1095C/1094C & 1095B/1094B Reporting & Filing
This is our annual reminder which you may receive or have already received from your Payroll provider, Accountant, Labor Attorney, etc. regarding the continued annual Form 1095-B or 1095-C delivery & filing requirements. The Affordable Care Act requires employers to prepare and provide certain forms depending on the employer size and type of health plan issued to employees:
- 2024 Form 1095-C: Applicable Large Employers (i.e. employers with 50 or more full-time + “full-time equivalent” employees in 2023, including members of an aggregated group or under common control) must furnish & deliver a 2024 Form 1095-C to all full-time employees (full-time as defined by ACA) whether they were enrolled in health coverage or not and who were employed for any period of time in the reporting year (2024). Additionally, retirees and/or COBRA/State Continuation enrollees that had coverage for any period of time in the reporting year (2024) also need to receive a Form 1095-C. * See below regarding new legislation on furnishing the forms.
- 2024 Form 1095-B: Smaller employers that are not an ALE but that provide self-insured or partially self-insured medical coverage to employees in 2024, must furnish & deliver a 2024 Form 1095-B to all employees enrolled for any period of time in the reporting year (2024) as well as to retirees and/or COBRA/State Continuation enrollees that had coverage for any period of time in the reporting year (2024). * See below regarding new legislation on furnishing the forms.
There are two deadlines for the forms:
- The deadline for filing the 1095-B or 1095-C (whichever is applicable) forms along with the 1094-B or 1094-C (whichever is applicable) Transmittal forms with the IRS is by February 28th, 2025 if filed by paper or by March 31st, 2025, if filed electronically.
- The deadline for employers to provide notice of (and now optionally provide the actual) the Form 1095-B or 1095-C (whichever is applicable) to individuals is no later than March 3rd, 2025. *See below regarding new legislation on furnishing the forms.
*New legislation passed December 23rd, 2024:
- The Paperwork Burden Reduction Act (signed into law 12/23/24) eases an employer’s requirements for providing 1095-C forms to participants. Replacing the previous requirement of mailing 1095-C forms to all participants, the Act allows employers to only furnish the form if requested by the participant. (This leeway was previously granted on 1095-B forms, so now 1095-C forms have the same option.) To use this method, the employer must simply provide a formal notice to participants that the 1095-B and/or 1095-C forms are available upon request. Then if requested, the employer must furnish the form by the later of: 1) January 31st or 2) within 30 days after the request from the member. But again, the employer still needs to file the forms with the IRS.
eFiling threshold requirement:
- If filing more than 10 IRS forms, employers must efile with the IRS. Prior to a year ago, organizations could file up to 250 paper filings, but the threshold was greatly reduced last year to encourage electronic submission.
Hopefully, by now, you are familiar with this process since it has been around for years. For those employers that have grown in size and had become or continued to be an ALE in 2024 or had a self-insured or partially self-insured medical plan in 2024, we wanted to bring this to your attention as a courtesy to you. Also, a quick reminder that Stumm Insurance has access to a “Do-It-Yourself” online solution. For more information, please contact your Stumm service team as soon as possible if you would like to discuss this solution.
What’s your group size?
Over many years, the Employee Benefits industry and Labor & Health insurance laws have created several “company size thresholds”, which should be monitored by employers and, in most cases, reported to their insurance carriers (as well as State & Federal governments). The specific size thresholds for many of these laws/requirements vary and the measurement/calculation of these thresholds also vary, so an employer needs to follow the “counting methodology” (can be current or prior calendar year or averages) for each law/requirement. The most common employee thresholds (and some applicable laws) to monitor:
- 10 employees – eFiling IRS returns or statements
- 15 employees – American with Disabilities Act, Pregnancy Discrimination Act, Genetic Information Nondiscrimination Act
- 20 employees – Medicare/Group health plan coordination, COBRA, Age Discrimination in Employment Act
- 50 employees – Family Medical Leave Act, Applicable Large Employer (ALE) determination, ACA 1095 filing, health plan “Community rating” vs. “Experience rating” for certain states (including Illinois)
- 100 employees – Medicare/Group health plan coordination, EEO-1 reporting, 5500 filing, Medical Loss Ratio segment, health plan “Community rating” vs. “Experience rating” for certain states
At the end of each year, and/or prior to their health insurance anniversary date, Employers (both stand-alone, and those aggregated with other employers under common control) should maintain an accurate monthly headcount of full-time & part-time employees, follow the applicable counting methodology, determine if any threshold has been crossed, and prepare to alert the insurance companies and/or employees of any changes.
Insurance Rebates & Premium Credits
Since 2011, fully insured medical carriers/plans have been subject to the Medical Loss Ratio (MLR) rules – and some have been required to deliver rebates to customers, resulting in employers determining if/how much of the rebates need to be reimbursed back to plan participants. Remember, ERISA law does require employers to utilize “returned plan assets” (i.e., these rebates and/or premium credits) for the benefit of the welfare benefit plan. In other words, the employer can retain the portion of the rebate/credit equal to the percentage they funded, while issuing the remaining portion to plan participants. Keep in mind that if your company receives a rebate check, Stumm Insurance can assist you with the determination and calculation of any applicable rebates to your plan participants.
Crain’s Chicago Business, Best Places to Work 2024!
Stumm Insurance is proud to announce that our company was, once again, selected as one of the top 100 companies in Crain’s Chicago “Best Places to work” list in 2024! We are honored to be recognized, but truly acknowledge it is our employees that make working at Stumm such a positive experience. That positivity directly stems from working with all of you, our great clients, on a daily basis. So, we thank each and every one of you for helping us together achieve a spot on this esteemed list.