Mandatory ACA Reporting Requirements
Portico will mail IRS Form 1095-B, Health Coverage, to your sponsored health plan members if they and/or their family members had ELCA-Primary health benefits in 2022. Plan members can use this information when filing their individual income tax return, if required, to report they had minimum essential coverage. To demonstrate compliance that minimum essential coverage was offered by your organization, Portico will also file a copy of Form 1095-B with the IRS before the deadline, unless you are an Applicable Large Employer. Note: Applicable Large Employers (ALEs), however, have additional reporting requirements.
Do you fall into the category of Applicable Large Employer (ALE)? According to the IRS, “if an employer has at least 50 full-time employees, including full-time equivalent employees, on average during the prior year, the employer is an ALE for the current calendar year.”1 The IRS offers guidance to determine workforce size; please consult your tax advisor with additional questions.
To maintain ACA compliance, ALEs must issue 1095-C to sponsored health plan members and file Forms 1094-C and 1095-C with the IRS by the deadline to demonstrate compliance with the minimum essential health coverage requirement and the shared responsibility requirement.
- IRS Form 1094-C summarizes 1095-C information.
- IRS Form 1095-C reports information about minimum essential health coverage offered by the employer during the previous year.
ALEs are required to handle these tasks on their own, by the deadline.
Note: Employers in California, the District of Columbia, New Jersey, and Rhode Island are required to provide 1095-B reporting to their state/district. On behalf of employers, Portico will file the requisite 1095-B reporting with these states/district for employees and family members enrolled in ELCA-Primary benefits at any time during the plan year.
Although the federal individual health insurance mandate penalty no longer applies, the federal employer health mandate penalty remains in effect, and the IRS has issued penalty notices for noncompliance. If your organization receives a penalty notice, consult with your tax advisor or payroll provider right away. Employers can appeal the penalty or request an extension within 30 days. Keep in mind that all ELCA-Primary health benefit options meet the required standards of minimum essential coverage.
Helpful IRS Links
1094-C, 1095-C Instructions
Note: These forms are 2021 forms and will automatically update to 2022 when the IRS makes them available.
Notice of Coverage Options in the Marketplace: The Affordable Care Act requires organizations subject to the requirements of Section 18B of the Fair Labor Standards Act to provide this written notice to their employees, describing the existence of state exchanges and their potential eligibility for federal subsidies.2 The Notice is available on EmployerLink and must be provided to new employees within 14 days of their start date.
CHIP Notice: Your organization may be required to notify employees about potential opportunities for low-income children and their families to receive health coverage premium assistance under Medicaid or the Children’s Health Insurance Program (CHIP).
This requirement applies to employers that offer a group health plan, like the ELCA Health Plan, within a state that provides medical assistance under Medicaid or CHIP, but only if the employee pays all or a portion of the health coverage premium. Employers are required to provide this notice, Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP), annually, in paper form or electronically, before the first day of the plan year (Jan. 1). The Notice is available on EmployerLink.
Portico manages the following on your behalf:
- Patient-Centered Outcomes Research Institute (PCORI) Fee: Also known as comparative effectiveness tax, the annual PCORI Fee helps to fund the Patient-Centered Outcomes Research Trust Fund and is paid by Portico for each individual covered under the ELCA Health Plan.
- Summary of Benefits and Coverage (SBC) documents available on EmployerLink and myPortico: Standardized documents summarizing the key features of the Plan’s benefits and coverage.
Retirement Plan Contributions & Withholdings
As a reminder, during annual benefits enrollment, and any time throughout the year, employees may update their withholding elections for pretax contributions. Make sure to record these updates in your payroll system. It is your responsibility to keep track of employee contribution elections, adjust payroll withholdings, and submit contributions in a timely manner.
According to the IRS, failure to make deposits timely — however innocent the mistake —may result in plan disqualification and even civil and criminal penalties.3
For employers who offer Portico retirement benefits to their employees, make sure your payroll system is current by reviewing the payroll withholding summary.
1Determining if an Employer is an Applicable Large Employer, IRS, Retrieved September 9, 2022 from https://www.irs.gov/affordable-care-act/employers/determining-if-an-employer-is-an-applicable-large-employer
2Fair Labor Standards Act (FLSA) Advisor, U.S. Department of Labor, Retrieved September 9, 2022 from https://webapps.dol.gov/elaws/whd/flsa/scope/screen24.asp
3Retirement Topics – Contributions, IRS.gov, Retrieved September 12, 2022 from https://www.irs.gov/retirement-plans/plan-participant-employee/retirement-topics-contributions
Portico Benefit Services does not provide tax or legal advice; this is for educational purposes only. We provide certain written tax information of general application to help members understand the way in which we administer our plans. For tax questions or advice specific to you, consult with your own tax or legal advisor.