Monterey County Farm Bureau

Affordable Care Act

Responding to an IRS - SSA - CMS Data Match Request

Employers may receive a request from the Centers for Medicare & Medicaid Services (CMS) prompting the submission of group health plan information to support the IRS/SSA/CMS Data Match Project. The Data Match Program is designed to facilitate shared access to data between the Internal Revenue Service (IRS), the Social Security Administration (SSA), and CMS. The shared data allows each agency to pool information on Medicare beneficiaries who also have coverage under a group health plan, and make determinations as to the coordination of benefits between the two. Cooperation by employers is required by law, and the failure to properly respond to the request within 30 days of receipt may result in the imposition of penalties in the amount of $1,000 per individual listed in the letter.

Reason for the Request

Most often, an employer will receive a Data Match Request because a group health plan participant who also has Medicare coverage incurred medical expenses and submitted claims. In this instance, Medicare will need to determine whether it should pay the claim as primary or secondary to the group health plan according to Medicare Secondary Payer Rules.  CMS acknowledges that the request may be burdensome to some employers, but promotes the cost savings to employers, Medicare beneficiaries, providers, and Medicare as a worthy cause.

Required Information

The information requested for the Data Match is not exhaustive. Employers must provide group health plan information on specifically-named individuals (either an employee or a spouse). Employers will need to confirm that the named individual was employed and/or covered under the group health plan at the time a claim was incurred. Additional information about the type of coverage is also required.

How to Submit the Data

Submissions may be made online at the IRS/SSA/CMS Data Match Secure Website, either through the direct entry of data or through an electronic questionnaire. Employers also have the option to request a 30-day extension of time to submit the requested data. Instructions on how to complete the Data Match can be found here, along with information on Voluntary Data Sharing Agreements that an employer may enter into with CMS in lieu of completing future Data Match Requests.

Courtesy Felice Insurance (Author: Deborah Hyde, Front Page Post)


IRS Reporting Requirements for 2016 Tax Year

After previously releasing draft versions of the forms in July, the Internal Revenue Service (IRS) released the final versions of the 2016 ACA reporting forms in early October – less than four months out from the first of the two reporting deadlines. Fortunately, the final forms do not differ significantly from the forms used for 2015 reporting. There are, however, some key differences for employers to keep in mind.

Background

The Affordable Care Act (ACA) requires Applicable Large Employers (ALEs) to report to the IRS on offers of medical coverage made to full-time employees. The ACA also requires employers of all sizes that sponsor self-funded health plans to report to the IRS on all individuals covered under the self-funded plan during the calendar year.

2015 was the first year for which ACA reporting was mandated. While the core reporting requirements remain the same, employers should be aware of some changes in 2016.

What’s New for 2016?

  • Deadlines: Employers received a welcome delay of the 2015 reporting deadlines.  This year, however, employers should not expect a similar reprieve.  The original deadlines will apply.  Employee statements are due by January 31, 2017, and submissions to the IRS must be made by February 28, 2017, or March 31, 2017 if filing electronically.
  • Penalties: For 2016, the IRS will no longer offer a “good faith effort” exemption from filing penalties to employers who made a genuine effort to comply with the requirements.  Instead, employers will face a penalty of $260 per delinquent or incorrect form, with an annual maximum of $3.2 million.
  • Transition relief: Many forms of transition relief are no longer available to ALEs in 2016.  Last year, mid-size employers with 50-99 full-time employees were not required to comply with the employer mandate, and ALEs were required to offer coverage to only 70% of their full-time employee population.  This year, all ALEs are subject to the employer mandate provisions, and the threshold offer of coverage is up from 70% to 95%.
  • Offer of coverage codes: In addition to last year’s list of codes for reporting coverage on Line 14 of Form 1095-C, two new codes are available.  Codes 1J and 1K can be used to report conditional offers of medical coverage to a spouse.  A conditional offer of coverage is one that requires the spouse to satisfy a specific condition in order to be eligible for coverage.  For example, a requirement that the spouse not have access to other employer-provided coverage is considered a conditional offer.
  • Reporting COBRA: The IRS provides clarification in the 2016 instructions on how employers should report an offer of COBRA coverage on Form 1095-C.  An offer of COBRA coverage to a former employee (and dependents) should not be reported as an offer of coverage (i.e., no offer of coverage).  Conversely, an offer of COBRA coverage made to an active employee should be reported as an offer of coverage regardless of whether the active employee elects COBRA.

 

With the final 2016 forms and instructions now available, employers should not delay preparations to meet the upcoming January 31 deadline. Advance planning is critical, particularly for employers required to file electronically with the IRS (those filing 250 or more forms). Review the final forms here.

Information provided by Felice Insurance


Covered California, the health insurance marketplace for Californians not covered by employer-sponsored health insurance programs, is now open for business (started on October 1, 2013).  Coverage began on January 1st, 2014 for plans purchased throught this marketplace; there is an open enrollment period each year, genearlly from October through February.

SHOP, the small business health options plan, will be available to companies with up to 50 employees, with tax credits up to 50% for some employers (under 25 enrollees).  SHOP is offering up to 30 different group health plans.  Features of this program are that employers will not be subject ot risk-loss adjustment factors, plans that are on a level playing field with small group plans offered outside SHOP.

For more information, log onto www.eindividualhealth.com or visit www.CoveredCA.com.

Consumers in both the individual and SHOP market can purchase insurance plans directly from Covered California, or they can use the services of an agent that has been certified by Covered California, formally titled a Certified Insurance Agent (their services are free to consumers as they are paid by insurance carriers at the same rates inside or outside of the exchange).


Employers are required, beginning on October 1, 2013, to provide the insurance exchange notice to each new employee at the time of hiring.  For 2014, the U.S. Department of Labor will consider the notice to be delivered timely if it is provided within 14 days of an employee's start date.  On September 12, 2013, the DOL announced they would not assess penalties to employers for failing to provide this notice, but employers are still encouraged to provide this notice to their employees.  Sample notice lanaguage can be found here.


Additional resources can be found on the U.S. Department of Labor website here.