1. AFFORDABLE CARE ACT REPORTING REQUIREMENTS – A REVIEW December, 2015
New Jersey Association of School Business Officials
John F. Donahue, Executive Director
Michele D. Roemer, Ed.D., Assistant Executive Director

3. WHY ARE WE HERE?

4. TO AVOID THIS IN YOUR DISTRICT……
And Yourself!

5. AND YOUR OWN 1040 TAX RETURN THAT’S WHY!
Line 38 on 1040A

7. Shared Responsibility
Payment Worksheet
For line 61
FORM 8965

8. Because of this…..
EVERYONE eligible for
Health Insurance Benefits
will get a 1095

9. WHO ARE THE RESPONSIBLE PARTIES? EMPLOYER – YOU!
PRIVATE INSURANCE COMPANY

10. WHICH ONE ARE YOU?????
For State Health Benefits or HIF Districts – ALE’S (50 or more FTE’s)
Your employees will receive only one statement, a 1095-C which, you as the employer, will be responsible for preparing (Parts I, II, and III).
You, as the employer, will be responsible for transmitting the 1095-C forms to the IRS using transmittal form 1094-C
For Private Insurance Carrier Districts – ALE’S (50 or more FTE’s)
Your employees will receive two statements, a 1095-B from the Private Insurance Carrier and a 1095-C which, you as the employer, will be responsible for preparing (only parts I & II)
For State Health Benefits or HIF Districts – NON-ALE’s (less than 50 FTE’s)
Your employees will receive only one statement, a 1095-B- which, you as the employer will be responsible for preparing.
You, as the employer, will be responsible for transmitting the 1095-B forms to the IRS using transmittal form 1094-B
For Private Insurance Carrier Districts – NON-ALE’s (less than 50 FTE’s)
Your employees will receive one statement, a 1095-B from the Private Insurance Carrier.
You, as the employer will not be responsible for preparing and transmitting anything to the IRS.

11. SCENARIO 1 – 80% of your Employees
John Smith is employed by the Anytown BOE. He has been employed on a full-time basis from January – December, The BOE offers Minimum Value to the employee, and at least Minimum Essential Coverage offered to his dependents and spouse. He has one child who is 2 years old. The value of the lowest SINGLE plan for the BOE is $5,000. John’s salary is $55,000. Tier 4 contribution is 17% ($5,000 x 17% = $850/12 = $71)

12. Line 14 Codes Complete line 15 only if code
1B, 1C, 1D, or 1E is entered on
Line 14 either in the “All 12
Months” Box or any of the
Monthly boxes.
These are the coverage codes….

13. Line 16 Codes
As John likes to say, line 16 is your defense….

14. PART III COVERED INDIVIDUALS Complete if you are in SEHBP or a HIF.
1E – Employee, spouse
and dependent coverage
$71 lowest single plan monthly contribution
2C – Employee enrolled in coverage during the entire month
PART III
COVERED INDIVIDUALS
Complete if you are in SEHBP or a HIF.
Do NOT complete if you are with a private insurance. This information will be provided to the employee on the 1095-B, part IV by the private insurance carrier.
WHAT SHOULD AN EMPLOYEE BE CONCERNED ABOUT ON THIS FORM 1095-C = PART III (WHICH IS PART IV ON PRIVATE INSURANCE FORM 1095-B)

15. SCENARIO 2 – New Employee with Probationary Period
John Smith is employed by the Anytown BOE. He was employed on a full time basis as of February 1; however, the CBA requires a 60 day probationary period before he is eligible for health benefits. The BOE offer Minimum Value to the employee, and at least Minimum Essential Coverage offered to his dependents and spouse. He has one child who is 2 years old. The value of the lowest SINGLE plan for the BOE is $5,000. John’s salary is $55,000. Tier 4 contribution is 17%. $5,000 x 17% = $850 / 12 months = $71 per month of eligibility

16. PART III COVERED INDIVIDUALS Complete if you are in SEHBP or a HIF.
1H – No offer of coverage
1E - Employee, spouse and dependent coverage
$71 lowest single plan monthly contribution
2A – Employee not employed on any day of month
2D – Waiting Period
2C – Employee enrolled in coverage during the entire month
PART III
COVERED INDIVIDUALS
Complete if you are in SEHBP or a HIF.
Do NOT complete if you are with a private insurance. This information will be provided to the employee on the 1095-B, part IV by the private insurance carrier.

