what the 2nd lowest cost Silver Plan is for the state the person resides in along with the amount an individual received in advanced premium tax credits.
Form 8962 - The new tax form you complete that will provide a way to figure your tax credit and then reconciles with your advanced premium tax credit. You must submit this form to the IRS with your taxes if you qualify and receive a subsidy through the purchase of individual insurance through a marketplace.
Form 8965 - You must complete this form if you are claiming an exemption to the individual mandate. Important to note, you must have received an exemption from the Marketplace beforehand. You will provide the exemption certificate number you received on this tax form.
For insurers, Applicable Large Employers, and individuals who receive insurance through their employer you will use the following regulations and forms:
IRS Code 6055 - Provides that every fully insured and self funded plan must offer minimum essential coverage and will report this information by filing a return to the IRS and also by furnishing a statement to individuals who are offered insurance under the plan. The IRS uses this to show compliance with the individual mandate (5000A). In fully insured cases insurers are the ones providing documentation to the IRS and individuals who are covered under a group plan.
IRS Code 6056 - Only applies to Applicable Large Employers (50 or more FTE's). This section requires the employers to complete tax filing documents to the IRS and all of their employees. The IRS uses these tax forms to determine if an employer meets the Employer Mandate requirements and also determine if an employee is eligible for a premium tax credit or not.
IRS Form 1094-C - This form is generated by ALE's under IRS Code 6056 to show a summary of information for the employer who sponsors a health insurance plan. It covers eligibility methods, monthly enrollments, and minimum coverage requirements. It also asks for the total number of 1095-C forms the plan sponsor has sent.
IRS Form 1095-C - This form is given to all full-time employees and also provided to the IRS by all ALE's who offer fully insured and self funded plans. What sections to complete depend on whether an employer offers a fully insured or self funded plan. Regardless this is the most cumbersome portion of the reporting requirements for an employer. This data is used by the IRS to determine if an employer owes a penalty or if an employee is eligible for a tax credit. It also is used by the IRS to determine if someone is responsible for the individual mandate tax for not having insurance.
IRS Form 1094-B - This form is only required if an employer meets the following two requirements: 1. they offer minimum essential coverage and 2. the plan they offer is self-funded. If you don't meet these requirements then you will not have to deal with this form.
IRS Form 1095-B - This form is sent by insurers to all members who are covered under a fully insured medical plan. This includes: individual off exchange, small and large group fully insureds. Small group self funded accounts are also responsible for sending these to employees.