Late Friday evening a District Court judge in Texas ruled the Individual Mandate provision of the Affordable Care Act (ACA) was unconstitutional. Furthermore, the District Court ruled that the Individual Mandate was inseverable from the rest of the ACA so the District Court struck down the entire ACA. Subsequently, and most importantly for purposes of employer actions moving forward, the White House has stated that the ACA will remain the law of the land while the District Court decision is reviewed by the United States Court of Appeals for the Fifth Circuit and, then most likely, the Supreme Court of the United States. This article provides a brief overview of the decision and provides guidance on how an employer should handle the decision.
Texas District Court Rules Individual Mandate is Unconstitutional and Invalidates the Entire ACA – White House States the ACA Remains the Law of the Land
Annual Tradition Continues - 2018 Employee Statement Deadline Extended along with Good Faith Effort Standard
On November 29, 2018 the IRS provided every employer an automatic extension from the deadline to furnish the Form 1095-C statements to individuals. Additionally, the IRS extended the good faith efforts standard to the 2018 Forms. Both of these items are beneficial to employers but also will make the IRS less forgiving of late filers.
Two recent events have signaled that the employer mandate will continue to be stringently enforced in the years ahead. First, Democrats obtained control of the House in the 2018 midterm elections. While Republicans retained control of the Senate, the split Congress will make it challenging if not entirely impossible to repeal the employer mandate portion of the Affordable Care Act (ACA). Perhaps more importantly, the IRS has begun to send out Letters 226J to employers it believes owe a penalty under section 4980H of the Code (the code provision that enforces the employer mandate portion of the ACA). The remainder of this article provides an overview of the signals that all point to continued stringent enforcement of the employer mandate.
Final Instructions for the Forms 1094-C and 1095-C Released with Few Changes – However IRS Enforcing the Employer Mandate Changes Everything
The IRS recently released the final instructions to the Forms 1094-C and 1095-C with minimal changes compared to the final instructions from 2017. Most of the changes made compared to previous iterations were so minor they are not even worth mentioning, but somewhat baffling and lacking grammatical support, such as putting Arabic numbers like “4” instead of spelling out “four”. This article provides a brief summary of the most important change, the enforcement of the employer mandate which was not occurring when previous final instructions were released, discusses the few substantive changes and key dates, and provides a brief overview of penalties associated with the Forms. The article concludes by repeating our discussion of a problem that persists related to the code 2F on line 16 of the Form 1095-C.
The employer reporting requirements of the Affordable Care Act (ACA) are now almost four years old. For many, it has been an arduous process each year to comply with the rules laid out in the 2010 law but only recently enforced. For others, the right technology along with a couple of years of experience has turned the ACA reporting into a routine annual exercise.
As the surge of employers receiving a Letter 226J continues some employers have received a different letter, a Letter 5699, from the IRS related to the Affordable Care Act (ACA). A Letter 5699 is the vehicle the IRS is using to inquire about an employer’s reason for not filing the Forms 1094-C and 1095-C with the IRS in previous years. This article explains the Letter 5699, reviews when an employer must file the Forms 1094-C and 1095-C, and discusses other considerations an employer should make when responding to the Letter 5699.
For the last eight months many unlucky employers have received a Letter 226-J from the IRS. The Letter 226-J is the mechanism that the IRS is using to inform employers if the IRS believes the employer owes the IRS money as a result of the Affordable Care Act's (ACA) employer mandate. Once an employer receives a Letter 226-J, it must respond to the IRS, or the employer will be forced to pay the penalty amount stated on the Letter 226-J. Therefore, the best strategy is to avoid the Letter 226-J by ensuring you submit accurate data on the Forms 1094-C and 1095-C. Accord can help.
On July 11, 2018 the IRS released draft copies of the Forms 1094-C and 1095-C for 2018. We are still awaiting the instructions for both Forms which will provide more details, but we wanted to provide a brief summary of what we learned from the draft Forms.
