REQ EQUIRE UIREMENT MENTS: S: NE NEW HI HIRE E CHE HECKLIST - - PowerPoint PPT Presentation

KE KEEPING ING UP UP WITH H THE HE NOTI TICE CE REQ EQUIRE UIREMENT MENTS: S: NE NEW HI HIRE E CHE HECKLIST KLIST

NEW HIRE CHECKLIST: At Time Of Hire

NEW HIRE CHECKLIST FOR HEALTH PLANS

• I. Provide these notices to ALL new hires (whether or not they are eligible for the health plan)

☐Exchange Notice: Choose one of the following notices to provide to all new hires within 14 days after beginning employment: Date Provided ☐Click here for GBAIT Exchange Notice ☐Model Department of Labor notice* if you offer a health plan*: http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf ☐CHIP Notice. Provide this notice to all new hires with health plan enrollment materials. ☐If the employee is not eligible for the health plan, provide within 14 days of date of hire. ☐If the employee is eligible for the health plan, provide this notice with the enrollment packet (below) To access the current model notice, use the following link and click on Model Notices in the section titled Children’s Health Insurance Program: http://www.dol.gov/ebsa/compliance_assistance.html

EXCHANGE NOTICE: Page 1

INFORMATION ABOUT THE NEW HEALTH INSURANCE EXCHANGES As you may know, Health Insurance Exchanges (also called the Health Insurance Marketplace) now offer individual health insurance policies for you and your family. This notice is intended to give you information about the Exchange and employment-based coverage offered by your employer.

• Provide at time of hire, whether or not eligible for your health plan
• Model notice issued by Department of Labor is updated annually

EXCHANGE NOTICE: Page 2

Eligible employees are: ☐Full time employees (30 or more hours per week) ☐Part time employees. To be eligible as a part-time employee, you must work at least ______ hours per week, and you must complete 600 hours of service before you become eligible. Eligible dependents are: ☐Dependent children until age 26 ☐Spouses ☐However, we do not offer coverage to a spouse if: ☐He or she is eligible to enroll in other employer coverage (whether or not actually enrolled) ☐He or she is enrolled in other employer coverage For more information about the coverage offered by your employer, please check your summary plan description or contact ____________________________________.

NEW HIRE CHECKLIST: Prior To Enrollment

• II. Provide written information about the enrollment process to all new hires who are

eligible to enroll in the plan. The enrollment packet must include: Date Provided ☐Offer of Health Insurance: Click here for a sample Offer of Health Insurance ☐The current Summary of Benefits and Coverage for each option offered. Click the link that follows and select the SBCs for your plan options:

http://www.gabankers.com/WCM/Insurance___Retirement/Plan_Info/WCM/Insurance___Re tirement/GBA_Insurance_Trust/Medical%20Plans.aspx?hkey=0a614eef-91de-4b49-b6e2- 5c739cd29929

☐The Uniform Glossary. Click here: http://www.dol.gov/ebsa/pdf/sbcuniformglossary.pdf ☐The Creditable Coverage Notice* for Medicare Part D. Click here: Medicare Part D Creditable Coverage Notice ☐HIPAA Special Enrollment Rights. Click here for Special Enrollment Rights Notice ☐CHIP Notice. To access the current model notice, use the following link and click on Model Notices in the section titled Children’s Health Insurance Program: http://www.dol.gov/ebsa/compliance_assistance.html

OFFER OF COVERAGE

OFFER OF HEALTH INSURANCE COVERAGE Employee Name: __________________________________________ Date: __________________ Employee ID Number: _____________________________________ Date of Hire: ____________ Coverage options. We are pleased to offer health insurance coverage to eligible employees and family members under the health plan(s) listed below: Plan Name Employee-only Employee + spouse Employee + children Employee + family HMO 600 $ $ $ $ HMO 620 $ $ $ $ POS 440 $ $ $ $ (Note: these plan options are listed only as examples. Please insert the options you offer and complete the premium structure you have adopted for your employees.)