17. SCENARIO 3 – Waiting Period & Birth of Child 1st of Month
John Smith is employed by the Anytown BOE. He was employed on a full time basis as of February 1; however, the CBA requires a 60 day probationary period before his is eligible for health benefits. The BOE offers Minimum Value to the employee, and at least Minimum Essential Coverage is offered to his dependents and spouse. They have a child August 1. The value of the lowest SINGLE plan for the BOE is $5,000. John’s salary is $55,000. Tier 4 contribution is 17% ($5,000 x 17% = $850/12 = $71)

18. Complete if you are in SEHBP or a HIF.
1H – No offer of coverage
1D – Employee and Spouse Coverage
1E - Employee, spouse and dependent coverage
$71 lowest single plan monthly contribution
2A – Employee not employed on any day of month
2D – Waiting Period
2C – Employee enrolled in coverage during the entire month
PART III
COVERED INDIVIDUALS
Complete if you are in SEHBP or a HIF.
Do NOT complete if you are with a private insurance. This information will be provided to the employee on the 1095-B, part IV by the private insurance carrier.

19. SCENARIO 4 – PT Employee to FT Employee
John Smith is employed by the Anytown BOE. From January 1 through March 31 he is a part time employee. He is offered and accepts full time employment as of April 1. There is no probationary period. The BOE offers Minimum Value to the employee, and at least Minimum Essential Coverage is offered to his dependents and spouse. They have a child who is 2 years old. The value of the lowest SINGLE plan for the BOE is $5,000. John’s salary is $55,000. Tier 4 contribution is 17% ($5,000 x 17% = $850/12 = $71)

20. PART III COVERED INDIVIDUALS Complete if you are in SEHBP or a HIF.
1H – No offer of coverage
1E - Employee, spouse and dependent coverage
$71 lowest single plan monthly contribution
2B – employee not a full-time employee for the month
2C – Employee enrolled in coverage during the entire month
PART III
COVERED INDIVIDUALS
Complete if you are in SEHBP or a HIF.
Do NOT complete if you are with a private insurance. This information will be provided to the employee on the 1095-B, part IV by the private insurance carrier.

21. SCENARIO 5 – New Hire as of September 1
John Smith is employed by the Anytown BOE beginning September 1. . There is no probationary period. The BOE offers Minimum Value to the employee, and at least Minimum Essential Coverage is offered to his dependents and spouse. They have a child who is 2 years old. The value of the lowest SINGLE plan for the BOE is $5,000. John’s salary is $55,000. Tier 4 contribution is 17% ($5,000 x 17% = $850/12 = $71)

22. PART III COVERED INDIVIDUALS Complete if you are in SEHBP or a HIF.
1H – No offer of coverage
1E - Employee, spouse and dependent coverage
$71 lowest single plan monthly contribution
2A – Employee was not employed on any day of the calendar month
2C – Employee enrolled in coverage during the entire month
PART III
COVERED INDIVIDUALS
Complete if you are in SEHBP or a HIF.
Do NOT complete if you are with a private insurance. This information will be provided to the employee on the 1095-B, part IV by the private insurance carrier.