Similar to the Affordability Threshold - Sections 4980H(a) and 4980H(b) Penalty Amounts Set for Historic Increase in 2019
A few months back we wrote about how the affordability threshold was increasing significantly in 2019. Seeing this significant jump in the affordability threshold I was curious to see the adjusted section 4980H(a) and (b) penalty amounts related to the employer mandate for 2019. After all, we are halfway through 2018 and employers will soon need to make final decisions about their coverage options for the 2019 calendar year. After thoroughly reviewing the IRS website and other sources, I discovered there has been virtually nothing written about the section 4980H penalty amounts for 2019. Fortunately, after reviewing the Code and figuring out the premium adjustment percentage, it was easy to determine the penalty amounts for 2019 which were released in April 2018. This article explains the Code provision and the math behind the 2019 penalty amounts.
It is never too early to start thinking about the 2019 open enrollment season. Late last week the IRS released Rev. Proc. 2018-34 which, among other items, set the affordability threshold for employers in 2019. In order to avoid a potential section 4980H(b) penalty an employer must make sure one of its plans provides minimum value and is offered at an affordable price. An actuary will determine whether the minimum value threshold has been satisfied and this is generally not an issue for employers. However, an employer is in control as to whether the plan it is offering meets the affordability threshold.
In three years of serving clients of all size, level of complexity and industry, Accord Systems has developed a deep understanding of the requirements the ACA has placed on employers, as well as the impact on time and resources compliance has placed on HR, benefits and payroll. That experience led us to develop Forms Express. Our mission was to create the most efficient software and processes available for those employers who need to devote 30 minutes or less per month to tracking and reporting for ACA compliance, as well as production of 1095-C forms for employees. Forms Express is an affordable, efficient and accurate alternative to the administrative burdens and costly expense of ACA reporting. Read more at accord-aca.com
The deadline to file the Forms 1094-C and 1095-C with the IRS has passed for the third time. Similar to the two previous reporting seasons, many employers are receiving error messages indicating that there is an incorrect taxpayer identification number (TIN) submitted with their 2017 Forms. This is creating confusion as to what actions an employer must take to remedy the TIN errors. Fortunately, the IRS position has not changed and an employer still does not need to go through the solicitation process if it receives a TIN error message for an incorrect TIN! This article is intended to explain how the IRS software searches TINs, the TIN error messages an employer may receive, and what an employer needs to do if it received an error message indicating there is a TIN issue with one (or more) of the Forms 1095-C it submitted to the IRS.
Deadline to File the 2017 Forms 1094-C and 1095-C with the IRS is April 2, 2018 – How to Get More Time
The deadline to file the 2017 Forms 1094-C and 1095-C for paper filers, February 28, 2018, has come and gone. Therefore, to timely file the Forms 1094-C and 1095-C an employer’s only option is to file the Forms electronically. The deadline to electronically file the 2017 Forms 1094-C and 1095-C with the IRS is April 2, 2018. If an employer is not prepared by the deadline, the employer may receive an automatic 30 day extension by filing a Form 8809 with the IRS. This would extend the electronic deadline until April 30, 2018. This article provides basic instructions regarding how an employer should complete the Form 8809. Any employer who is unable to meet the March 31, 2018 deadline needs to complete the Form 8809 prior to next Monday.
Over the past several months some employers have received a Letter 226J from the IRS proposing a penalty under section 4980H of the Internal Revenue Code. The letters provided by the IRS to employers have provided many lessons for employers moving forward either to avoid these penalties entirely or to be able to effectively respond to such a letter. The following are four items an employer should consider to place itself in an optimal position in future years.
Deadline for Furnishing Form 1095-C Statements to Individuals Extended along with Good Faith Efforts Standard
On December 22, 2017 the IRS provided every employer an automatic extension from the deadline to furnish the Form 1095-C statements to individuals. Additionally, the IRS extended the good faith efforts standard to the 2017 Forms. This is a surprise that should be helpful to employers but also will make the IRS less forgiving of late filers.
The IRS recently released sample versions of the Forms 14764 and 14765. While the IRS previously discussed these Forms in the sample Letter 226J, additional details were provided with the release of the specific Forms. This article describes the new details disclosed by the release of the Forms.
The IRS took another big step in the enforcement of the employer mandate penalty by releasing a sample Letter 226J. As discussed in a previous article, the IRS plans to provide a Letter 226J to each Applicable Large Employer member (ALE member) it believes owes an employer mandate penalty (or an Employer Shared Responsibility Payment (ESRP) as the Letter 226J references the penalty). This article discusses what new items the IRS disclosed in the sample Letter 226J.