• Provide

e prior to enrollmen ment

• Docume

ument nt that t this s offer er has been n made to avoid id ACA penaltie alties

OFFER OF COVERAGE

• Eligibility. We offer this coverage as indicated in the boxes checked below:

☐Full time employees (30 or more hours per week) ☐Part time employees. To be eligible as a part-time employee, you must work at least ______ hours per week, and you must complete 600 hours of service before you become eligible. ☐Dependent children until age 26 ☐Spouse ☐However, we do not offer coverage to a spouse if: ☐He or she is eligible to enroll in other employer coverage (whether or not actually enrolled) ☐He or she is enrolled in other employer coverage

OFFER OF COVERAGE

Coverage Effective Date: If you complete all required enrollment procedures on a timely basis, your coverage will become effective as of the date indicated in the box checked below: ☐The first day of the first month ☐The first day of the second month ☐The first day of the third month after you begin employment as a full time employee, or if checked above, after you meet the eligibility requirements for a part time employee.

OFFER OF COVERAGE

Enrollment Procedures: We have attached some important information about our coverage. This includes:  Summaries of Benefits and Coverage  Uniform Glossary  Medicare Certificate of Creditable Coverage  Special Enrollment Rights Notice  CHIP Notice Additional information will be provided if you decide to enroll. If you wish to enroll, you should submit your enrollment materials to [Name, contact information] no later than [DATE]. If you submit your materials by that date, your coverage will become effective on [DATE]. By enrolling in the plan you authorize us to withhold your required contributions from your paychecks while your coverage is in effect. If you decide not to enroll at this time, you should know that you will not have another chance to enroll until January 1 of next year or upon the occurrence of a “special enrollment event” as described in the Special Enrollment Rights Notice. Please sign below to acknowledge that you have received this offer of coverage. Employee Signature: ________________________________________ Date: __________________

SUMMARY OF BENEFITS AND COVERAGE

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan

document at www.gabankers.com/GBAIT/gbaithome.asp or by calling 1-877-380-0193. Important Questions Answers Why this Matters: What is the overall deductible?

$0

See the chart starting on page 2 for your costs for services this plan covers. Are there other deductibles for specific services?

• Yes. $200/ person for name brand

prescription drugs when generic equivalent is available. There are no

• ther specific deductibles.

You must pay all of the costs for these services up to a specific deductible amount before this plan begins to pay for these services. Is there an out–of– pocket limit on my expenses?

• Yes. $2,500 person/$5,000 family

for coinsurance, $4,100 per person/

$8,200 family for copays and Rx

expense. The out-of-pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses. What is not included in the out–of–pocket limit? Premiums, balance-billed charges, pre- authorization penalties, charges over maximum allowed amount, services plan doesn’t cover Even though you pay these expenses, they don’t count toward the out-of-pocket limit. Is there an overall annual limit on what the plan pays? No The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits. Does this plan use a network of providers?

• Yes. See www.anthem.com for a list of

participating providers If you use an in-network doctor or other health care provider, this plan will pay some or all of the costs of covered services. Be aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participating for providers in their network. See the chart starting on page 2 for how this plan pays different kinds of providers. Do I need a referral to see a specialist? No You can see the specialist you choose without permission from this plan Are there services this plan doesn’t cover? Yes Some of the services this plan doesn’t cover are listed on page 5. See your policy

• r plan document for additional information about excluded services.