23. SCENARIO 6 – New Hire as of September 15
John Smith is employed by the Anytown BOE beginning September 15 and benefits begin immediately. There is no probationary period. The BOE offers Minimum Value to the employee, and at least Minimum Essential Coverage is offered to his dependents and spouse. They have a child who is 2 years old. The value of the lowest SINGLE plan for the BOE is $5,000. John’s salary is $55,000. Tier 4 contribution is 17% ($5,000 x 17% = $850/12 = $71)

24. 1H – No offer of coverage
1E - Employee, spouse and dependent coverage
$71 lowest single plan monthly contribution
2A – Employee was not employed on any day of the calendar month
2C – Employee enrolled in coverage during the entire month
PART III
COVERED INDIVIDUALS
Complete if you are in SEHBP or a HIF.
Do NOT complete if you are with a private insurance. This information will be provided to the employee on the 1095-B, part IV by the private insurance carrier.
NOTE: Part II of FORM 1095-C months offered will NOT match with FORM 1095-C Part III months offered.
ACCORDING TO THE 2015 Instruction Forms for 1094-C and 1095-C:
Page 9 – Part II Line 14 “An employer offers health coverage for a month only if it offers health coverage that would provide
Coverage for every day of that calendar month.
Page 12 – Column (e) “if the individual was not covered for all 12 months of the calendar year, check the applicable box(es)
For the months in which the individual was covered for at least one day in the month.
SEPTEMBER
LINE 16
SHOULD BE 2B

25. SCENARIO 7 – Part Time Employee who receives benefits due to CBA
John Smith is employed by the Anytown BOE as a part time employee from January 1 through December 31. There is no probationary period. The BOE offers Minimum Value to the employee, and at least Minimum Essential Coverage is offered to his dependents and spouse due to the negotiated Collective Bargaining Agreement.

26. 1G – Coverage offered to employee who was not ft for any month of the calendar year and who enrolled for one or more months of the calendar year.
If employee starts March 1 – January and February would include the regular codes of 1H (no coverage offered) and 2A (not employed) from March – December put 1G
Note: According to the IRS Instructions (page 10) for line 14 the code 1G is used. You do NOT enter anything on line 15 or line 16.

27. SCENARIO 8 – Employee Waives Insurance
John Smith is employed by the Anytown BOE as a full time employee from January 1 through December 31. The BOE offers Minimum Value to the employee, and at least Minimum Essential Coverage is offered to his dependents and spouse. He waives coverage. At this time, our best guess for reporting employees who waive out of insurance is to place on line 14 a 1E.

28. COBRA INFORMATION CAN BE FOUND AT THIS LINK #16 AND #17
Private insurance – you only report in part II if the employee or the employee and spouse and/or dependents take coverage. If employee does not you do NOT report. The main difference is line 15 and the amount the person pays.

29. TRANSMITTAL FORM 1094-C
FOR
SUBMISSION OF
1095-C FORMS

30. This is the authoritative
transmittal
Anytown
The numbers on lines 18 and 20 are what will be compared to lines column B (see next page) to determine 70% compliance for the 2015 calendar year.
If employer certifies that it is eligible for Section 4980H Transition
Was an ALE on business days in 2014
2/9/2014 – 12/31/14 ALE
a. did not reduce the size of its
workforce or reduce the overall
hours of service of it employees
b. Did not materially reduce the
health coverage, if any, it
offered as of 2/9/2014.

31. If using 4890H Transition Relief column (e) A = 50-99 employees
B = 100+
A or B
A or B
A or B
Please note:
The number you place on lines 18 and 20 may be higher than any of the numbers in column b due to resignations, terminations, COBRA continuation of coverage
The total employee count in column
c will vary depending on substitutes.
A or B
A or B
A or B
A or B
A or B
A or B
A or B
A or B
A or B
A or B

32. SCENARIO NON-ALE (less than 50 FTE’s) SEHBP or HIF
John Smith is employed by the Anytown BOE. He has been employed on a full-time basis from January – December, The BOE offers Minimum Value to the employee, and at least Minimum Essential Coverage offered to his dependents and spouse. He has one child who is 2 years old.
In this scenario – NON-ALE with SEHBP or HIF you will, as the employer, will be responsible for providing the employee with the 1095-B Employee Form and submit this information to the IRS using the 1095-B Transmittal Form
IF ANYONE RAISES THEIR HANDS THAT THEY ARE #3 FROM SLIDE 9. As an employer who has private insurance – being familiar with 1095-B may help you with questions from your employees.

