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Health Care Reporting Requirements for Business

Smart business owners know the importance of keeping good records. The Affordable Care Act has created one more incentive for employers to keep abreast of sometimes complicated reporting requirements, by requiring them to provide information about company-provided health care to both their employees and the government.

Not all of the law’s employer responsibility provisions have been implemented yet. Nevertheless, it makes good business sense to establish effective systems to meet obligations that are likely to be rolled out soon. Acting early will give business owners more time to iron out any wrinkles before the law comes to bear.

Reporting to Employees

The Affordable Care Act requires most employers to report the cost of any employer-sponsored group health plan on employee Forms W-2. This requirement applies to all employers who provide what the government defines as “applicable coverage,” even if the employers are religious organizations or are not subject to Consolidated Omnibus Budget Reconciliation Act (COBRA) requirements. Small businesses issuing fewer than 250 Forms W-2 total are exempt from the reporting requirement until further guidance is issued.

For businesses subject to the rules, the amount reported in Box 12 of Form W-2 must include both the employer and employee portions of the plan’s cost. Certain forms of coverage must be reported, while other forms are either optional or excluded. For more information, see the IRS’ full chart of reporting requirements. (1)

Affected employers are not required to issue Forms W-2 to workers who would not normally receive one, such as retirees, simply to fulfill the requirement. For terminated employees, employers may use any reasonable method to report partial-year coverage, as long as the method is applied consistently. For employees who voluntarily leave and request Forms W-2 in writing prior to year-end, employers must provide the forms within 30 days of the request, but are not required to report the health benefit amounts.

Proposed Section 6056 regulations from the Internal Revenue Service would mainly affect reporting to the Service, though they would also require employers to notify employees in writing of any employee-related information shared with the IRS. These statements will need to be provided annually by January 31. Note that these regulations are still under discussion, and that there is a chance Form W-2 reporting alone could satisfy the requirement. Nevertheless, employers should pay attention to how the final regulations are worded.

Employers subject to the Fair Labor Standards Act have a responsibility to provide all new employees, both part- and full-time, with a written notice pertaining to the Health Insurance Marketplace. These employers include federal, state and local government agencies; hospitals and institutions engaged primarily in the care of the sick, the aged or the developmentally disabled who live on the premises; preschools, elementary and secondary schools, postsecondary institutions of higher learning and schools for gifted children; and companies or organizations with annual sales of receipts over $500,000.

The Health Insurance Marketplace, often referred to as the exchanges, may provide alternatives that cost less than the employer-provided health care plan, if any. Employers must make clear that employer contributions, if any, may be lost if the new employee chooses to pursue private insurance instead. Employers may satisfy the notice requirement through third-party entities, such as insurers or multiemployer health plans, as long as every new employee receives such a notice regardless of whether he or she plans to enroll in the company health care plan.

Finally, any employer providing a health care option must also furnish employees with a standard Summary of Benefits and Coverage (SBC) form. This form explains what services and care the plan does and does not cover. It also lays out the plan’s cost clearly.

Reporting to the IRS

As previously mentioned, the Affordable Care Act introduced new reporting guidelines for employers, known as Section 6056 rules, which mainly affect how employers will report to the IRS. Last September, the Treasury issued proposed regulations to provide further guidance on how businesses should observe the rules; the final regulations were released in mid-February. For the most part, these regulations only apply to employers that had 50 or more full-time employees (or full-time equivalent employees) for the prior year.

Affected large employers must file a return with the IRS reporting certain information for every employee who was full-time for at least one month during the calendar year, including:

The employee’s name
The employee’s address
The employee’s Taxpayer Identification Number (TIN)
Information about the health care coverage offered to each employee by month, including
What coverage was available
The employee’s share of the lowest-cost, self-only premium
Which months, if any, the employee was actually covered under the plan

The return will also specify how many employees the business had each month in the calendar year. These requirements are currently scheduled to take effect in 2015.

In addition to Section 6056 rules, certain employers may also fall subject to Section 6055 rules, regardless of size. These rules mainly apply to institutions providing health insurance, such as insurers. However, businesses that self-insure may also need to follow these rules. Affected businesses must provide information for each individual enrolled in minimum essential coverage, including the individual’s name, taxpayer ID number and the months in which the individual received coverage.

The IRS is currently considering allowing Section 6055 and Section 6056 reporting to be submitted together for organizations subject to both sets of rules. However, this concession has not yet been granted. Like Section 6056 rules, Section 6055 rules are scheduled to become mandatory in 2015, but are optional in 2014.

Employers that self-insure may also fall subject to the Patient-Centered Outcomes Research Trust Fund fee (the PCORI fee). The fee applies to policy years ending after September 30, 2012 and before October 1, 2019, and is equal to the product of the average number of individuals covered for the year and the applicable dollar amount. Organizations subject to the fee will need to file Form 720 annually to report and pay the fee.

If any of a business’ employees are liable for the Additional Medicare Tax, employers will also need to withhold the tax, set at 0.9 percent, and report the withholding. The threshold earnings amount to determine the tax liability is $200,000 for single filers and $250,000 for married taxpayers filing jointly. This tax should not be confused with the Net Investment Income Tax (NIIT), which is also sometimes called the Medicare surtax. The NIIT does not affect wages and is not the employer’s responsibility.