Last week we wrote about the Boston Business Journal reporting, the employer mandate penalty notices would soon be sent by the IRS. While many may view this as the boy crying wolf yet again, the IRS has updated its Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act to expound upon the questions related to Making an Employer Shared Responsibility Payment (see questions 55 through 58). The procedures which were updated on November 2, 2017 are the IRS’ strongest signal that the employer mandate penalties are imminent. This article describes the details the IRS has provided regarding the enforcement of the employer mandate penalties and the corresponding appeals procedures.
Last week, the Boston Business Journal, citing unnamed IRS and White House officials, reported that the IRS would be issuing employer mandate penalty notices in November. If the report is true, this would continue the IRS’ more stringent enforcement of the Affordable Care Act (ACA) in 2017 as previously discussed in articles regarding the IRS enforcing each Applicable Large Employer member (ALE member) filing its own Form 1094-C and the IRS requiring the ACA information to be completed on individual tax returns for the 2017 calendar year. This article explores some scenarios as to why the IRS may be contacting an employer with an employer mandate penalty notice.
IRS Begins to Draw the Line in the Sand – Won’t Accept Individual Tax Returns without ACA Information
Last week the IRS released a statement on the IRS website informing the public that it would not accept individual tax returns in 2017 that did not indicate whether the individual had health coverage, had an exemption from the individual mandate, or will make a shared responsibility payment under the individual mandate. Therefore, for the first time, an individual must complete line 61 (as shown in previous iterations) of the Form 1040 when filing his/her tax return. This article explains what the new IRS position means for the future of ACA compliance from an employer’s perspective.
It is Illegal for a Standard Measurement Period to Start on October 1 – Manipulation is Needed for that Start Date
Employers who sponsor a calendar year plan and who have adopted the look back measurement method will soon be reaching the end date of the standard measurement period. Just as in previous years, this has brought to my attention a lingering problem with the setup of many employers standard measurement periods. Unfortunately, many employers have setup standard measurement periods that start prior to October 3 of the particular year in question, in this case October 3, 2016. This article explains why starting a standard measurement period prior to October 3 creates a problem and addresses a few potential solutions.
Over the past six months many employers have received notifications from the IRS that they have failed to file the Forms 1094-C and 1095-C with the IRS. This type of noncompliance is often due to the employer failing to file a Form 1094-C for each Applicable Large Employer (ALE) member. The instructions to the Form 1094-C are clear that each ALE member must file a Form 1094-C. However, many employers only filed one Form 1094-C for all of its ALE members. Employers who filed in this manner are receiving letters from the IRS inquiring where the Forms 1094-C are for the employer’s other ALE members.
Last week the draft instructions to the Forms 1094-C and 1095-C were released with minimal changes compared to the final instructions from 2016. Most of the changes made in the draft instructions are the elimination of discussions related to the transition relief provisions that applied in previous years, but can never apply for the 2017 Forms. Pleasantly this makes the instructions a bit shorter yet just as fun to read. This article provides a brief summary to the changes and new notes added to the draft instructions for the Forms 1094-C and 1095-C, discusses key dates, and provides a brief overview of penalties associated with the Forms. The article concludes by discussing a problem that persists related to the code 2F on line 16 of the Form 1095-C.
Open enrollment season is fast approaching so every employer will need to begin to finalize the prices of the plan or plans that it will offer its employees. In order to avoid a potential section 4980H(b) penalty an employer must make sure one of its plans provides minimum value and is offered at an affordable price. An actuary will determine whether the minimum value threshold has been satisfied and this is generally not an issue for employers. However, an employer is in control as to whether the plan it is offering meets the affordability threshold.
A few weeks back I was curious as to what the adjusted section 4980H(a) and (b) penalty amounts related to the employer mandate would be in 2018. After all we are getting late in 2017 and employers will soon need to make final decisions as to their coverage options for the 2018 calendar year. After thoroughly reviewing the IRS website and looking elsewhere we discovered there has been virtually nothing written about the section 4980H penalty amounts for 2018. Fortunately, after reading the Code and figuring out what the premium adjustment percentage was for 2018 it is easy to determine the penalty amounts for 2018. This article explains the Code provision and the math behind the 2018 penalties.
