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Help with 1094 and 1095 Forms

Employers subject to section 4980H of the Internal Revenue Code (“Code”), generally meaning employers with 50 or more full-time employees (including full-time equivalent employees) in the preceding calendar year, use Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, and Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, to report the information required under Code sections 6055 and 6056 about offers of health coverage  and enrollment in health coverage for their employees.  Form 1094-C must be used to report to the IRS summary information for each employer and to transmit Forms 1095-C to the IRS.  Form 1095-C is used to report information about each employee.  The information reported on Form 1094-C and Form 1095-C is used in determining whether an employer owes a payment under the employer shared responsibility provisions under section 4980H.  Form 1095-C is also used by the IRS and the employee in determining the eligibility of the employee for the premium tax credit. 

Employers that offer employer-sponsored self-insured coverage also use Form 1095-C to report information to the IRS and to employees about individuals who have minimum essential coverage under the employer plan and therefore have met the individual shared responsibility requirement for the months that they are covered under the plan.

These FAQs provide detailed information about completing Form 1094-C and Form 1095-C. For information about the reporting requirements under section 6056, including guidance on who is an ALE member, see section 4980H Questions and Answers and section 6056 Questions and Answers.  For details about additional reporting requirements applicable to sponsors of self-insured health plans under section 6055, see Questions and Answers on Information Reporting by Health Coverage Providers.

Does The Affordable Care Act Affect COBRA?

With the passing of the Affordable Care Act, many are asking now “How does this affect my COBRA?” The passing of the Patient Protection and Affordable Care Act did not eliminate or change the COBRA rules.

COBRA, the Consolidated Omnibus Budget Reconciliation Act of 1986 allows workers and family members the option to continue on their prior employers group  medical plan for a specific number of months.  If your prior company had 20 or more employees in the previous year and they offered a group health plan, then COBRA would apply to your company.  If your previous company had less than 20 employees in the previous year and offered a group health plan, then Colorado Continuation of Benefits would apply to your company.

The employee count must include part time and part time equivalent employees.  To determine if you are eligible for COBRA or Colorado Continuation of Benefits the rules are as follows:

With COBRA, you are eligible after 1 day of being covered under your employers plan. Colorado Continuation of benefits requires that you are covered under your employers group health plan for at least 6 months, then you would be eligible.

The qualifying events that would enable you to secure coverage under COBRA or Continuation of Benefits in Colorado would include:

  • Termination of employment (Voluntary and Involuntary)
  • Death
  • Divorce
  • Eligibility for Medicare
  • Change in employment, Full Time to Part Time
  • Military recruitment

The coverage you are eligible for under COBRA or State Continuation is usually the exact same plan that was in place prior to your qualifying event.

The length of coverage for COBRA and Continuation of Benefits is normally 18 months, but certain qualifying events could allow you to extend your coverage to 36 months.  For example, if your spouse dies you would be allowed to continue on Cobra for 36 months.

If you are eligible for COBRA or Colorado Continuation of Benefits you might also qualify for a subsidy through the Connect For Health Colorado marketplace plans.  Researching whether or not you qualify for a tax credit might enable you to save some money and give you another option to investigate before signing up for COBRA or Continuation of Benefits.

Please note you have a certain period of time to notify your previous employer if you want to elect the COBRA or State Continuation of Benefits.  With COBRA you have up to 60 days to elect coverage.  With State Continuation you would have only up to 30 days for this election.

Keeping these deadlines in mind, you have actually more options since the passing of Affordable Care Act to decide whom you would like to continue your medical coverage with after you have experienced some type of qualifying event.

Please refer to this form on COBRA vs State Continuation of Benefits for more detailed information.