33. Any NON-ALE (less than 50 fte’s) who
participate in SEHBP or a HIF is required
to provide a 1095-B to each employee,
plus file the 1095-B’s with a 1094-B
Transmittal.
You are reporting coverage only, there
is no requirement for codes or lowest cost
amounts to be indicated on this form.
PLEASE NOTE: Any NON-ALE in a private
Insurance plan is not responsible for
submission of any forms. Forms 1095-B
Employee forms and B Transmittal
will be submitted by the insurance
company on behalf of the BOE.
It may be important for you, as the
employer, to be familiar with this form
in case your employee(s) have any questions.

34. Transmittal Form 1095-B
For 1095-B employee forms
To be used by NON-ALE’s
(less than 50 fte’s) who
Participate in SEHBP or a HIF

35. HOW TO TRANSMIT ELECTRONICALLY
Register with e-service (if you are not registered) After you register you will have access to the ACA Application for TCC

37. The RESPONSIBLE OFFICIAL (and contact) will be required to include their social security number.
The RESPONSIBLE OFFICIAL (and contact) will be required to include their adjusted gross income from their most recent income tax return.

38. ONLY COMPLETE IF YOUR ADDRESS HAS CHANGED FROM THE LAST ADDRESS YOU PROVIDED TO THE IRS
Must hit accept to be registered.

39. e-service log – in (must be registered)
Select APPLICATION from e-service home page
Select ACA APPLICATION FOR TCC
COMPLETE THE FOLLOWING STEPS:
Each Responsible Official and Contact must be registered and confirmed with e-service
The Responsible Official will begin the application and designate other individuals who are authorized to be either a Responsible Official or Contact
All Responsible Officials must sign the Terms of Agreement and submit the application
After the application is completed and submitted, the IRS will perform checks before assigning the TCC.
All users authorized to access the application can modify and update the application as necessary. The application can be updated as needed.

40. INFORMATION NEEDED TO COMPLETE THE ACA APPLICATION FOR TCC – click on link
Your BOE’S EIN
Legal business name, business type, physical and mailing addresses and phone number
Responsible Officials and Contact information
Taxpayers Identification Number (SSN or ITIN)
Date of Birth and US Citizenship
Contact Information including address, title, phone number
Roles of your firm/organization
Forms that you will filing
Transmission method you will use

41. DUE DATES – FOR CALENDAR YEAR 2015
INDIVIDUAL STATEMENTS (EMPLOYEE INFORMATION)
Employers must furnish to each of its full-employees a 1095-C or if part time a 1095-B by January 31 (for this year February 1)
IRS RETURNS (EMPLOYEE INFORMATION & TRANSMITTALS)
Filing deadline for 2016 is February 29, 2016; March 31 if filed electronically*
*Electronic filing is REQUIRED for reporting entitles that file 250 or more individual statements per calendar year. This applies separately to each type of individual return (1095-C or 1095-B).

42. 9/21/2018

43. DATA FILE in EPIC

47. QUESTIONS ??????
To review: For SEHBP and HIF Applicable Large Employers – you as the employer is responsible for providing the 1095-C to your employees, including part III. You can get this information from the Division of Pensions and Benefits through EPIC.
For districts with private insurance ALE – the insurance company will provide the 1095-B to each employee with benefits and you, as the empoyer will provide a 1095-C parts I and II only! Make sure you check with your carrier to find out if they will be providing you with copies of the 1095-B
For Private Non-ALE – the insurance company will provide a 1095-B to all employees who receive coverage. YOU, as the employer have no responsibility of reporting.
For SEHBP and HIF Non-Ale – you, as the employer must complete 1095-B for all employees who receive benefits.

48. RESOURCES IRS WEBSITE: www.irs.gov
Form-1094-C-and-Form-1095-C
Under-the-Affordable-Care-Act
(tutorial on getting access to ACA application TCC)
(e-service to get access to the ACA Application for TCC)
SEHBP - Data available for Part III of 1095-C)
9/21/2018