On August 14, 2017 the IRS released its second iteration of the draft Form 1095-C for 2017. Previously on July 27, 2017, the IRS had released draft copies of both the Forms 1094-C and 1095-C. We anticipate the instructions to the Forms 1094-C and 1095-C to be released any day. However, as the reporting season is fast approaching, here is a brief summary of what we have learned from the draft Forms released to date.
When John McCain cast his no vote on the latest health care bill another Republican plan to repeal and replace the Affordable Care Act was essentially defeated. This has been a recurring theme for all of the bills that have been stuck in Congress over the last five months. All the bills debated and voted upon by both the House and Senate have cast a cloud of confusion over what an employer must do to comply with the ACA. The purpose of this article is to provide an overview of what the current law requires for the 2017 reporting season and things to keep in mind for the 2018 open enrollment period.
Employers are now two and half years into operating in the employer mandate world. The employer mandate caused many employers to amend the eligibility conditions for their health plans to avoid potential penalties. Unfortunately, some employers are failing to document the eligibility conditions for their health plans. Other employers have documented their health plan’s eligibility conditions but failed to coordinate the eligibility conditions with their insurance company. These two oversights are starting to cause employers expensive problems. This article explores the dangers of not documenting and coordinating the eligibility conditions of an employer’s health plan.
Just like the 2015 reporting season, one of the most common errors employers received when submitting the Form 1094-C/Form 1095-C packet for the 2016 reporting season was an error message stating there is an incorrect taxpayer identification number (TIN). As many learned last year, the TIN error could be a result of incorrect data entry, a marriage that occurred midyear changing the last name of an individual, but frequently was caused for no apparent reason. This article is intended to explain how the IRS software searches TINs, the improvements that have been made, and what an employer needs to do if it received an error message indicating there is a TIN issue with one (or more) of the Forms 1095-C it submitted to the IRS. The good news is an employer still does not need to go through the solicitation process if it receives a TIN error message for an incorrect TIN! A recent conversation with the IRS reaffirmed this position.
It is possible we have finally arrived at the month in which the IRS will begin to assess penalties against employers who fell short of the employer mandate standards under the Affordable Care Act (ACA). Speculation that employer mandate penalties may be assessed in May 2017 are largely based on the recently released TIGTA audit report which referenced several IRS tools required to assess the penalties being launched in May 2017. As a result, a publication explaining how an employer should handle a potential penalty from the IRS is appropriate at this time.
On April 7, 2017 the Treasury Inspector General for Tax Administration (TIGTA) released its findings from its audit conducted to assess the IRS’s ability to ensure compliance with the Affordable Care Act’s (ACA) employer mandate. The audit discovered several major issues with the technology being used to assist the IRS enforce the employer mandate. The technological trouble the IRS is experiencing is undoubtedly one of the reasons the IRS has not penalized a single employer under the employer mandate. This article briefly explores some of the issues discussed in the audit report and how an employer should use the findings of the report in the future.
On Monday March 6, 2017 the Republicans released a bill that would repeal and replace certain provisions of the Affordable Care Act (ACA). The bill has faced harsh criticism from both Democrats and certain Republicans and as currently constructed is unlikely to pass. Nonetheless, it is the first step in the process of repealing or amending the ACA which still appears inevitable under the country’s current leadership. This article provides a brief summary of five items employers should be aware of in the bill.
The deadline to file the Forms 1094-C and 1095-C for paper filers, February 28, 2017, is only days away. An employer who has elected to, or is required to, file electronically will have until March 31, 2017 to file the Forms 1094-C and 1095-C. If an employer is not prepared by the requisite deadline, the employer may receive an automatic 30 day extension by filing a Form 8809 with the IRS. This extends the paper deadline until March 30, 2017 and the electronic deadline to May 1, 2017. This article provides basic instructions regarding how an employer should complete the Form 8809.
If an employer has not already done so, it will soon be completing the Forms 1094-C and 1095-C for the 2016 calendar year. Despite being the second year these Forms are required to be filed by Applicable Large Employers (ALE), there is still a significant amount of confusion surrounding the deadlines and details related to the Forms. This article is intended to provide a reminder of five important issues related to the Forms 1094-C and 1095-C.