NEW HIRE CHECKLIST: At Time of Enrollment

• III. Provide the following information when the employee enrolls in the plan

☐Provide a copy of the SPD Click on this link and select the appropriate Certificate Booklet for the plan selected by the employee: http://www.gabankers.com/WCM/Insurance___Retirement/Plan_Certificate_ Books/WCM/Insurance___Retirement/GBA_Insurance_Trust/Plan_Certificat e_Books.aspx?hkey=38a65eda-7fbf-4e86-96ab-be7a63a35f9b ☐Initial COBRA Notice. This notice requirement is satisfied when you notify GBAIT through the new hire enrollment process ☐HIPAA Privacy Practices Notice ☐ Click here for GBAIT Privacy Practices Notice ☐Women’s Health and Cancer Rights Notice: Click here for Model Notice *Model Notices and forms marked with an asterisk require customization. Hard copies of notices current as of February 1, 2015

HE HEALTH TH INSURANCE SURANCE INFOR ORMA MATION TION REP EPORTING ORTING: : Form rms 1094 4 and and 1095

HEALTH TH INSU SURANCE ANCE INFORMA MATION ION RE REPORTING: TING: Forms rms 1094 4 and nd 1095 5

Information is reported to employees and the IRS

 Coverage

age infor

• rmation

mation is used ed to det eterm ermine ine if EM EMPL PLOYEE YEE is subj bject ect to pena naltie lties

 Emplo

Employer er pla lan infor

• rmation

mation is used ed to det etermine ermine if EM EMPL PLOYER ER is subject bject to pena naltie lties

HEALTH TH INSU SURANCE ANCE INFORMA MATION ION RE REPORTING: TING: Forms rms 1094 4 and nd 1095 5

Information is reported to employees and the IRS

 Ev

Ever ery y emplo ployer th that at offer ers s health alth insur urance ance mu must t rep epor

• rt

t co coverage erage information

• rmation

 On

Only ly th the emplo loyer ers s subject bject to th the pay-or

• r-pla

play y penalties nalties mu must t rep epor

• rt

t emplo employer er pla lan n informa

• rmation

tion

HEALTH TH INSU SURANCE ANCE INFORMA MATION ION RE REPORTING: TING: Forms rms 1094 4 and nd 1095 5

Different strokes for different folks

 Emplo

loyers ers not not sub ubject ect to penalties file forms in the “B Series”

 Emplo

loyers ers wit ith h 50 or r mo more re ful ull l time me and nd ful ull l time me equiv equival alent ent em emplo ployees ees file le the e “C Series”

 Emplo

loyers ers with h 50-99 99 ful ull l time me and nd ful ull l time me equiv equivale lent nt em empl ployees ees file le C Se Seri ries es even en though ugh not not sub ubjec ject t to pen enalties alties for r 2015

HEALTH TH INSU SURANCE ANCE INFORMA MATION ION RE REPORTING: TING: Forms rms 1094 4 and nd 1095 5

Different strokes for different folks

B

B Series: : Below 50

C

C Series: Can’t think

• f anything Clever

TRANSMITTING INFORMATION TO THE IRS Forms 1094-B and 1094-C

TRA RANSM NSMITT ITTAL AL OF OF INF NFORM ORMATION: ION: Form

• rm 1094-B,

B, Form

• rm 1094-C

C

Form 1094 is used to transmit information to the IRS

 1094

094-B

 Basic employer information  Copies of employee returns

(1095-B)

 1094

094-C

 Detailed information required  Copies of employee returns

(1095-C)

 Electronic filing required >

250 returns

COVERAGE INFORMATION Forms 1095-B and 1095-C

Form 1095-C Department of the Treasury Internal Revenue Service

Employer-Provided Health Insurance Offer and Coverage

CORRECTED

▶ Information about Form 1095-C and its separate instructions is at www.irs.gov/f1095c.

OMB No. 1545-2251

2014

Part I Employee Applicable Large Employer Member (Employer)

1 Name of employee 2 Social security number (SSN) 7 Name of employer 8 Employer identification number (EIN) 3 Street address (including apartment no.) 9 Street address (including room or suite no.) 10 Contact telephone number 4 City or town 5 State or province 6 Country and ZIP or foreign postal code 11 City or town 12 State or province 13 Country and ZIP or foreign postal code

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code) All 12 Months

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share

• f Lowest Cost

Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Part III Covered Individuals VOID

600115

If Employer provided self-insured coverage, check the box and enter the information for each covered individual.

