Affordable Health Care

Employers and Coverage Providers: 11 Facts About Health Care Information Forms

Under the Affordable Care Act, insurance companies, self-insured companies, and large businesses and businesses that provide health insurance to their employees must submit information returns to the IRS and individuals reporting on health coverage.
Taxpayers can use the information on these forms when they file their tax returns to verify the months that they had minimum essential coverage and determine if they satisfied the individual shared responsibility provision of the health care law. The IRS will use the information on the statements to verify the months of the individual’s coverage.
Here is some information about the types of forms, the purpose of each, and noteworthy dates
Form 1095-C, Employer-Provided Health Insurance Offer and Coverage
• This form is filed by applicable large employers, which generally are employers with 50 or more full-time employees, including full-time equivalents. • ALEs send this form to certain employees, with information about what coverage the employer offered.
• Employers that offer health coverage referred to as “self-insured coverage” send this form to individuals they cover, with information about who was covered and when.
• This form is submitted to the IRS with Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns.
• The deadline for filing this form with the IRS is February 28, 2017, or March 31, 2017 if filing electronically.
• The deadline for furnishing this form to the employee is March 2, 2017, which is a 30-day extension from the original due date of January 31.
Form 1095-B, Health Coverage Information Return
• This form is filed by providers of minimum essential coverage, including employers that are not applicable large employers, but who offer employer-sponsored self-insured health coverage.
• It is used to report information to covered individuals about each person enrolled in coverage – this form is sent to the person identified as the responsible individual on the form.
• This form is submitted to the IRS with Form 1094-B, Transmittal of Health Coverage Information Returns.
• The deadline for filing this form with the IRS is February 28, 2017, or March 31, 2017 if filing electronically.
• The deadline for furnishing this form to the covered individual is March 2, 2017, which is a 30-day extension from the original due date of January 31.

A Series of Yes-or-No Questions help you Determine Eligibility for the Premium Tax Credit

A Series of Yes-or-No Questions help you Determine Eligibility for the Premium Tax Credit
The premium tax credit – also known simply as PTC – is a credit for certain people who enroll, or whose family member enrolls, in a qualified health plan offered through a Health Insurance Marketplace. Answer the yes-or-no questions in the chart – or via accessible text – and follow the arrows to find out if you may be eligible for the premium tax credit.
The current open season with the Health Insurance Marketplace is underway and runs through Jan. 31, 2017. You must enroll by Dec. 15, 2016 to have coverage begin on January 1, 2017.
Here are links to information and resources referenced in the graphic:
• Form 8962, Premium Tax Credit (PTC) and Instructions
• Information about the federal poverty line (FPL)
• Publication 974, Premium Tax Credit (PTC)
• Interactive Tax Assistant: Am I Eligible to Claim the Premium Tax Credit

Employers that hire Holiday Help: Understand the Health Care Law’s Rules Around Seasonal Workers

season workersAs an employer, your size – for purposes of the Affordable Care Act – is determined by the number of your employees. If you hire seasonal or holiday workers, you should know how these employees are counted under the health care law.
Employer benefits, opportunities and requirements are dependent upon your organization’s size and the applicable rules. If you have at least 50 full-time employees, including full-time equivalent employees, on average during the prior year, you are an ALE for the current calendar year. However, there is an exception for seasonal workers.
If you have at least 50 full-time employees, including full-time equivalent employees, on average during the prior year, your organization is an ALE. Here’s the exception: If your workforce exceeds 50 full-time employees for 120 days or fewer during a calendar year, and the employees in excess of 50 during that period were seasonal workers, your organization is not considered an ALE. For this purpose, a seasonal worker is an employee who performs labor or services on a seasonal basis.
The terms seasonal worker and seasonal employee are both used in the employer shared responsibility provisions, but in two different contexts. Only the term seasonal worker is relevant for determining whether an employer is an applicable large employer subject to the employer shared responsibility provisions. For information on the difference between a seasonal worker and a seasonal employee under the employer shared responsibility provisions see our Questions and Answers page.
See the Determining if an Employer is an Applicable Large Employer page on IRS.gov/aca for details about counting full-time and full-time equivalent employees. You can also see our Health Care Law: Highlights for Applicable Large Employers video on the IRS YouTube channel’s Health Care playlist. IRS.gov/aca also has information that can answer your employees’ questions about the health care law.

