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Minimum Essential Coverage Reporting & Health Net

Jun 11, 2015

Health Net, like all health plan companies, is required to report Minimum Essential Coverage (MEC) data to the IRS for individuals, including covered dependents, beginning in 2016. As part of this requirement, Health Net is required to collect tax identification numbers (TIN) or Social Security numbers (SSN) – and they need your help!

Minimum Essential Coverage (MEC) reporting is a requirement under Section 6055 of the Affordable Care Act. Beginning in 2016, Health Net is required to file:

Both forms are filed for these plan types:

Reporting is not required for government programs including state health plans, Medicare, and Medicaid (Medi-Cal in California).

SSN/TIN Collection – Encourage Your Clients to Provide

The IRS forms require the name and Social Security number (SSN) or a tax identification number (TIN) for each covered individual. The months for which that individual was enrolled for at least one day of coverage and entitled to receive benefits also will be reported.

Health Net is required to make three attempts to collect SSNs/TINs for covered members in order to provide complete reporting to the IRS. Their first attempt is at the time of enrollment, followed by two annual solicitations. Health Net will begin these attempts this year. Please encourage your clients to include TIN/SSNs for themselves and their covered dependents on the enrollment form and/or to respond to Health Net's request.

Reassure them that it is completely safe to give Health Net this information. It’s also to their benefit. Without the SSN/TIN, the IRS will not be able to match coverage reported on your client’s IRS Form 1040 with the coverage information Health Net will report on the Form 1095-B. The inability to match could result in a tax penalty related to the ACA individual responsibility mandate.

Filing Requirements At-a-Glance

In addition to the forms that health plans are required to file, the Marketplaces and certain employer groups also have form-filing requirements. The chart below outlines who sends what form.

 

Plan TypeMinimum Essential Coverage Reporting (Section 6055)Employer Shared Responsibility Reporting (Section 6056)
Individual (Marketplace plan)Form 1095-A
Sent by the Marketplace
N/A
Individual (non-Marketplace)Forms 1094-B & 1095-B
Filed and sent by the Health Plan
N/A
Small Group fully insured plan (SHOP and non-Marketplace)Forms 1094-B & 1095-B
Filed and sent by the Health Plan
N/A
Small Group self-insured plan (non-ALE)Forms 1094-B & 1095-B Employer’s responsibility to file and send statements to employees/former employeesN/A
ALE fully insured planForms 1094-B & 1095-B
Filed and sent by the Health Plan
Forms 1094-C & 1095-C
(sections I & II only)
Employer responsibility to file and send statements to employees
ALE self-insured planForms 1094-C & 1095-C
(all sections) •
Employer’s responsibility to file and send statements to employees •
Self-insured large group plans meet reporting requirements of both section 6055 and 6056 by filing Forms 1094-C & 1095-C
Showing 1 to 6 of 6 entries

 

Additional Forms and Information
IRS Form 1095-A – Health Insurance Marketplace Statement
IRS Form 1094-C – Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns
IRS Form 1095-C – Employer-Provided Health Insurance Offer and Coverage Insurance
IRS Form 1094-B – Transmittal of Health Coverage Information Returns
IRS Form 1095-B – Health Coverage
IRS FAQ – ESR section 6056 reporting

This information is for general purposes only and is not legal or tax advice. For more detailed information about IRS filings, tax or legal implications, please contact your professional tax advisor or legal counselor.

For questions regarding minimum essential coverage reporting, please ​contact a member of your b&p Sales Team - 888.722.3373.

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