(a) Name of covered individual(s) (b) SSN (c) DOB (If SSN is not available) (d) Covered all 12 months (e) Months of Coverage

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 17 18 19 20 21 22 For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

• Cat. No. 60705M

Form 1095-C (2014)

COVERA RAGE INF INFORMA RMATION ION: : Form rm 10 1095-B, , Part IV IV, Form rm 10 1095-C, C, Part III III

Form 1095 must show coverage information for every person who had coverage for at least one day in 2015

 Emplo

Employee ees

 Including spouse and

dependent child(ren)

 Full time and part time

 Ea

Early ly retirees etirees

 Including spouse and

dependent child(ren)

 COB

OBRA RA par arti ticipants cipants

 Including spouse and

dependent child(ren)

COVERA RAGE INF INFORMA RMATION ION: : Form 10 1095-B, B, Lin ines 1-7, Form rm 10 1095-C, C, Lin ines s 1-6

Form 1095 must be delivered to the “responsible individual”

Em

Emplo ployee

Retiree

tiree

COBRA “head of

household”

COVERA RAGE INF INFORMA RMATION ION: : Form 10 1095-B, B, Lin ine 23(e); e); Form 10 1095-C, C, Lin ine 17(e) (e)

Form 1095 must show coverage for the month if person had coverage for at least one day that month

 GB

GBAIT IT co coverage erage ru runs ns fr from m fir irst st of f mo month nth to

• la

last st of

• f

month nth

COVERA RAGE INF INFORMA RMATION ION: : Form rm 10 1095-B, , Lin ine 23(b); ); Form rm 10 1095-C, C, Lin ine 17(b)

Form 1095 must show so social ial se securit urity y num umber bers s for every covered person

 If you do not have the SSN,

you may use DOB but: t:

 Must request SSN at

enrollment

 Must request again no later

than December 31 of year enrolled

 Must request for 3rd time no

later than December 31 of second year of enrollment

 Document requests

TIME FOR A BREAK!

FORM 1095-C: PART II - THE BASICS

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

The in e informa rmati tion

• n request

equested ed in in Par Part II ge gener erally y must t be e gi given en on

• n a m

a mont nth-by by-month month bas asis is:

• Cover

erage ge or status us (e. e.g. g., pa part-ti time me or full-time time) for

• ne da

e day in in a m month th is is r rep eported ed for the e en entir ire mo e month th

• If cir

ircum umsta tances nces do do not not chan ange ge over er the e cour urse se of the year, the “All 12 Months” box can be completed

FORM 1095-C: PART II - THE BASICS

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Line e 14: Was the emplo loyee ee offered red coverage rage for each month? th?

• An “offer” means the employee is eligible and was given a reasonable opportunity

to enroll

• The codes that are entered in Line 14 include information about the type of

coverage offered:

• Minimum essential coverage (MEC)
• Minimum value (MV)
• Dependent and/or spouse coverage

IMPOR ORTANT ANT NOTE: TE: All of the slides des in this s deck k assume ume the coverage age is MEC, MV, and is avai ailab able e to emp mployees, es, spouses uses and depende ndent nts

FORM 1095-C: PART II - THE BASICS

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Line e 14: Was the emplo loyee ee offered red coverage rage for each month? th?

• Codes

es applica icable e to GBAIT AIT plans ns include: ude:

• 1A – Emp

mployee ee offered ed coverage erage at monthl thly cost t less s than n or equal qual to $93.18* 18*

• 1E -

Empl mployee ee offered ered coverage erage (at t monthly thly cost st greater er than n $93.18)* )*

• 1G -

Coverage erage offered ered to emp mployee ee who was not

• t a full-ti

time me emp mployee ee at any time e during g year, and emp mployee ee enrolled ed

• 1H -

Emplo ployee ee was not

• t offered

ered coverage erage *All referen ences ces to $93.18 18 are valid d for 2015 only. See next t slide e for defini niti tion n of employee’s cost

FORM 1095-C: PART II - THE BASICS

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Line 15: What was the employee’s lowest cost?

