How to Complete and File Forms 1094-B and 1095-B for ACA Information-Reporting Purposes

Author: Gloria Ju

The Affordable Care Act (ACA) created two annual information-reporting requirements:

  • Under Section 6055 of the Internal Revenue Code (IRC), small self-insured employers, health insurance issuers, government agencies and other health coverage providers must report information on each individual to whom minimum essential coverage (MEC) was provided.
  • Under Section 6056 of the IRC, every applicable large employer (ALE) subject to the ACA's employer shared responsibility (or pay or play) mandate must report the terms and conditions of the health care coverage the employer offered to its full-time employees.

This information must be filed with the Internal Revenue Service (IRS) and furnished to individual employees. This How To will help a self-insured employer correctly file and furnish Form 1094-B (Transmittal of Health Coverage Information Returns) and Form 1095-B (Health Coverage Information Return) for Section 6055 purposes. These forms are to be used by an employer that is not an ALE. Note that substitute forms may be used, but the substitute forms must include all of the information required by Forms 1094-B and 1095-B and must satisfy all of the IRS's form and content requirements.

Forms 1094-C and 1095-C are to be used by an ALE for Section 6055 and Section 6056 purposes. See How to Complete and File Forms 1094-C and 1095-C for ACA Information-Reporting Purposes.

Step 1: Determine Whether the Employer Is Covered

Every employer that provides MEC to an individual during a calendar year and that is not an ALE (i.e., the employer has fewer than 50 full-time employees, including full-time equivalent employees) must file Forms 1094-B and 1095-B. Plan sponsors are responsible for reporting self-insured employer coverage. Plan sponsors of self-insured employer coverage include:

  • Each participating employer (for its own employees) in a plan or arrangement established or maintained by more than one employer;
  • The association, committee, joint board of trustees or similar group of representatives that establishes or maintains a multiemployer plan;
  • The employee organization for a plan or arrangement maintained solely by an employee organization; and
  • Each participating employer (for its own employees) for a plan or arrangement maintained by a multiple employer welfare arrangement.

Step 2: Obtain an Employer Identification Number, If Needed

Forms 1094-B and 1095-B both require an Employer Identification Number (EIN). An employer that does not have an EIN may apply for one by:

  • Going to IRS.gov; or
  • Faxing or mailing Form SS-4, Application for Employer Identification Number, to the IRS.

Step 3: Determine Reporting Requirement, If Individual Covered by More Than One Type of MEC

If an individual is covered by more than one type of MEC, reporting is required of only one type, if one of the following rules applies:

If the individual is covered by more than one type of MEC provided by the same provider, the provider is required to report only one of the types of coverage. Under this exception, if an individual is covered by a self-insured major medical plan and a health reimbursement arrangement (HRA) provided by the same employer, the employer is the provider of both types of coverage and, therefore, is required to report coverage under only one of those arrangements.

A provider of MEC generally is not required to report coverage for which an individual is eligible only if the individual is covered by other MEC for which reporting is required. (For employer-sponsored coverage, this exception applies only if both types of coverage are under group health plans of the same employer.) This exception applies to the following situations:

  • An insurance company offering a Medicare or TRICARE supplement for which only individuals enrolled in Medicare or TRICARE are eligible is not required to report coverage under the Medicare or TRICARE supplement.
  • A state Medicaid agency is not required to report Medicaid coverage for which only individuals enrolled in other MEC, such as employer-sponsored coverage or a qualified health plan, are eligible.
  • An employer with an insured major medical plan and HRA coverage for which an individual is eligible because the individual enrolls in the insured major medical plan is not required to report the coverage under the HRA for an individual covered by both arrangements.

An employer must be aware that if an individual is covered by an HRA sponsored by one employer and a non-HRA group health plan sponsored by another employer (e.g., spousal coverage), then each employer must report the coverage that the employer provides.

Step 4: Fill Out Form 1094-B (Transmittal Form)

An employer must file a Form 1094-B when it files one or more Forms 1095-B. See Step 5: Fill Out Form 1095-B (Information Return).

