Benefit News

Reminder: Upcoming ACA and State Mandate Reporting Deadlines

February 16, 2021

As a reminder, there are upcoming deadlines for Affordable Care Act (ACA) reporting under internal Revenue Code (Code) Section 6055 and Section 6056 for the 2020 calendar year. Specifically, reporting entities must:

  • File returns with the IRS by March 1, 2021, since February 28, 2021, is a Sunday (or March 31, 2021, if filing electronically); and
  • Furnish statements to individuals by March 2, 2021.

In addition, the states of California, New Jersey, District of Columbia, and Rhode Island have upcoming reporting deadlines to comply with their respective state’s individual mandate requirements. These are also summarized below.

ACA Reporting Under Code Sections 6055 and 6056

  • Code Section 6055 applies to providers of minimum essential coverage (MEC), such as health insurance issuers and employers with self-insured health plans. These entities generally use Forms 1094-B and 1095-B to report information about the coverage they provided during the previous year.
  • Code Section 6056 applies to applicable large employers (ALEs). Generally, those employers with 50 or more full-time employees, including full-time equivalents, in the previous year. ALEs use Forms 1094-C and 1095-C to report information relating to the health coverage that they offer (or do not offer) to their full-time employees.

The ACA’s individual mandate penalty was reduced to zero beginning in 2019. As a result, the IRS has been studying whether and how the Code Section 6055 reporting requirements should change, if at all, for future years. Despite the elimination of the individual mandate penalty, Code Section 6055 reporting continues to be required, although transition relief from penalties under Code Section 6722 is available in some situations.

California Individual Mandate Reporting Requirements

To help administer the individual mandate, California law imposes a reporting requirement on every entity that provides MEC to an individual during a calendar year, similar to the ACA’s reporting requirement under Code Section 6055. This reporting requirement applies to:

  • Employers or other sponsors of employment-based health plans, for employment-based MEC;
  • The State Department of Health Care Services and county welfare departments, for MEC under a state program;
  • Carriers licensed or otherwise authorized to offer health coverage, for MEC they provide that is not described above (including catastrophic plan coverage);
  • The Exchange, for individual health plans (except catastrophic plans) on the Exchange; and
  • Any other provider of MEC (including the University of California, for coverage under a student health insurance program).

Under this reporting requirement, entities that provide MEC will be required to provide the following information to covered individuals and the California Franchise Tax Board (FTB):

  • The name, address and Social Security number (SSN) or taxpayer identification number (TIN) of the primary insured, and the name and SSN or TIN of each other individual covered under the policy;
  • The dates during which those individuals were covered under MEC during the calendar year; and
  • Any other information the FTB may require.

The law specifically provides that the California reporting requirement may be satisfied by providing the same information that is currently reported under the Federal Code Section 6055 reporting requirement, using the same federal forms (that is, Forms 1094-B and 1095-B, or 1094-C and 1095-C, as appropriate).

For this purpose, the Forms 1095-B and 1095-C (self-insured plans) must be provided to the employee and any individual receiving MEC through an employer by January 31 of the year following the calendar year to which the return relates. These forms must also be filed with the FTB by March 31 of the year following the calendar year to which the return relates. However, the California instructions for these forms provide that no penalty will be imposed under this requirement for forms filed with the FTB on or before May 31. Note that in most instances, the carrier will undertake responsibility for providing and filing the Forms 1095-B; whereas, the employer or plan sponsor will undertake this responsibility for self-insured plans.

District of Columbia Reporting Requirements

To help administer the individual mandate penalty, D.C. imposes a reporting requirement on every entity that provides MEC to an individual during a calendar year, similar to the ACA’s reporting requirement under Internal Revenue Code Section 6055. This reporting requirement applies to:

  • Employers or other sponsors of employment-based health plans that covered at least 50 full-time employees, including at least one D.C. resident, during the applicable calendar year;
  • Persons or entities that provided MEC to a D.C. resident during the applicable calendar year;
  • The D.C. Department of Health Care Finance; and
  • Insurance carriers licensed or otherwise authorized to offer MEC.

To satisfy this reporting requirement, reporting entities are required to electronically file the federal Forms 1094-C and 1095-C, or 1094-B and 1095-B, as applicable, through www.MyTax.DC.gov, using the D.C. Office of Tax and Revenue’s (OTR’s) prescribed layouts and file formats. The deadline is 30 days after the IRS deadline for submitting Forms 1095-B or 1095-C, including any extensions granted by the IRS. OTR published Notice 2019-04 to provide more information on this reporting requirement.