• The “employee’s lowest cost” is the monthly amount the employee would have to pay

for:

• Self-only coverage
• For the lowest cost coverage offered by the employer
• This will NOT be the amount an employee pays if he covers dependents and/or

chooses a richer plan

• Enter the amount of the employee’s lowest cost to the penny

FORM 1095-C: PART II - THE BASICS

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Line e 16: Was the emplo loyee ee enrolled

• lled for the month?

th? If not, , why not?

The following wing codes s may be used d freque quently ntly : 2A 2A: Not employed on any day of the month 2B 2B: Not full-time at any time during the month and did not enroll (if offered) 2C 2C: Employee enrolled. Thi his s code trum umps ps all ot

• thers that

t may apply! y! 2D 2D: Waiting period or initial measurement period 2F 2F: Employee lowest cost not greater than W-2 safe harbor 2G: Employee lowest cost not greater than FPL safe harbor ($93.18 for 2015) 2H 2H: Employee lowest cost less than 9.5% of rate of pay

FORM 1095-C: PART II - THE BASICS

IMPORTAN ANT T NOTE: : The c e code des s for Lin ine 1 e 16 are v e ver ery compl plex x and de d depe pend d upo pon empl employer er- and d empl employee ee- spe pecif ific ic cir ircumsta cumstances nces. . The e follo lowi wing ng slid ides es il illus ustra trate e the e use of e of thes ese e code des s in in c common mmon scen enarios, ios, but the e Form m 109 095-C C Instructi ructions

• ns should

ld be c e consult ulted ed for po possib ible le excep epti tions

• ns or exclusi

usions.

• ns.

DECODING FORM 1095-C: Part II

QUES ESTION TION 1: WAS COVERAGE OFFERED TO THE EMPLOYEE THIS MONTH?

Employee’s lowest cost < $93.18 Employee’s lowest cost > $93.18

LINE 14 Use Code 1A LINE 15 QUESTIO ION N 2: DID EMPLOYEE ENROLL THIS MONTH? YES NO LINE 16 Code 2C Code 2G

YES NO

Use Code 1E Leave Blank Enter Ee’s Lowest Cost QUESTIO ION N 2: DID EMPLOYEE ENROLL THIS MONTH? YES NO Code 2C Use Code 1H Leave Blank CODE 2A, 2B. 2D, 2F. OR 2H, or Leave Blank Leave Blank

DECODING FORM 1095-C: PART II

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Example mple 1:

• Employee is hired into a full time position on January 2, 2015
• Employer does not have a waiting period
• Employee enrolls as soon as she is able
• Employer pays full cost of employee coverage

1H 1H 2D 2D 1A 1A 2C 2C 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 1A 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C

FORM 1095-C: PART II - THE “EASY” ONES

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Templ emplate e 1:

• Empl

ployee ee empl employed ed in in a p a par art-ti time me stat atus us for r ever ery month th

• Cover

erage ge for r at lea east one mo e month

1G 1G

• Do not compl

plet ete e Lin ines es 1 15 5 or 16

• Par

Part III shoul uld d be e compl plet eted ed to show w mont nths hs of cover erage ge for r empl employee ee and de d depe pende dents

FORM 1095-C: PART II - THE “EASY” ONES

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Templ emplate e 2:

• Reti

etiree ee or COBRA A hea ead d of house usehold hold wit ith no empl employme yment t status us du durin ing g the e yea ear

• Cover

erage ge for r at lea east one mo e month

1G 1G

• Do not compl

plet ete e Lin ines es 1 15 5 or 16

• Par

Part III shoul uld d be e compl plet eted ed to show w mont nths hs of cover erage ge for r empl employee ee and de d depe pende dents

