Who, When, and Where
Forms 1094-B and 1095-B are required to be completed by carriers and employers with a self-funded group health plan. This reporting is required for both grandfathered and non-grandfathered group health plans. Form 1094-B is the transmittal to be distributed to individuals while 1095-B is the reporting that must be provided to the IRS.
The return and transmittal must be filed with the IRS on or before February 28 (March 31 if filed electronically) of the year following the calendar year. The first reports are due the beginning of 2016 for the 2015 calendar year. If the due date is on a Saturday, Sunday, or legal holiday, it must be filed by the next business day. The transmittal (1094-B) must be furnished to employees on or before January 31. Statements must be furnished on paper by mail, unless the recipient has consented to receive it electronically. The instructions provide a physical address, depending on the state, for paper returns to be sent to. If there are 250 or more returns being filed, they must be filed electronically.
There are a few changes on the 2015 instructions. If an employer is required to file electronically and finds that they are unable to do so, they need to submit Form 8508, Request for Waiver From Filing Information Returns Electronically. This must be submitted at least 45 days before the due date of the returns. If electronic filing is required and a proper waiver is not obtained to waive the electronic filing requirement, the employer will be subject to a penalty of $250 per return in excess of 250 unless a reasonable cause can be established.
Also, an explanation of how to file a corrected Form 1095-B is provided, along with examples for when one may be needed, such as a retroactive change in coverage after the initial form has been sent. The 2015 draft instructions outline how an employer can go about requesting an extension of time to furnish the Form 1095-B to recipients. Generally, the maximum amount of time that may be granted will be 30 days.
The transmittal, Form 1094-B, must contain the following information:
- Line 1: The filer’s complete name
- Line 2: Nine-digit employer identification number (EIN)
- Lines 3 & 4: Name and phone number of the person to contact with questions
- Lines 5-8: The filer’s complete address
- Line 9: Total number of Forms 1095-B that are being transmitted with Form 1094-B
Form 1095-B is divided into four parts. The information required for each part is as follows:
Part 1: Responsible Individual (Policy Holder)
- Line 1: Name of the responsible individual. This refers to the primary insured (typically the employee or former employee)
- Line 2: Social Security Number of the responsible individual (first five numbers may be replaced with Xs or *s)
- Line 3: Only if line 2 is blank, enter the responsible individual’s date of birth
- Lines 4-7: Complete mailing address of the responsible individual
- Line 8: Enter the appropriate letter to describe the policy. Self-funded plan sponsors would enter “B” for Employer-sponsored coverage
Employers reporting on self-funded group health plans should skip Part II and skip directly to Part III.
- Lines 16-22: Enter the name, EIN, and complete mailing address of the entity providing the coverage. For self-funded plans, this would be the plan sponsor’s information. Line 18 should contain the phone number for individuals to call with questions.
- Column (a): Name of each covered individual (including spouses and dependents)
- Column (b): Social Security Number of each covered individual
- Column (c): Only if column (b) is blank - date of birth of the covered individual
- Column (d): Check this box if the individual was covered for at least 1 day per month for all 12 months of the calendar year
- Column (e): If the individual was not covered for all 12 months, here is where it will be identified as to which months the individual was and wasn’t covered for at least one day.
The new instructions also include an explanation for the revision of the Form 1095-B to include additional covered individuals on a Covered Individuals Continuation Sheet(s) as applicable..
Again, this reporting is to be done by the carriers for fully-insured group health plans and the plan sponsor (often the employer) of self-funded plans.