Summary
Requires individuals to report information about the status of their health insurance coverage to the IRS.
Implementation Status
2012
In April 2012, the IRS issued three Requests for Comment regarding reporting requirements for issuers of minimum essential coverage for purposes of determining compliance with the individual mandate. The first relates to valuating employer coverage for purposes of complying with this section. The second and third notices relates to the reporting requirements themselves.
2013
On July 2, in a blog posting on the Treasury Department’s website, the Administration announced the delay – until 2015 – of mandatory insurer and employer information reporting requirements and thus also postponed enforcement of the employer mandate and associated penalties.
On July 9, Assistant Secretary of the Treasury for Tax Policy Mark Mazur wrote to Rep. Fred Upton (R-MI), Chairman of the Energy and Commerce Committee, regarding the employer mandate and information reporting requirement delay, citing the Department’s “longstanding administrative authority to grant transition relief when implementing new legislation like the ACA.”
On July 9, the IRS released a Notice providing transition relief for 2014 from information reporting and the employer mandate – with no reporting requirements or penalties until 2015, although voluntary reporting in 2014 is encouraged – while noting that this release has “no effect on the effective date or application of other Affordable Care Act provisions,” including Exchange subsidies or the individual mandate.
On July 9, congressional Republicans wrote to President Obama inquiring about the employer mandate delay.
On July 10, congressional Republican leaders sought a CBO estimate of the delays’ budgetary effects.
Several congressional committees held hearings on the delays, including two by the House Ways and Means Health Subcommittee on July 10 (testimony) and July 17 (testimony), the latter of which included a Treasury Department official. The House Energy and Commerce Oversight and Investigations Subcommittee held a hearing on July 18 at which J. Mark Iwry, Senior Advisor to the Secretary and Deputy Assistant Secretary for Retirement and Health Policy, testified. On July 23, the House Education and Workforce Subcommittee on Health, Employment, Labor, and Pensions – as well as the Subcommittee on Workforce Protections – held a joint hearing, “Examining the Delay and Its Effect on Workplaces.”
On July 30, the Congressional Budget Office today released an analysis estimating that the Administration’s recently announced 1-year delay of employer and insurer information reporting requirements and employer mandate penalties will increase the net federal cost of the Affordable Care Act’s coverage-related provisions by $12B over 10 years.
On September 9, following the one-year delay of employer mandate enforcement and associated information reporting requirements, the IRS published a proposed rule on information reporting for applicable large employers under section 6056 of the Internal Revenue Code (IRC) relating to employers’ offers of health insurance coverage and employee statements used in premium tax credit administration, among other requirements, as well as a proposed rule on information reporting for those offering minimum essential coverage. A Treasury Department fact sheet included farther below provides an overview of select provisions of both rules, including specific proposals the Department says present a “variety of options to potentially reduce or streamline information reporting.” The IRS proposes that these information requirements take effect for calendar years (CYs) beginning after December 31, 2014 (i.e., in CY 2015)—affirming previously issued transition relief; voluntary compliance is encouraged for 2014. Comments are due on November 8.
2014
On Jan. 7, 2014 the Treasury published a semi-annual regulatory agenda listing a previously issued proposed rule on employer information reporting, a component of enforcing the now-delayed employer mandate, in its 2014 semiannual regulatory agenda. Treasury notes that the regulation provides “guidance on rules that require applicable large employers to file certain information with the Internal Revenue Service on coverage under an eligible employer-sponsored health plan and furnish to individuals statements that set forth the information required to be reported to the Internal Revenue Service.”
On July 24, 2014, the IRS released draft tax forms to be used for reporting health coverage status, including an employer’s compliance with the ACA’s employer mandate, construed as evidence that the Administration is moving forward with the employer mandate after having delayed it. The IRS said “we anticipate that draft instructions relating to the forms will be posted to IRS.gov in August,” adding “both the forms and instructions will be finalized later this year.” Forms include:
- 1095-B: Health Coverage (draft) for providing to enrollees
- 1095-C: Employer-Provided Health Insurance Offer and Coverage (draft) for large employer information reporting
- 1095A: Health Insurance Marketplace Statement (draft) for Marketplace reporting to enrollees and the IRS
- 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns (draft)
On Aug. 28, the IRS posted draft instructions for completing the forms through which employers and insurers report health coverage information to employees and individuals, as well as the IRS. The ACA-driven information reporting enables employer mandate implementation and, as previously announced, filing is voluntary for tax year 2014. Drafts include:
- Instructions for completing employer information reporting (here).
- Instructions for completing insurer information reporting (here).
- Form with instructions for recipient on employers’ reporting of offers and coverage (1095-C).