FORM 1095-C: PART II - THE “EASY” ONES

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Templ emplate e 3:

• Ful

ull tim ime e empl employee, ee, el elig igib ible e for covera erage ge al all yea ear long ng

• Enroll

lled ed in in cover erage ge for r ever ery month th

• Empl

mployee ee lowest est cost st is is < $93. 3.18

1A 1A

• Do not compl

plet ete e Lin ine 1 e 15

• Par

Part III shoul uld d be e compl plet eted ed to show w mont nths hs of cover erage ge for r empl employee ee and de d depe pende dents

2C 2C

FORM 1095-C: PART II - THE “EASY” ONES

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Templat plate e 3A: What if the emplo loyee ee did not enroll

• ll at all during

ing the year?

• Ful

ull l time me emplo loyee ee, , eligib gible le for covera erage ge all year r long ng

• No coverage

rage in 2015

• Emplo

ployee ee lowest st cost is < $93.18 18

1A 1A

• Code

de 2G: If emplo loyee e had enrolle led, d, cost st would uld be < $93. 3.18

• Code

de 2I: : Al Alternat rnate e code de ????

• Do not
• t com
• mple

lete e Line ne 15

• Par

Part III I shoul

• uld

d be com

• mple

leted ed to show mon

• nth

ths s of cover erage age for r emplo loyee e and depende pendents nts

2G 2G

FORM 1095-C: PART II - THE “EASY-ISH” ONES

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Templat plate e 3B: What if the emplo loyee ee was enrolled

• lled only for part

t of the year? r?

• Full

l time me emplo loyee, ee, eligible gible for covera erage ge all year r long

• Coverage

erage in place July y 1 – Decemb mber er 31, 2 2015

• Emplo

ployee ee lowest st cost is < $93.18 18

1A 1A

• Code

de 2G: If emplo loyee e had enrolled, led, cost t would ld be < $93. 3.18

• Code

de 2C: : Emp mployee ee enrolled led

• Do not
• t comp
• mple

lete e Line 15

• Pa

Part III I should

• uld be comp
• mple

leted ed to show mon

• nths

ths of cover erage age for r emplo loyee e and depen pende dents ts

2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2G 2G 2G 2G 2G 2G 2G 2G 2G 2G 2G 2G

DECODING FORM 1095-C: PART II

Example mple 2:

• Employee has worked in a full time position since 2013
• He declines enrollment in 2015
• He gets married in February and enrolls himself and spouse in the POS 440 as of

March 1

• They have a baby in November and baby is enrolled effective as of DOB
• Employer offers the following options:

Plan Opti tion

• n

Emp mployee e only Ee Ee + spouse use Ee Ee + childr dren en Ee Ee + fa fami mily HMO 620 $75.00 $250.00 $200.00 $350.00 POS 440 $135.00 $400.00 $320.00 $600.00

DECODING FORM 1095-C: PART II

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

• Par

Part III should ld be c e compl plet eted ed to show w months hs of cover erage ge for r empl employee ee and d de depe pende dents Example 2: And the answer is…

1A 1A 2G 2G 2G 2G 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C

FORM 1095-C: PART II - THE “EASY” ONES

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$95.00

$ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Templat plate e 4:

• Full

l time me emplo loyee, ee, eligible gible for covera erage ge all year r long

• Enrolled
• lled in coverage

rage for every y month th

• Emplo

ployee ee lowest st cost is > $ $93.18.

• 18. No

No cost t change nge dur uring ng the year

1E 1E

• Code

de 1E – cover erage ge offer ered ed at cost st > $93. 3.18

• Par

Part III shoul uld d be e compl plet eted ed to show w mont nths hs of cover erage ge for r empl employee ee and de d depe pende dents

2C 2C

FORM 1095-C: PART II - THE “EASY” ONES

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

95.00

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Templat plate e 4A: What if the emplo loyee ee did not enroll

• ll at all during

ing the year?