Lines 1-8: Require completion of the filer's name and address, EIN, and the name and telephone number of the person to contact with questions. An employer may use a P.O. Box instead of a street address.

Line 9: This line is used to enter the total number of Forms 1095-B that are being transmitted with Form 1094-B.

Step 5: Fill Out Form 1095-B (Information Return)

An employer must file a Form 1095-B for each individual who is covered by MEC, including full-time, part-time and former employees.

Part I - Responsible Individual

Lines 1-7 require completion of the responsible individual's name; address; and Social Security Number (SSN), Taxpayer Identification Number (TIN) or date of birth.

Line 1: The responsible individual can be a primary insured employee, former employee, parent, uniformed services sponsor or other person enrolling individuals in coverage. It is not the business or business owner that is the policy-holder for its employees.

Line 2: Include dashes in the SSN (i.e., XXX-XX-XXXX). If the responsible individual does not have a SSN, a TIN may be entered instead. No SSN or TIN is needed if the responsible individual is not a covered individual identified in Part IV.

Line 3: Date of birth is needed only if there is no SSN or TIN.

Lines 4-7: A responsible individual's P.O. Box may be entered instead of a street address.

Line 8: Enter the letter identifying the origin of the policy:

  • A: Small Business Health Options Program (SHOP).
  • B: Employer-sponsored coverage.
  • C: Government-sponsored program.
  • D: Individual market insurance.
  • E: Multiemployer plan.
  • F: Other designated MEC.

An employer reporting self-insured group health plan coverage (code B) can skip Part II and go to Part III.

Line 9: Is reserved for future use.

Part II - Information About Certain Employer-Sponsored Coverage

This part is to be filled out by issuers or carriers of insured group health plans, including coverage purchased through the SHOP. If the employer is a member of a controlled group, then information should be entered for the specified control group member that is the covered employee's employer. If the coverage is provided through an association or a Multiple Employer Welfare Arrangement, then information should be entered for the participating employer of the employee. This part is not to be completed if an employer reports self-insured group health coverage or if coverage is provided through a multiemployer plan.

Lines 10-15: Require completion of the name, EIN and complete mailing address of the employer sponsoring the coverage. An employer may use a P.O. Box instead of a street address.

Part III - Issuer or Other Coverage Provider

This part is to be completed by the issuer or carrier of insured coverage, sponsor of a self-insured employer plan, government agency providing government-sponsored coverage or other entity.

Lines 16-17, 19-22: Require completion of the name, EIN and complete mailing address of the coverage provider.

Line 18: Requires the telephone number of a contact who can provide additional information.

Part IV - Covered Individuals

Lines 23-38 require completion of each covered individual's name; SSN, TIN or date of birth; and months of coverage.

Column (a): Enter the name of each covered individual.

Column (b): Include dashes in the SSNs (i.e., XXX-XX-XXXX). If a covered individual does not have a SSN, a TIN may be entered instead.

Column (c): Date of birth is needed only if there is no SSN or TIN.

Column (d): An individual is considered to be covered in all 12 months if he or she was covered at least one day per month in each of the 12 months of the calendar year.

Column (e): If an individual was not covered for all 12 months, the employer must check the box(es) corresponding to the month(s) in which the individual was covered for at least one day.

Part IV - Covered Individuals - Continuation Sheet

If there are more than six covered individuals, the information for the additional covered individuals must be completed on the continuation sheet(s). Continuation sheets are not included in the count of Forms 1095-B submitted with the accompanying Form 1094-B.

Step 6: File Forms With the IRS

Forms 1094-B and 1095-B must be filed with the IRS by February 28 (paper) or March 31 (electronic) of the year following the calendar year to which the return relates. Paper forms must be mailed on or before the due date. If the due date falls on a nonbusiness day (i.e., Saturday, Sunday or legal holiday), the due date is the next business day.