- Form with instructions for recipient for insurer reporting of health coverage (1095-B).
On Nov. 26, the IRS and Treasury released notices (here and here) seeking comment on proposed information collections through which applicable large employers, insurers and self-insured plans report on coverage.
On Nov. 26, the IRS published two notices (here and here) on estimated reporting burden under Form 1094-B and Form 1095-B for minimum essential coverage by insurers and additional information reporting by applicable large employers. Comments were due by Dec. 26.
2015
On Feb. 25, the IRS released a publication designed to assist employers in understanding ACA information reporting requirements.
On July 30, in a “tax tip,” IRS explains the employer mandate and associated information reporting requirements.
On Sept. 9, the IRS posted “What Information Must a Health Coverage Provider Report to the IRS?”
On Sept. 16, the IRS posted “Questions and Answers to Help Your Organization Understand ACA Reporting Requirements.”
On Sept. 18, Treasury and IRS issued a notice indicating that they intend to propose regulations under section 6055 of the Internal Revenue Code for health insurance issuers and filers reporting on insured group health plans.
On Dec. 8, the IRS released a “tax tip” addressing “Eight Things [Applicable Large Employers] Should Know about Information Reporting and Health Coverage Offers.”
On Dec. 22, the IRS released a “tax tip” highlighting “Eight Facts about New ACA Information Statements.”
On Dec. 28, the IRS issued a notice extending the due dates for the 2015 information reporting requirements for both furnishing to individuals and filing with the IRS.
2016
On Feb. 18, CMS announced a mechanism “to disclose information maintained in the system “to the IRS for the purposes of reporting Medicare Part A enrollment information and to provide statements to the individual enrollees with respect to whom information is reported to the IRS.”
On May 11, the IRS posted a “tax tip” titled “Why Employers Need to Count Employees.”
On June 24, the IRS posted a Test Package for Electronic Filers of ACA Information Returns (AIR) for the 2015 Processing Year.
On July 8, the IRS published a proposed rule on the premium tax credit and individual mandate. The IRS explains that it “address[es] various issues regarding: (1) eligibility for the premium tax credit (including how opt-out arrangements affect an employee’s required contribution); (2) the due date for payment of premiums in the case of retroactive enrollments; (3) the premium assistance amount when certain coverage is terminated mid-month; (4) the benchmark plan premium (including how pediatric dental benefits affect the benchmark plan premium); (5) the reconciliation of advance payments for an individual whom no one claims as a dependent; and (6) certain information reporting rules [applicable to Exchanges].” Comments are due by Sept. 6, 2016.
On July 29, the IRS released a proposed rule that addresses delayed Form 1095-B information reporting by catastrophic health plans as well as provides for information reporting by the state agency administering ACA Basic Health Programs, among other provisions. Comments are due by Oct. 3, 2016.
On Aug. 3, the IRS issued proposed regulations providing rules requiring issuers to report coverage under a catastrophic plan enrolled in through the Marketplace, clarifying the circumstances under which reporting is not required for an individual covered by more than one plan or program that is minimum essential coverage.
On Sept. 29, the IRS announced that software developers and transmitters may access recent webinars on ACA Information Return processes (Aug. 23 slides; Aug. 20 slides; July 19 slides; July 14 slides).
On Nov. 18, the IRS posted a notice indicating that it was extending the due date for certain 2016 information reporting requirements. The IRS indicated that “[s]pecifically, this notice extends the due date for furnishing to individuals the 2016 Form 1095-B, Health Coverage, and the 2016 Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, from January 31, 2017, to March 2, 2017,” and “also extends good-faith transition relief from section 6721 and 6722 penalties to the 2016 information-reporting requirements under sections 6055 and 6056.”
2017
On April 10, the Treasury Inspector General for Tax Administration released a report on employer mandate implementation and made seven recommendations regarding the IRS’ processing of Forms 1094-C and 1095-C.
Statutory Text
SEC. 1502. REPORTING OF HEALTH INSURANCE COVERAGE.
(a) IN GENERAL.—Part III of subchapter A of chapter 61 of the
Internal Revenue Code of 1986 is amended by inserting after subpart
C the following new subpart:
‘‘Subpart D—Information Regarding Health
Insurance Coverage
‘‘Sec. 6055. Reporting of health insurance coverage.
‘‘SEC. 6055. REPORTING OF HEALTH INSURANCE COVERAGE.
‘‘(a) IN GENERAL.—Every person who provides minimum essential
coverage to an individual during a calendar year shall, at such
time as the Secretary may prescribe, make a return described in
subsection (b).