• Ful

ull l time me emplo loyee ee, , eligib gible le for covera erage ge all year r long ng

• No coverage

rage in 2015

• Emplo

ployee ee lowest st cost is > $ $93.18 18

1E 1E

• Leave

e Line 16 blank

• Pa

Part t III should ld not be comple leted ed (beca ecause use no coverage) rage)

FORM 1095-C: PART II - THE “EASY-ISH” ONES

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

95.00

$ $ $ $ $ $ $ $ $ $ $ $ $

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Templat ate 4B: What at if the employee wa was enrolled d only for part t of the year?

• Full time

e employee, , eligib ible for coverag age all year long

• Coverage

ge in place July 1 – December 31, 1, 2015

• Employee lowes

west t cost is > $ $93.18.

• 8. No c

cost change ge during ing year

1E 1E

• Code

e 2C: Emplo mployee e enrolled

• lled
• Pa

Part t III should ld be comple mpleted ed to show months nths of coverage rage for emp mplo loyee e and depende ndent nts

2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C

FORM 1095-C: PART II – NOTHIN’ EASY ABOUT IT

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$

$ $ $ $

95.00

$

95.00

$

95.00

$

95.00

$

95.00

$

95.00

$

95.00

$

95.00

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Templat ate 5: Employee is hired d March h 15

• Full time

e employee, , eligib ible for coverag age beginni ning ng May 1

• Enrolls in coverage

ge June e 1 – December 31, 1, 2015

• Employee lowes

west t cost is > $ $93.18.

• 8. No c

cost change ge during ing year

2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2A 2A 2A 2A 2D 2D 2D 2D 2C 2C 1H 1H 1H 1H 1H 1H 1H 1H 1E 1E 1E 1E 1E 1E 1E 1E 1E 1E 1E 1E 1E 1E 1E 1E

Code de 1H: No

• Offer

er of coverage erage Code de 1E: E: Cover erag age e offere ered Code de 2A: A: Em Emplo loyee e not

• t emplo

loyed Code de 2D: Waiti ting ng period iod Code de 2C: : Em Employee ee enrolled led

• Par

Part III I shoul

• uld

d be com

• mple

leted ed to show mon

• nth

ths s of cover erage age for r emplo loyee e and depende pendents nts

2C 2C

DECODING FORM 1095-C: PART II

Example mple 3:

• Employee is hired into a full time position starting March 15, 2015
• Employee enrolls in the POS 440 when first able
• Employer offers the following options:

Plan Opti tion

• n

Emp mployee e only Ee Ee + spouse use Ee Ee + childr dren en Ee Ee + fa fami mily HMO 620 $105.00 $250.00 $200.00 $350.00 POS 440 $155.00 $400.00 $320.00 $600.00

• Employer has a 2-month waiting period

DECODING FORM 1095-C: PART II

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $

$105.00

.00

105.0 .00 $ $105.00

.00

$105.00

.00

$105.00

.00

$105.00

.00

$105.00

.00

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Example 3: And the answer is…

2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2A 2A 2D 2D 1H 1H 1H 1H 1E 1E 1E 1E 1E 1E 1E 1E 2A 2A 1H 1H 1H 1H 1H 1H 2D 2D 2D 2D

DECODING FORM 1095-C: PART II

Example mple 4:

• Employee is hired as a part time employee in 2014. Effective April 15, 2015, he is

promoted to a full time position.