What to Do if You Get a Letter about the Premium Tax Credit

Some taxpayers will be receiving an IRS letter about the premium tax credit; this letter is also known as a 12C letter. Be sure to read your letter carefully and respond timely. Here are answers to questions you may have about this letter.
Why am I getting this letter?
The IRS sent you this letter because the Marketplace notified us that they made advance payments of the premium tax credit on your behalf to your or your family’s insurance company last year.
• You also received this letter because – when you filed your individual 2015 tax return – you didn’t reconcile the advance payments of the premium tax credit. To reconcile, you use Form 8962, Premium Tax Credit, to compare the advance payments with the amount of your credit. Filing your tax return without including Form 8962 will delay your refund and prevent you from receiving advance credit payments in future years.
What do I need to do now?
• You must respond to the letter, even if you disagree with the information in it. If you disagree, send the IRS a letter explaining what you think is in error.
• If you received this letter, but didn’t enroll in health insurance through the Marketplace, you must let the IRS know.
• The letter outlines the information you should provide in your response, which includes:

• A copy of the Form 1095-A, Health Insurance Marketplace Statement, that your Marketplace sent earlier this year
• A completed Form 8962
• The second page of your tax return, which includes the “Tax and Credits” and “Payments” sections, showing the necessary corrections and your signature. You must complete either the line for “excess advance premium tax credit repayment” or the line for “net premium tax credit.”
• If you originally filed a Form 1040EZ tax return, you must transfer the information from your Form 1040EZ to a Form 1040A and include it with your response to the 12C letter.
Is there anything else I need to know?
• If you need your Form 1095-A, you should contact your Marketplace directly. The IRS does not issue and cannot provide that information to you.
• Do not file a Form 1040X, Amended U.S. Individual Income Tax Return. Once you respond to the letter, the IRS uses the information you provide to process your tax return.
• You can mail or fax your response. Be sure to include a copy of the letter with your response. Use the mailing address and fax number in the letter to respond.
• For more information about the health care law and the premium tax credit, visit IRS.gov/aca for more information.

If you have questions or need help responding fell free to call us at ASY for assistance

Here’s the 4-1-1 on Calculating an Individual Shared Responsibility Payment

The Affordable Care Act requires you and each member of your family to have minimum essential coverage, qualify for an insurance coverage exemption, or make an individual shared responsibility payment for months without coverage or an exemption when you file your federal income tax return.

In general, the annual payment amount is the greater of these two amounts:
• A percentage of your household income – 2 percent of income above filing threshold for 2015
• A flat dollar amount – $325 per adult and $162.50 per child for a family maximum of $975 for 2015
However, this is capped at the national average premium for a bronze level health plan available through the Marketplace. You will owe 1/12th of the annual payment for each month you or your dependents don’t have either coverage or an exemption.
Your payment amount is capped at the cost of the national average premium for a bronze level health plan available through the Marketplace. For 2015, the annual national average premium for a bronze level health plan available through the Marketplace is $2,484 per year – or $207 per month – for an individual and $12,240 per year – or $1,020 per month – for a family with five or more members.
If you are required to make a payment, you can use the worksheets located in the instructions to Form 8965, Health Coverage Exemptions, to figure the shared responsibility payment amount due.
If you did not have coverage and your income was below the tax filing threshold for your filing status, you qualify for a coverage exemption. You do not have to file a tax return solely to claim this exemption. However, if you do file a return, you should file Form 8965, Health Coverage Exemptions, and you should not make a payment with your return.
For more information about determining the amount and reporting your payment on your tax return, see our Calculating the Payment page. You can also use the Individual Shared Responsibility Payment Estimator, which can help you estimate the amount you may have to pay if you did not have minimum essential coverage during the year.

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