Following up on regulations and forms published earlier this year, the IRS has issued instructions and other guidance on the shared responsibility reporting requirements under the Affordable Care Act. The new rules require:

  • Health benefit providers, including group health plan sponsors and insurers, to provide information on an individual’s compliance with the individual mandate requirements
  • Employers to furnish information about their compliance with the employer mandate, as well as information relevant to an individual’s qualification for subsidized coverage through a health insurance exchange

Although these forms may be voluntarily filed in 2015 (for the 2014 year), filers are not required to submit the forms until 2016 (for the 2015 year).

The new guidance includes:

Employers subject to the employer mandate will be particularly interested in the instructions to Form 1094-C and Form 1095-C. Form 1094-C serves as a transmittal form to the IRS, while Form 1095-C provides information to employees and the IRS about health coverage, similar to how Form W-2 provides information on compensation. Employers with self-funded plans will complete Form 1095-C in its entirety with information relevant to both the individual and employer mandates. Employers with insured plans will fill out only the portions of Form 1095-C relevant to the employer mandate, with their insurers completing Form 1095-B with information relevant to the individual mandate.

Form 1095-A has been designed for completion by Health Insurance Marketplaces (the health insurance exchanges). Form 1040 has been revised to include a line relating to compliance with the individual mandate.

The new forms and instructions are drafts that may yet be revised. However, employers may begin developing systems and processes to gather and report information under the new requirements.

As the federal health care reform effort gained steam, Ballard Spahr attorneys established the Health Care Reform Initiative to monitor and analyze legislative developments. With federal health care reform now a reality, our attorneys are assisting health care entities and employers in understanding the relevant changes and planning for the future. They also have launched the Health Care Reform Dashboard, an online resource center for news and analysis on developments under the Affordable Care Act.

If you have questions about this alert, contact Edward I. Leeds at 215.864.8419 or, Brian M. Pinheiro at 215.864.8511 or, Diane A. Thompson at 424.204.4334 or, or any other member of the Employee Benefits and Executive Compensation Group with whom you work.