• Employee enrolls in the HMO when first able
• Employer offers the following options:

Plan Opti tion

• n

Emp mployee e only Ee Ee + spouse use Ee Ee + childr dren en Ee Ee + fa fami mily HMO 620 $105.00 $250.00 $200.00 $350.00 POS 440 $155.00 $400.00 $320.00 $600.00

• Employer has a 2-month waiting period

DECODING FORM 1095-C: PART II

Part II Employee Offer and Coverage

14 Offer of Coverage (enter required code)

All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

15 Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage

$ $ $ $ $ $ $

$105.0 .00 $105.00

.00

$105.00

.00

$105.00

.00

$105.0 .00 $105.0 .00

16 Applicable Section 4980H Safe Harbor (enter code, if applicable)

Example 4: And the answer is…

2D 2D 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2C 2B 2B 2B 2B 1H 1H 1H 1H 1H 1H 1E 1E 1E 1E 1E 1E 2B 2B 1H 1H 1H 1H 1H 1H 2D 2D 2D 2D

SENDING IT OFF TO THE IRS: FORM 1094-C

 Transmits copies of 1095-C’s and:

 Employer information  Control group information  Special exemptions and interim relief that apply to

the employer

 Monthly employee census data

SENDING IT OFF TO THE IRS: FORM 1094-C

(a) Minimum Essential Coverage Offer Indicator

Did you offer GBAIT coverage to at least 70%* of full time employees**?

(b) Full-Time Employee Count for ALE Member

Count all full time employees**

(c) Total Employee Count for ALE Member

Count all full time and part time employees, including employees in waiting period or initial measurement period.

(d) Aggregated Group Indicator

See instructions and check if applicable.

(e) Section 4980H Transition Relief Indicator Use:

• Code A if you

qualify for 50-99 relief (next slide)*

• Code B for 100+

full time and FTE employees

Yes No

23

All12 Months

D D D

24

Jan

D D D

25

Feb

D D D

26

Mar

D D D

* 70% for 2015 only. Stand andard is 95% in later er year ars. s. ** Full time e emplo loyee ees: at leas ast t 30 hours per week.

• eek. Do not
• t count

t emplo loyees es in wait waitin ing peri riod

• d or initia

ial l measu asuremen ment perio iod

SENDING IT OFF TO THE IRS: FORM 1094-C

 50-99 Transition Relief:

 Employer and all members in control group had

between 50 and 99 full time AND full time equivalent employees in 2014

 From 2/9/14 thru 12/31/15, employer/control group

did not reduce workforce or reduce overall hours of service in order to qualify for relief

 From 2/9/14 thru 12/31/15, employer/control group

did not eliminate or materially reduce health care coverage

 NOTE: This relief applies only in 2015

SENDING IT OFF TO THE IRS: FORM 1094-C

A – Check this box if you offered GBAIT

coverage:



To at least 1 full time employee



Who was covered for all 12 months of 2015



At employee’s lowest cost < $93.18



“Simplified” reporting to employee if this method is used Impa mpact ct on 1095-C: C: If you check box A you must:



Use Code 1A on Line 14



Do not complete Line 15 for any such

• employee. (See Template 3)

SENDING IT OFF TO THE IRS: FORM 1094-C

B – Check this box if you offered GBAIT

coverage:



To at least 95% of full time employees (not including employees in waiting period or initial measurement period)



For at least one month of 2015



At employee’s lowest cost < $93.18



“Simplified” reporting to employee if this method is used



This box is optional and rules are unclear Imp mpac act t on 1095-C: C: If you check box B, you must:



Use Code 1A on Line 14



Use Code 1I on Line 14 for months employee did not receive a qualifying

• ffer



Do not complete Line 15

SENDING IT OFF TO THE IRS: FORM 1094-C

BOX C –

 Employers/control groups with at least 100 full time and full

time equivalent employees will check this box.

 Employers/control groups with at least 50 but fewer than 100

full time and full time equivalent employees will check this box if they meet the requirements or the “50-99 Transition Relief” (See previous slide.)

SENDING IT OFF TO THE IRS: FORM 1094-C

BOX D–

 You may check this box if you offered GBAIT coverage to at

least 98% of ALL (full time and part time) employees

 Coverage must meet the affordability standard for all

employees

 If this box is checked, it is not necessary to complete the full

time employee count in Part III,column (b)