Proposed regulations - Guidance on health insurance coverage offered by large employers, information reporting of minimum essential coverage 

September 6: The Treasury Department and IRS released for publication in the Federal Register two sets of proposed regulations that provide guidance to large employers on health insurance coverage offered to employees and guidance concerning information reporting of minimum essential coverage.

  • One set of proposed regulations (REG-136630-12) [PDF 209 KB] provides guidance for “large employers”—i.e., those satisfying the definition under section 4980H and subject to the section 6056 requirements to furnish statements to employees for use in determining eligibility for the insurance premium tax credit under section 36B—about compliance with the employer shared-responsibility provisions and the health care coverage offered to employees.


  • The second set of proposed regulations (REG-132455-11) [PDF 179 KB] provides guidance to providers of minimum essential health coverage that are subject to the information reporting requirements of section 6055—i.e., health insurance issuers, certain employers, and others that provide minimum essential coverage to individuals and that must report to the IRS information about the type and period of coverage and furnish related statements to covered individuals.

Both sets of proposed regulations will appear in the Federal Register on Monday, September 9, 2013. Comments or requests to speak at public hearings (scheduled for November 2013) are due 60 days after this date of publication.

Background

The health care law (known as the Affordable Care Act or ACA):


  • Requires information reporting (under section 6055) by insurers, self-insuring employers, and other parties that provide health coverage
  • 
  • Provides for information reporting (also under section 6056) by employers that are large enough to be subject to the employer shared-responsibility provisions regarding the health coverage they offer their full-time employees.

Under these rules, employers, insurers, and other reporting entities must report:


For section 6055—


  • Information about the entity providing coverage, including contact information
  • A list of individuals with identifying information and the months they were covered

For section 6056—


  • Information about the applicable large employer offering coverage (including contact information for the employer and the number of full-time employees).
  • A list of full-time employees and information about the coverage offered to each, by month, including the cost of self-only coverage

Proposed regulations

According to a Treasury Department release, the proposed regulations describe a variety of options that could potentially reduce or streamline information reporting by:


  • Replacing section 6056 employee statements with Form W-2 reporting on offers of employer-sponsored coverage to employees, spouses, and dependents
  • Eliminating the need to determine whether particular employees are full-time if adequate coverage is offered to all potentially full-time employees
  • Allowing employers to report the specific cost to an employee of purchasing employer-sponsored coverage only if the cost is above a specified dollar amount
  • Allowing self-insured group health plans to avoid furnishing employee statements under both section 6055 and section 6056 by furnishing a single substitute statement
  • Limiting the required reporting for certain self-insured employers offering no-cost coverage to employees and their families
  • Permitting health insurance issuers to forgo reporting under section 6055 on individual coverage offered through a “marketplace” because that information will be provided by the “marketplace”
  • Permitting health insurance issuers, employers, and other reporting entities under section 6055 to forgo reporting the specific dates of coverage (instead reporting only the months of coverage), the amount of any cost-sharing reductions, or the portion of the premium paid by an employer.

Once the final regulations are published, reporting entities will be encouraged to voluntarily implement information reporting in 2014 (when reporting will be optional), in preparation for the full application of the reporting provisions in 2015.




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