Affordable Care Act  Reporting Requirements

In 2010, the Affordable Care Act (ObamaCare) was enacted into law.  Beginning for the calendar year ended December 31, 2015 the act requires reporting that effects both employers and individuals. 

We recommend that each of your take a moment to review your situation and determine if you have a filing requirement under the Affordable Care Act.  To do this, we recommend the following steps:

1)  Determine if you have a Fully Insured Health Plan or a Self-Insured Health Plan.

• A Fully Insured Health Plan is a type of plan purchased by an employer from an insurance company where the insurance company assumes the health coverage risk. Most employers offer fully insured health plans.
  
• A self-insured health plan is a type of plan where the employer assumes the risk of paying participants’ claims out of its general assets or a trust.
  

2)  Determine if you have more than 50 full time employees (those working 30 or more hours a week) and Full Time Equivalent (FTE)

       employees.

• IMPORTANT – if you are part of a controlled group, you must combine all employees of each company when making this calculation.
  
• The number of Full Time Equivalent Employees is calculated by adding all the hours worked by part-time employees for a week (those working less than 30 hours per week) and dividing by 120.
  

If you have less than a combination of 50 full time employees & full time equivalent employees and either offer a Fully Insured Health Plan or do not provide health insurance– STOP.  You do not have a filing requirement but may wish to communicate information to your employees.  Informational samples can be found on our communication page.

3)  If you have more than 50 full time and full time equivalent employees, please use this flow chart to determine which forms

       you need to file.

4)  Once you have identified which forms you need to file, gather the information necessary to complete them. Depending on your

       situation, this may include, but is not limited to:

• Employee’s name, SSN, and address;
  
• Employer’s name, EIN, telephone number, and address;
  
• For each month, whether coverage was offered and to whom it was offered (e.g., employee only; employee and dependents);
  
• The employee’s share of the monthly premium;
  
• Each covered individual’s (including the employee and his or her spouse and/or dependents) name, SSN or date of birth (if SSN is unavailable), and the months he or she was covered by the plan for at least one day
  

 5)  Consider how you will communicate information about the new form to your employees. Because employees will receive the form

        for the first time in 2016, consider letting employees know that they will use it to prepare their 2015 tax return. If your insurer is

        responsible for providing the forms, consider coordinating your communication strategy with your insurer. 

       Informational samples can be found on our communication page.

You should start gathering the information now so that you have the necessary data to complete the forms early next year. Note that if you file late, you may be subject to a penalty up to $250 per form ($500 if both the form furnished to the individual and filed with the IRS are late).