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ACA Reporting (6055 and 6056) Deadlines
ACA reporting is coming due in March! The 2024 forms and instructions have been out
for months. However, new relief previously available to small employers now extends to
large employers, allowing them to only provide 1095 forms to individuals upon request
starting March 3 as long as they post proper notice to their public website by March 3.
All forms must be electronically submitted to the IRS by March 31.
WHO THIS APPLIES TO:
- Applicable large employers (ALEs) responsible for 1094-C/1095-C forms whether they sponsor any type of medical plan or not
- ALEs are typically those with 50+ full-time and equivalent employees, with employers in a controlled group or affiliated service group combining their employee counts
- Small employers who are not ALEs sponsoring level-funded, self-funded, or ICHRA plans, making them responsible for 1094-B/1095-B forms
1095 Statements to Individuals
1095-B or 1095-C statements must be provided to individuals 30 days after January 31, or March
3 this year. However, if the employer responsible for completing 1095 forms provides proper notice
on their public website by March 3 and keeps it there through October 15, then the employer can
provide the 1095 form to only those who request it. Guidance states all size employers can take
advantage of this in an easy two-step approach.
First, the main public webpage must provide a prominent link to “Tax Information.” A public
webpage should be a website former employees can access and would be reasonably expected to
visit to find employer contact information.
Then the secondary public webpage that link takes people to must also be accessible to former
employees and must include the following content:
GO DEEPER:
- “IMPORTANT HEALTH COVERAGE TAX DOCUMENTS” in all caps
- How a “responsible individual” may request a copy of “Form 1095-B, Health Coverage,” or
- How a “full-time employee” may request a copy of “Form 1095-C, Employer-Provided Health Insurance Offer and Coverage”
- With email address, mailing address, and telephone number
Requests must be honored within 30 days. Individuals can give consent to electronic delivery,
and that individual’s consent may be relied upon until revoked in writing.
Electronic Filing to IRS
As a reminder, starting last year, all 1094/1095 forms must be filed electronically for all
employers who file 10 or more of various types of information returns combined (i.e., after
they add up all the W-2, 1099, 1095, and a few others listed here). This essentially means
every employer with an ACA reporting obligation must e-file their forms to the IRS by March
31. An extension can be requested by submitting Form 8809 no later than March 31.
In addition, the penalty for failing to file electronically or for failing to submit accurate or
complete forms is increasing to $330 per return or statement (up from $310). This is reduced
to $130 if corrected by August 1, or $60 if corrected within 30 days of the original due date.
These fees apply separately related to statements due to individuals by March 3 vs. returns
due to the IRS by March 31.
Keep in mind that several states (CA, MA, NJ, RI, and D.C.) have additional state filing
obligations.
Employers should consider the preparations of such filings, including any state filings, and
work with their payroll provider or ACA reporting vendor to complete any applicable filings
electronically by the above due dates.
https://www.irs.gov/forms-pubs/about-form-8809
https://www.irs.gov/forms-pubs/about-form-8809
Medicare Part D Coverage Disclosures Due March 3rd for Calendar Year Plans
Any sized employer who sponsors a group health plan is required to notify the
Center for Medicare and Medicaid Services (CMS) of the plan’s Medicare Part D
creditable coverage status, generally within 60 days of the plan’s renewal and in
other circumstances as outlined below.
WHO THIS APPLIES TO:
- All size employers with any group medical plan, including an ICHRA.
GO DEEPER:
This must be done through an online form available on the CMS website. Hard copies
are typically not allowed, unless the company has no internet access.
The form is relatively straightforward. The only two questions that require a little work
are as follows:
- Estimate how many Medicare-eligible individuals are covered at the start of the plan year, including active employees, retirees, disabled individuals or anyone on COBRA.
However, if the employer sponsors a retiree drug subsidy (RDS), any RDS participants
should be excluded. If the employer has no employee or spouse enrolled who is age
65+ and is unsure how many might be eligible for Medicare due to disability or ESRD,
then zero can be entered. - The last date a Part D creditability notice was sent to employees.
While this disclosure is typically due within 60 days of the plan’s renewal, CMS must be
notified earlier (within 30 days) after the group’s prescription drug plan’s creditability
changes or the plan terminates.
Lastly, there is no specific penalty for failure to complete the Disclosure to CMS Form, but
ERISA plan fiduciaries will want to ensure operating in compliance with all laws and this is
an easy five-minute submission.
https://www.cms.gov/medicare/employers-plan-sponsors/creditable-coverage/disclosure-form
Next Round of RxDC Submissions Due by Sunday, June 1, 2025
Section 204 of Consolidated Appropriations Act (CAA) requires group health
plans and issuers to report detailed prescription drug data, but also requires
information related to healthcare spending. The next round of reports for data
during the “reference year” 2024 must be submitted directly to CMS by Sunday,
June 1, 2025.