For further information, also visit the Frequently Asked Questions on the OTR website here.

New Jersey Reporting Requirements

To help administer the individual mandate penalty, the New Jersey Health Insurance Market Preservation Act imposes a reporting requirement on every entity that provides MEC to an individual during a calendar year, similar to the ACA’s reporting requirement under Code Section 6055. This reporting requirement applies to:

  • Employers or other sponsors of employment-based health plans, for employment-based MEC;
  • The New Jersey Department of Human Services, for the NJ FamilyCare Program; and
  • Carriers licensed or otherwise authorized to offer health coverage, for coverage they provide that is not described above.

Under this reporting requirement, entities that provide MEC are required to provide the following information to covered individuals and the New Jersey state treasurer:

  • The name, address and Social Security number (SSN) or taxpayer identification number (TIN) of the primary insured, and the name and SSN or TIN of each other individual covered under the policy;
  • The dates during which that individual was covered under MEC during the calendar year; and
  • Any other information the state treasurer may require.

To satisfy this reporting requirement, reporting entities are required to file the federal Forms 1094-C and 1095-C, or 1094-B and 1095-B, as applicable, through New Jersey’s system for filing of W-2 forms. For 2020 coverage information, the deadline for filing these forms electronically is March 31, 2021. More information on this reporting requirement is available on the NJ Department of the Treasury website.

Entities that provide MEC are also required to provide information to covered individuals. For 2020 coverage information, the deadline for furnishing Forms 1095-B or 1095-C to individuals, as applicable, is March 2, 2021.

For further information, visit the state’s website here.

Rhode Island Reporting Requirements

To help administer the individual mandate penalty, Rhode Island imposes a reporting requirement on every entity that provides MEC to an individual during a calendar year, similar to the ACA’s reporting requirement under Internal Revenue Code Section 6055. This reporting requirement applies to:

  • Employers or other sponsors of employment-based health plans, for employment-based MEC;
  • The Rhode Island Medicaid single state agency, for Medicaid or Children’s Health Insurance Program (CHIP) coverage; and
  • Carriers licensed or otherwise authorized to offer health coverage, for coverage they provide that is not described above.

For coverage provided by a governmental unit (or any agency or instrumentality thereof), the officer or employee who enters into the agreement to provide the coverage (or the person appropriately designated for purposes of this reporting requirement) is responsible for completing this reporting. An affected entity may contract with third-party service providers, including insurance carriers, to provide the required returns and statements.

Under this reporting requirement, entities that provide MEC are required to provide the following information to covered individuals and the Rhode Island tax administrator:

  • The name, address and taxpayer identification number (TIN) of the primary insured, and the name and TIN of each other individual covered under the policy;
  • The dates during which that individual was covered under MEC during the calendar year; and
  • Any other information the tax administrator may require.

Affected entities are also required to provide a written statement to each individual whose name is included on the return. The statement must contain the name, address and contact information of the affected entity and the information included in the return with respect to the individuals listed. This written statement must generally be provided on or before January 31 of the year following the calendar year for which the return was required to be made. However, for the 2020 Tax Year only, the Division of Taxation will extend the state reporting deadline (1) to individuals to March 2, 2021 and (2) to the Division to March 31, 2021. It is presumed that the Forms 1095-B and Forms 1095-C (self-insured plans) will be provided for this purpose.

For further information visit the Rhode Island’s Division of Taxation website here.

For additional information, please contact your Burnham Consultant or Burnham, A Baldwin Risk Partner at 949‐833‐2983 or inquiries@burnhambenefits.com.


Burnham Benefits does not engage in the practice of law and this publication should not be construed as the providing of legal advice or a legal opinion of any kind. The consulting advice we provide is intended solely to assist in assessing its compliance with the Patient Protection and Affordable Care Act and other applicable federal and state law requirements, and is based on Burnham Benefit’s interpretation of federal guidance in effect as of the date of this publication. To the best of our knowledge, the information provided herein, and assumptions relied on, are reasonable and accurate as of the date of this publication. Furthermore, to ensure compliance with IRS Circular 230, any tax advice contained in this publication is not intended to be used, and cannot be used, for purposes of (i) avoiding penalties imposed under the United States Internal Revenue Code or (ii) promoting, marketing or recommending to another person any tax-related matter.

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