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 2023. 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. Applicable Large Employers (ALEs) and organizations located in Massachusetts, 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.
If employers request health coverage information needed to complete the forms, Portico will provide the information.
Important Instructions
Please complete Form 1095-C as an ALE with an insured group health plan. This means that for the IRS filing, ALEs do not complete Part III of Form 1095-C for plan members sponsored in ELCA-Primary health benefits.
Additional Reporting for Massachusetts
Employers in Massachusetts are required to issue MA Form 1099-HC to its sponsored plan members if they and/or their family members had ELCA-Primary health benefits. The MA Form 1099-HC must also be filed with the MA Department of Revenue. The employer is responsible for completing the requirements imposed by Massachusetts. If employers request health coverage information needed to complete the form, Portico will provide the information.
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.
Patient-Centered Outcomes Research Institute (PCORI) Fee
The ACA imposes a patient-centered-outcomes-research-trust-fund fee on employers that offer certain types of health coverage under a self-insured health plan. The fees help fund the PCORI and its clinical effectiveness research to improve the quality of health care. The fee is paid by Portico.
Helpful IRS Links
1094-C, 1095-C Instructions
Form 1094-C
Form 1095-C
FAQs
Note: These forms are 2022 forms and will automatically update to 2023 when the IRS makes them available.
Additional Information on 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.
Resources
1Determining if an Employer is an Applicable Large Employer, IRS, Retrieved September 20, 2023, from 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 20, 2023, from webapps.dol.gov/elaws/whd/flsa/scope/screen24.asp.
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.