President Trump and the Republicans have made it clear that changes are coming to the Affordable Care Act (ACA). Congress has already taken preliminary, complicated steps through budgetary reconciliation to repeal key parts of the ACA and President Trump signed an executive order calling for a prompt repeal of the ACA. While neither action impacts an employer’s obligation to file the Forms 1094-C and 1095-C in 2016, all indications are significant changes are coming to the ACA in the future. On the surface, a repeal of the ACA appears to provide employers relief from complicated, burdensome regulations. However, examining recent benefit trends and the pre-ACA landscape, employers could be in store for a flood of complicated State and local laws if the ACA is repealed.
Deadline to Furnish Form 1095-C Employee Statements Approaching – Unlikely to Change if ACA is Repealed
Tomorrow, January 20, 2017, President Trump will officially take office. This has led many to speculate on the immediate demise of the Affordable Care Act (ACA). While changes to the ACA are assuredly coming, these changes are unlikely to impact the 2016 ACA reporting requirements. The deadline for employers to furnish the Form 1095-C employee statements is March 2, 2017. If an employer has not already begun the process of completing a Form 1095-C for its applicable employees, there is not much time left to accurately complete lines 14, 15, and 16, print and address the Forms, and place the Forms in the mail.
Employers have recently begun to hear back from the Department of Health and Human Services (HHS) regarding their appeal of the section 1411 notices they received. Many employers have been surprised to learn their appeal was unsuccessful with HHS as they offered the employee in question minimum value coverage at an affordable price under the Affordable Care Act’s (ACA) standard for each month of the 2016 calendar year. For better or worse, an unsuccessful HHS appeal is the end of the HHS appeals process for an employer. Therefore, the employer is stuck with the adverse HHS decision. This article explains why employers experiencing an unsuccessful HHS do not need worry and instead should be thankful as everyone is winning from the employer’s perspective in the scenario.
Rescinding Coverage from a Full-Time Employee during a Stability Period: Legal, but Fraught with Danger
We recently worked with an employer who was utilizing the look back measurement method to the fullest extent. The employer had the intention of rescinding coverage to certain ongoing full-time employees. While this strategy is certainly possible, there are many hoops an employer executing this strategy must jump through to accomplish this task. This article explains how an employer can execute this strategy, but explains why it is not worth the cost for all but the largest of employers.
Form 1095-C Deadline for Furnishing Statements to Individuals Extended along with Good Faith Efforts Standard
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The election of President Trump on Wednesday morning created new complications and uncertainty in the already complex world of the Affordable Care Act and, in particular, ACA compliance in 2016. In this article we explore the four possible outcomes that may occur with regard to 2016 reporting. As the math below shows, the logical choice for all employers is compliance with the ACA reporting requirements in 2016.
We recently performed an audit on our software to make sure the automation process was working properly in light of the updated language in the final instructions to the Forms 1094-C and 1095-C. Particular attention was paid to lines 14, 15, and 16 of the Form 1095-C. These three lines are one of the main tools the government uses to assess the section 4980H penalties against an employer. Lines 14, 15, and 16 tell the government a 12 chapter narrative about the employee entered on the Form 1095-C.
Earlier this week the final instructions to the Forms 1094-C and 1095-C were released. We have previously written two articles separately discussing how the draft instructions impact the Form 1094-C and the Form 1095-C. The points made in each of these articles remain valid as the final instructions do not change anything of substance from the draft instructions. The remainder of this article discusses a few points the final instructions emphasized and provides five key takeaways from the 2016 final instructions.
Despite almost being two years into the Play or Pay provision of the Affordable Care Act (ACA) there is still confusion surrounding some aspects of the complex provision. The ACA provides an employer the option to offer 95 percent of its full-time employees minimum essential coverage or risk paying a section 4980H penalty. If the look back measurement method is adopted, an employee can be classified as a full-time employee, a part-time employee, a variable hour employee, a seasonal employee, or an ongoing employee. The remainder of this publication reviews the rules of the look back measurement method as it relates to ongoing employees. Previous publications detailed the rules for the other four categories of employees.