WHO THIS APPLIES TO:
- All size employers sponsoring a group medical plan and prescription drug
benefit that is not an ICHRA
GO DEEPER:
In order to comply with this requirement, employers must rely heavily on their claims
administrators because these service providers possess the required data.
Any gaps in submissions should be addressed by either the employer submitting themselves
in the government’s HIOS system or engaging with a third-party vendor to assist with
coordinating submissions.
Typically, the claims administrator or carrier will facilitate the full reporting but will ask the
employer for key information needed two to three months before the June 1 annual deadline.
- They primarily need to know how much the employer paid vs. how much participants
paid (including COBRA participants) for the previous calendar year’s medical/Rx
coverage (even if the plan does not operate on a calendar year). - If self-funded, the premium “equivalent” for this will be actual fixed costs plus actual
claims (choose either incurred claims or paid claims for the calendar year, and stick
with that choice every year), less stop loss rebates and pharmacy rebates retained by
the plan.
Employer plan sponsors, especially self-funded health plan sponsors, should continue to
take necessary steps in order to prepare for the June 1 deadline. Helpful information can be
found on CMS’s RxDC webpage.
CHIP Model Notice Updated
The DOL has updated the CHIP model notice as of Jan 31, 2025.
WHO THIS APPLIES TO:
- All size employers sponsoring any type of medical plan which employees
contribute to.
An employer is subject to the CHIP annual notice requirement if its group health plan covers
participants who reside in a state that provides a premium assistance subsidy, regardless of
the employer’s location.
A model notice is available in English and Spanish. The notice is updated January 31 and
July 31 each year to reflect changes in the phone, email, and website information when states
make changes.
Employers sponsoring a group health plan should provide the CHIP notice with other health
plan eligibility materials, such as with new hire and annual open enrollment materials or with
the summary plan description (SPD).
GO DEEPER:
FEDERAL UPDATES
HHS OCR Rescinds March 2, 2022, Gender Affirming Care Guidance
On February 20, 2025, the Department of Health and Human Services (HHS)
Office for Civil Rights (OCR) issued a rescission of the “HHS Notice and Guidance
on Gender Affirming Care, Civil Rights, and Patient Privacy” issued March 2,
2022. This rescission is effective immediately.
WHO THIS APPLIES TO:
- Employers of any size sponsoring a medical plan
The 2022 guidance had stated:
- Restrictions on gender-affirming care “likely violates Section 1557”
- Gender dysphoria might qualify as a disability, so restrictions on gender dysphoria
treatment “may…violate Section 504 and Title II of the ADA” - Disclosure of protected health information (PHI) about gender affirming care is subject
to additional restrictions
These provisions are immediately rescinded, largely due to legal challenges that have
prevailed and the new administration wanting to move forward with new guidance to be
issued in the near future. Executive orders and this rescission have indicated intent to issue
rules clarifying §1557 does not consider restrictions on gender dysphoria treatment to be
discrimination on the basis of sex, that gender dysphoria is not a disability, and that HIPAA
law allows the disclosure of PHI without the individual’s express authorization when such
disclosure is required by another law and complies with that law’s requirements.
However, this notice does not discuss the application of Title VII civil rights protections, and
the 11th Circuit did determine last year in Lange v. Houston County, Georgia, that a health
plan restricting gender dysphoria treatment was discriminating on the basis of sex.
Employers wanting to impose restrictions on gender dysphoria treatment may want to
discuss with counsel while waiting for updated laws or regulations.
GO DEEPER:
https://www.hhs.gov/sites/default/files/ocr-rescission-february-20-2025-notice-guidance.pdf
Executive Order to Expand Access to In Vitro Fertilization
On February 18, 2025, President Trump issued executive order 14216
directing the Assistant to the President for Domestic Policy to provide policy
recommendations on improving access to IVF and “aggressively reducing out-of-
pocket and health plan costs for IVF treatment.”
WHO THIS APPLIES TO:
- Employers of any size sponsoring a medical plan
GO DEEPER:
While the executive order does not facilitate any changes yet, employers may want to
consider budgeting for potential future IVF coverage rules. Nothing is known yet about the
direction this could take, but some possibilities might include:
- A possible coverage mandate
- Approximately one quarter of plans offer coverage and often limit to one or two
rounds of IVF - California recently passed a law mandating large group fully insured plans must
cover three rounds of IVF, and fully insured small group carriers must offer IVF
coverage for employers who want it, for plan years on/after July 1, 2025
- Approximately one quarter of plans offer coverage and often limit to one or two
- Diagnosis and treatment of IVF possibly being deemed an essential health benefit
(EHB), which would mean:- An annual or lifetime dollar limit could not apply
- In-network cost-sharing would be subject to the in-network out-of-pocket limit
- There may also be considerations for expanding what is reimbursable under flexible
spending accounts (FSAs), health reimbursement arrangements (HRAs), and health
savings accounts (HSAs). We will be watching for further guidance.