While small businesses are largely exempt from these mandatory reporting requirements, businesses with fewer than 25 full-time employees may wish to secure a tax credit for voluntarily providing health care coverage to their workers. Qualifying businesses will need to apply for the credit using Form 8941.

Self-employed individuals may also be eligible for a tax deduction for the cost of their health care. However, the Affordable Care Act has made this deduction solely applicable to income taxes, whereas in the past a deduction against self-employment taxes was available. Eligibility for this deduction is determined on a month-by-month basis.

Reporting to States

Certain states may have their own health care reporting requirements. For example, Massachusetts-based employers with 11 or more employees must file an Employer Health Insurance Responsibility Disclosure and an Employee Health Insurance Responsibility Disclosure for each employee. While these rules are not a product of the Affordable Care Act, employers should take care to comply with all state-specific reporting requirements as well as with federal rules.

Retiree Health Care Benefits Continue to Decline

Employer-based retirement health care insurance benefits continue to decline, according to recent industry reports.

Many retirees have been able to rely on private or state employer-based retirement health benefits for supplemental health care coverage while on Medicare in the past, but this is becoming less common.

Employer-based health-related benefits can provide important coverage for the gaps that exist in Medicare programs. Additional coverage benefits can alleviate the cost-sharing requirements and deductibles associated with Medicare. Caps on the amount that can be spent out-of-pocket, often associated with supplemental coverage, are also often helpful for retirees.

Overall, supplemental retiree health and medical benefits sponsored by a private or municipal employer have helped many retirees cope with high medical costs often incurred in retirement.

The Kaiser Family Foundation recently reported, however, that the number of large private employers-considered employers with 200 or more employees-offering retiree healthcare benefits has dropped from 66 percent in 1988 to 23 percent in 2015.

Companies that do continue to offer retiree health benefits have been making changes aimed at reducing the cost of benefits, including:

Instituting caps on the amount of the provider’s financial liability
Shifting from defined benefit to defined contribution plans
Offering retiree health care benefits through Medicare Advantage plan contracts
Creating benefit programs through private health insurance exchanges

State employers have also not been immune to the trend, but the type and level of coverage being offered by most states is significantly different than retirement health care coverage being offered by large companies.

Unlike many private employers, state governments continue to offer some level of retiree health care benefits to help attract and retain talented workers, according to a report titled “State Retiree Health Plan Spending,” published by The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation in May, 2016.

With the exception of Idaho, all states currently offer newly-hired state employees some level of retirement health care benefits as part of their benefits package, according to the report. Of the states offering retiree medical benefits, 38 have made the commitment to contribute to health care premiums for the coverage being offered. State employers are, however, also making changes to the retirement health care insurance benefits they provide to state workers.

Significant among these changes for the states is at least one driving force-the Governmental Accounting Standards Board (GASB) now requires states to report liabilities for retirement benefits other than pensions in their financial statements. The changes were required from all states by the end of 2008. As a result, the increased financial transparency forced states to review the cost of their other post-employment benefits (OPEB) and address how they plan to pay for them.

Because retirement health care benefits account for the majority of the states’ OPEB obligations, many states have made policy changes to address the upcoming obligations. Factors such as date of hire, date of retirement or vesting eligibility, including minimum age and minimum service year requirements, are now being used by states to vary or limit retirement health care benefits.

Overall, from 2010 to 2013, the states saw their OPEB liabilities decrease by 10 percent from $627 billion after inflation adjustments. While this may sound contradictory, the declines are attributed to a slowdown in the growth of health care costs coupled with benefit modifications aimed at cost reductions.

To look at one state as an example, California’s recent budget revealed that health care benefits for retirees are costing the state more than $2 billion a year for an 80 percent increase over the prior 10 years. Although the situation recently changed, California was previously one of 18 states that had nothing set aside to cover its future retiree health care benefit costs of $80.3 billion.

It should be noted that retiree health care plans are typically funded by plan sponsors on a “pay as you go” basis, meaning that monies to pay current and future health care obligations are taken from current assets and not set aside in advance. This differs significantly from pension plans governed by ERISA, which are subject to funding guidelines.

In response to California’s unfunded OPEB liability, employees and the state are now paying into a fund for future retiree health care benefit costs. The state is also matching $88 million in employee contributions and paying an additional $240 million to prefund future retirement health care benefit costs. The changes are impacting retirees as well as state and private employers.

Overall, employer-based retirement health care benefits, once important for supplementing Medicare for retired seniors, continue to decline.

The Potential Impact of Eroding Employer-Based Health Care Retirement Benefits

Many baby boomers who are currently covered by retiree medical plans and plan to rely on future employer-paid medical benefits, are likely to be disappointed to learn that these benefit plans can be changed or terminated. ERISA-governed benefit plans typically contain a “reservation of rights” provision allowing the plan sponsor to change or terminate all or parts of the plan. Many private and state employers are reducing or terminating retiree health benefits due to the increasing cost of insurance premiums, rising health care costs, and increases in longevity.