ACA Reporting Change: No Longer Necessary to Distribute Form 1095 to Employees

Two bills—the Employer Reporting Improvement Act and the Paperwork Burden Reduction Act—were signed into law on December 23, 2024. These two Acts change the requirements for distributing IRS Forms 1095-B and 1095-C to all employees and covered individuals.

Background

Under the ACA, all employers (or health insurers for fully insured plans) were required to report information about any health coverage offered to their employees via Forms 1095-B or 1095-C. These paper forms are also required to be filed with the IRS, covered by the IRS Form 1094-B or 1094-C.

Based upon data from the ACA’s Exchange/Marketplace and these Form 1095s, the IRS would determine if any Employer Shared Responsibility Payments (not-so-affectionately known as the “penalties”) were due and send the employer a letter (IRS 226J letter) asking for any clarification before the proposed penalties were assessed. Employers only had 30 days from the date of the letter to respond, in many cases noting a coding error on the Form 1095. Since the IRS used the US mail, often the employer had very few days to research the reason for the proposed penalty and to respond accordingly. If the response from the employer was late, the IRS could not only assess the proposed penalty, but additional penalties as well.

Further, the period for assessing and collecting the penalties had no statute of limitations which would otherwise potentially limit the liability for older assessments.

Changes Under the Two Acts

The two Acts will make several important changes that will improve the reporting and enforcement process for plan sponsors.

Forms 1095-B and 1095-C. Plan sponsors and health insurance providers for fully insured plans are no longer required to send these forms to all eligible (full-time) employees and covered individuals. Instead, only if an employee requests a form must one be provided by the later of January 31st of the year following the coverage year or 30 days after the date of the request. However, note that in order to take advantage of this new rule, plan sponsors must provide a notice to employees letting them know they have the right to ask for a 1095 form. There is no model notice yet, but employers can likely make a good-faith effort to draft such a notice.

Electronic Distribution of Requested Form. If the employee has previously given their consent to receive the form electronically (and as long as they haven’t revoked that consent), the 1095 can be provided electronically. While we don’t yet have guidance on this new provision, a good-faith effort—such as including a consent to receive the Form electronically on the request form—may suffice.

Extension of Response Time to Penalty Letters. Plan sponsors will now have 90 days, not 30, to respond to a proposed penalty assessment letter from the IRS before any further action is taken. Given our history assisting employers with responding to these IRS 226J letters, most often the proposed penalty was due to a coding error or missed employee on the 1095, not a failure to offer affordable minimum essential coverage. The change will allow employers reasonable time to research the issue and respond to the IRS in a timely manner.

Statute of Limitations on Penalty Assessments. Instead of an open-ended period to assess penalties, there is now a six year period for collecting any penalties from employers, starting from the later of the due date for the 1095 Forms or the actual filing date, whichever is later.

Important Note. The 1095-B or 1095-C must still be prepared and remitted to the IRS with the corresponding Form 1094. These two Acts only change the distribution requirements to employees and covered individuals in group health plans.

Effective Date. The effective date of the Paperwork Burden Reduction Act is for all calendar years after 2023. The effective date for the Employer Reporting Improvement Act is for returns due after December 31, 2024. Thus, most employers will be relieved of the IRS Form 1095-B and 1095-C requirements for distribution to employees for returns that are due January 31, 2025 for the 2024 year.