An employer may choose to file Forms 1094-B and 1095-B electronically or on paper.

Electronic filers must use the ACA Information Return System (AIR). According to IRS Publication 5164 and Publication 5165, an employer should:

  • Determine the responsible individuals and contacts who will handle the electronic filing;
  • Register with e-services;
  • Complete an Application for Transmitter Control Code (TCC), if the employer acts as an issuer, a software developer and/or a transmitter; and
  • Conduct ACA Assurance Testing System (AATS) testing. Different testing requirements apply depending on whether the employer acts as an issuer, a software developer and/or a transmitter. Software developers must pass AATS testing annually, while issuers and transmitters must do so the first year only.

An employer may apply for a hardship waiver from the electronic filing requirement by filing Form 8508, Request for Waiver From Filing Information Returns Electronically, at least 45 days before the due date of the returns. A waiver is good for only one tax year, so an employer must reapply in subsequent years.

Mailing addresses for paper filers are as follows:

  • Department of Treasury IRS Service Center, Austin, Texas 73301 (if the employer's legal residence, principal place of business or principal office or agency is located outside of the US or in Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, Virginia or West Virginia); or
  • Department of Treasury IRS Service Center, Kansas City, Missouri 64999 (if the employer's legal residence, principal place of business or principal office or agency is located in Alaska, California, Colorado, District of Columbia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Utah, Washington, Wisconsin or Wyoming).

Mailed forms should be sent flat (not folded) via first-class mail. If sending many forms in multiple packages, the employer should write its name on each package, number them consecutively and include Form 1094-B in package number one.

Step 7: Furnish Individual Statements to Employees

To fulfill the individual notice requirement, an employer may furnish a copy of Form 1095-B to the responsible individual named on the form. The individual statements must be furnished by January 31 of the year following the calendar year to which the form relates. If the due date falls on a nonbusiness day (i.e., Saturday, Sunday or legal holiday), the due date is the next business day. Note that for 2016 information reported in 2017 only, the deadline is extended to March 2, 2017.

An employer may truncate SSNs or TINs by showing only the last four digits and replacing the first five digits with Xs or asterisks. EINs may also be truncated. Truncation is not allowed on forms filed with the IRS, however.

Individual statements must be mailed to the recipient's last known permanent address (or temporary address if no permanent address is known), unless the individual has affirmatively consented to electronic receipt.

Step 8: Apply For an Extension, If Needed

An employer may receive an automatic 30-day extension for filing returns with the IRS by filing Form 8809, Application for Extension of Time to File Information Returns. The form must be filed with the IRS on or before the due date for Forms 1094-B and 1095-B. An employer may apply for an additional 30-day extension under certain hardship conditions.

In order to receive an extension of up to 30 days for furnishing employee statements, an employer must send a letter to the IRS, Attn: Extension of Time Coordinator, 240 Murall Drive, Mail Stop 4360, Kearneysville, WV 25430. The letter must be postmarked by the due date for the statements and must include:

  • Filer's name, TIN and address;
  • Type of return;
  • A statement that the extension request is for providing statements to recipients;
  • Reason for the delay; and
  • Signature of the filer or authorized representative.

Step 9: File Corrected Forms, If Needed

If an employer files a Form 1095-B with the IRS on paper and later determines there was an error on it (or there was a retroactive change in coverage), the employer must file a corrected return as soon as possible. The employer should fully complete Form 1095-B and enter an X in the "Corrected" checkbox. Form 1094-B should be filed with corrected Forms 1095-B. A copy of the corrected Form 1095-B must also be furnished to the individual who received the original Form 1095-B.

If correcting a Form 1095-B that has been furnished to an individual, but has not yet been filed with the IRS, the employer should write "Corrected" on the new Form 1095-B for the individual.

Instructions for making corrections to electronically filed forms are found in Publication 5165.

Step 10: Maintain Documentation

An employer must keep copies of information returns filed with the IRS, or maintain the ability to reconstruct the data, for a minimum of three years from the due date of the returns.