Despite almost being two years into the Play or Pay provision of the Affordable Care Act (ACA) there is still confusion surrounding some aspects of the complex provision. The ACA provides an employer the option to offer 95 percent of its full-time employees minimum essential coverage or risk paying a section 4980H penalty. For section 4980H purposes, a full-time employee is an employee who averages at least 30 hours of service per week. An employer can treat 130 hours of service as the monthly equivalent of 30 hours per week. Additionally, an employer has the option to adopt the look back measurement method. The logical choice for almost every employer is to adopt the optional look back measurement method to track its employees’ hours of service. This publication is the second part of a three part series. All of the points, such as documenting the look back measurement method and counting hours of service, discussed in first part of the three part series are relevant for the second part. A future publication will detail the rules for the last category, ongoing employees.
Despite almost being two years into the Play or Pay provision of the Affordable Care Act (ACA) there is still confusion surrounding some aspects of the complex provision. The ACA provides an employer the option to offer 95 percent of its full-time employees minimum essential coverage or risk paying a section 4980H penalty. If the look back measurement method is adopted, an employee can be classified as a full-time employee, a part-time employee, a variable hour employee, a seasonal employee, or an ongoing employee. The remainder of this publication reviews the rules of the look back measurement method as it relates to full-time employees and some basic features of the look back measurement method. Future publications will detail the rules for the other four categories of employees.
In early August the draft instructions were released for the Forms 1094-C and 1095-C for 2016. While not much has changed, there are some differences in the Forms compared to 2015 and the IRS emphasized certain areas we assume many filers struggled with in 2015. This article is intended to provide an overview of the changes, provide helpful reminders, and point out things the IRS emphasized in the instructions to the Form 1094-C. Read more at accord-aca.com
In early August the draft instructions were released for the Forms 1094-C and 1095-C for 2016. While not much pertinent has changed, there are some differences in the Forms compared to 2015. This article is intended to provide an overview of the changes, provide helpful reminders, and point out things the IRS emphasized in the instructions to the Form 1095-C. Read more at accord-aca.com
Earlier this week we caught up with a knowledgeable person at the IRS regarding an employer’s solicitation obligations for an incorrect taxpayer identification number. Almost every employer who submitted a packet of Form 1095-Cs received an AIRTN500 error message for at least one of the Form 1095-Cs.
One common error an employer received from the Affordable Care Act Information Return system when submitting a packet of Form 1095-Cs was an error reporting that a Form 1095-C was submitted with an incorrect taxpayer identification number. The error code displayed when this occurs is AIRTN500 which signifies an individual name and TIN does not match the IRS database.
On August 2, 2016 the IRS published in the Federal Register proposed regulations which among other things attempt to clarify the confusion regarding taxpayer identification number solicitations. This is the government’s third attempt to clarify the issue since the creation of IRC section 6055.
Many employers have struggled to apply the rules discussed in the Affordable Care Act, often complaining that the rules are too complex and create too much work. We understand that initially the rules can be burdensome and hard to apply. However, we have great news for employers with seasonal employees. Seasonal employees are almost always going to be treated the exact same way and no Form 1095-C will need to be reported for the typical seasonal employee.
To assist employers with this complex issue Accord created Form Patrol which does not allow an employer to submit a Form 1095-C with impossible code combinations. We believe accurate line 14, 15, and 16 codes combinations is an obligation an employer has in order to fulfill its good faith efforts standard for the 2015 calendar year.
One of the most common errors employers are receiving when submitting the Form 1094-C/Form 1095-C packet is an error message stating there is an incorrect taxpayer identification number. The incorrect TINs could be a result of incorrect data entry, a marriage that occurred during the year changing the employee’s last name which no longer matches the system the federal government uses, or an employee intentionally falsifying his/her TIN. Regardless of the reason, an employer needs to take appropriate steps to avoid a penalty for filing a Form 1095-C with incorrect information.
The best way for an employer to fully protect itself from a 4980H penalty is to offer coverage that provides minimum value at an affordable price to all of its full-time employees and their dependents. This article explores how an employer can ensure that its offer of coverage will be deemed affordable. Read more at accord-aca.com.