‘‘(b) FORM AND MANNER OF RETURN.— ‘‘(1) IN GENERAL.—A return is described in this subsection
if such return—
‘‘(A) is in such form as the Secretary may prescribe,
and
‘‘(B) contains—
‘‘(i) the name, address and TIN of the primary insured
and the name and TIN of each other individual
obtaining coverage under the policy,
‘‘(ii) the dates during which such individual was
covered under minimum essential coverage during the
calendar year,
‘‘(iii) in the case of minimum essential coverage
which consists of health insurance coverage, information
concerning—
‘‘(I) whether or not the coverage is a qualified
health plan offered through an Exchange established
under section 1311 of the Patient Protection
and Affordable Care Act, and
‘‘(II) in the case of a qualified health plan, the
amount (if any) of any advance payment under
section 1412 of the Patient Protection and Affordable
Care Act of any cost-sharing reduction under
section 1402 of such Act or of any premium tax
credit under section 36B with respect to such coverage,
and
‘‘(iv) such other information as the Secretary may
require.
‘‘(2) INFORMATION RELATING TO EMPLOYER-PROVIDED COVERAGE.—If
minimum essential coverage provided to an individual
under subsection (a) consists of health insurance coverage
of a health insurance issuer provided through a group
health plan of an employer, a return described in this subsection
shall include—
‘‘(A) the name, address, and employer identification
number of the employer maintaining the plan,
‘‘(B) the portion of the premium (if any) required to be
paid by the employer, and
‘‘(C) if the health insurance coverage is a qualified
health plan in the small group market offered through an
Exchange, such other information as the Secretary may require
for administration of the credit under section 45R
(relating to credit for employee health insurance expenses
of small employers).
‘‘(c) STATEMENTS TO BE FURNISHED TO INDIVIDUALS WITH RESPECT
TO WHOM INFORMATION IS REPORTED.—
‘‘(1) IN GENERAL.—Every person required to make a return
under subsection (a) shall furnish to each individual whose
name is required to be set forth in such return a written statement
showing—
‘‘(A) the name and address of the person required to
make such return and the phone number of the information
contact for such person, and
‘‘(B) the information required to be shown on the return
with respect to such individual.
‘‘(2) TIME FOR FURNISHING STATEMENTS.—The written
statement required under paragraph (1) shall be furnished on
or before January 31 of the year following the calendar year
for which the return under subsection (a) was required to be
made.
‘‘(d) COVERAGE PROVIDED BY GOVERNMENTAL UNITS.—In the
case of coverage provided by any governmental unit or any agency
or instrumentality thereof, the officer or employee who enters into
the agreement to provide such coverage (or the person appropriately
designated for purposes of this section) shall make the returns
and statements required by this section.
‘‘(e) MINIMUM ESSENTIAL COVERAGE.—For purposes of this section,
the term ‘minimum essential coverage’ has the meaning given
such term by section 5000A(f).’’.
(b) ASSESSABLE PENALTIES.—
(1) Subparagraph (B) of section 6724(d)(1) of the Internal
Revenue Code of 1986 (relating to definitions) is amended by
striking ‘‘or’’ at the end of clause (xxii), by striking ‘‘and’’ at the
end of clause (xxiii) and inserting ‘‘or’’, and by inserting after
clause (xxiii) the following new clause:
‘‘(xxiv) section 6055 (relating to returns relating to
information regarding health insurance coverage),
and’’.
(2) Paragraph (2) of section 6724(d) of such Code is amended
by striking ‘‘or’’ at the end of subparagraph (EE), by striking
the period at the end of subparagraph (FF) and inserting
‘‘, or’’ and by inserting after subparagraph (FF) the following
new subparagraph:
‘‘(GG) section 6055(c) (relating to statements relating
to information regarding health insurance coverage).’’.
(c) NOTIFICATION OF NONENROLLMENT.—Not later than June
30 of each year, the Secretary of the Treasury, acting through the
Internal Revenue Service and in consultation with the Secretary of
Health and Human Services, shall send a notification to each individual
who files an individual income tax return and who is not enrolled
in minimum essential coverage (as defined in section 5000A
of the Internal Revenue Code of 1986). Such notification shall contain
information on the services available through the Exchange
operating in the State in which such individual resides.
(d) CONFORMING AMENDMENT.—The table of subparts for part
III of subchapter A of chapter 61 of such Code is amended by inserting
after the item relating to subpart C the following new item:
‘‘SUBPART D—INFORMATION REGARDING HEALTH INSURANCE COVERAGE’’.
(e) EFFECTIVE DATE.—The amendments made by this section
shall apply to calendar years beginning after 2013.