Required ACA Reporting

The Affordable Care Act (ACA) requires insurers, self-insured employers, applicable large employers (ALE), and other coverage providers to issue certain reports to individuals and the federal government, including Form 720 used for paying the Patient-Centered Outcomes Research (PCOR) fee, and Forms 1095-B and 1095-C used to satisfy requirements under the Employer Shared Responsibility Rules.

Patient-Centered Outcomes Research (PCOR) Fee

The Patient-Centered Outcomes Research fee is a fee on insurers of specified health plans and on plan sponsors of applicable self-insured health plans that are used to fund the Patient-Centered Outcomes Research Institute. This fee may change annually based on inflation.

The PCOR fee applies to plan years ending before October 1, 2029. For plan sponsors with fully insured medical plans, the insurer is responsible for paying for the annual tax filing and PCOR fee payment.  Plan sponsors of self-funded medical plans, non-excepted Health Reimbursement Arrangements (HRAs), and non-excepted Health Care Flexible Spending Accounts (FSAs) are responsible for this annual tax filing and PCOR fee payment. For example, if an employer sponsors a fully-insured medical plan that is integrated with a non-excepted HRA, the insurer will pay the PCOR fee for the major medical plan and the plan sponsor will pay the PCOR fee for the HRA.  An employer that sponsors both a self-funded medical plan that is integrated with a non-excepted HRA is only required to pay the PCOR fee on the self-funded major medical plan.  The PCOR fee applies to employers of all sizes, both private and public sector employers, and both for-profit and not-for-profit organizations.

The tax filing for the PCOR fee is due annually on July 31st. Each year, the fees that are due are related to the plan year ending in the prior calendar year.

The tax filing is completed with IRS Form 720. Please refer to the Form 720 Instructions for more information.

EBC provides HRA clients with information that HRA clients can use when they are completing their Form 720 related to PCOR fees.

Employer Reporting

Employers (or their insurers) that provide minimum essential coverage (MEC) are required to provide tax forms to plan participants and to the IRS that provide information related to medical insurance coverage for the participant and their dependents. This is called Section 6055 Reporting.

In addition, Applicable Large Employers (“ALEs”) subject to the ACA’s employer shared responsibility provisions must provide tax forms that include verification of enrollment, offers of coverage and affordability. This is called Section 6056 Reporting.

The employer reporting requirements are complex and an employer may need to seek assistance from a tax advisor or third party to help them compile the required data, create the necessary forms and submit and distribute the forms by the required dates.

Section 6055 Reporting

Section 6055 Reporting is completed using Form 1095-B which must be provided to each covered “responsible individual” (e.g., employee, COBRA QB, retiree) annually by March 2nd (March 1st in leap years) for coverage in the prior calendar year. The Form 1095-B is provided by the insurer for insured medical plans and by the employer for a self-insured medical plan (but see discussion below regarding ALEs that can use the Form 1095-C for Section 6055 Reporting). In addition to sending out Form 1095-B to participants, the employer must also submit Form 1094-B to the IRS annually by February 28th (March 31st if filed electronically). Employers who offer certain HRAs are also subject to Section 6055 Reporting (see more below).

Here are some helpful links related to Section 6055 Reporting:

Section 6056 Reporting
  • Section 6056 Reporting is completed using Form 1095-C and must be provided to each full-time employee annually by March 2nd (March 1st in leap years) for coverage offered in the prior calendar year. This form is provided by the ALE. In addition to sending out Form 1095-C to employees, the employer must also submit Form 1094-C to the IRS annually by February 28th (March 31st if filed electronically). Employers who offer certain HRAs are also subject to Section 6056 Reporting (see more below).

    If an ALE is required to perform both Section 6055 Reporting and Section 6056 Reporting, the ALE typically can use the Form 1095-C for both purposes.

    Here are some helpful links related to Section 6056 Reporting:

HRA Clients
  • Employer reporting requirements typically don’t apply to HRAs, but exceptions apply. These exceptions include:
    • a retiree-only HRA for retirees who are not enrolled in the employer’s group health plan;
    • post-employment benefits (PEBs) for former employees who are not enrolled in the employer’s group health plan;
    • an HRA that covers employees who are not enrolled in the employer’s group health plan (e.g., employees covered under a spouse’s employer plan); and
    • an HRA that covers an employees’ family members who are not enrolled in the employer’s group health plan.

    If one or more of the above exceptions applies, the employer would use the Forms 1094-B and 1095-B to report the HRA coverage unless the employer is an ALE, in which case the employer can report the HRA coverage using Forms 1094-C and 1095-C. EBC can provide supporting information to assist an employer in completing these forms, but the employer should work with their tax advisor or ACA reporting vendor to complete and submit the forms.

COBRA Clients
  • An employer that is an ALE is may be required to report on its offer of coverage to COBRA qualified beneficiaries who are still active employees but who have their group medical plan coverage through COBRA due to a reduction in hours.