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Employers No Longer Need to Automatically Distribute ACA Reporting 1095 to Employees

Summary of Key Changes to ACA Reporting Requirements

On December 23, 2024, the Employer Reporting Improvement Act and the Paperwork Burden Reduction Act were signed into law, significantly altering the requirements for distributing IRS Forms 1095-B and 1095-C to employees and covered individuals. 

ACA Reporting

As a reminder, the Affordable Care Act (ACA) required that Applicable Large Employers (ALEs) and health insurers report health coverage information to employees and covered individuals using Forms 1095-B or 1095-C. These forms were filed with the IRS alongside Forms 1094-B or 1094-C to determine if employers owed Employer Shared Responsibility Payments ("penalties"). 

Key Changes Introduced by the Acts

1. Distribution of Forms 1095-B and 1095-C

•  Employers and insurers are no longer required to provide these forms to all eligible employees and/or covered individuals. 

•  A form must be provided only upon request, and it must be delivered by the later of: 

•  January 31 of the year following the coverage year, or 

•  30 days after the request date.

•  Employers must notify employees of their right to request these forms. However, a model notice hasn’t been created yet.  Employers are expected to make a good-faith effort in drafting this communication.  Contact your Relationship Manager if you would like assistance with this communication.   

•  If employees have consented (or haven’t actively requested to NOT receive electronically), the communications and forms can be delivered electronically.  Contact your Relationship Manager for more information on Electronic Safe Harbor communications.

2. Extended Response Time for IRS Penalty Letters and Statute of Limitations for Penalties

• Employers previously had a 30-day window to respond to IRS letters, often leading to rushed investigations and responses. Additionally, there was no statute of limitations for assessing penalties, leaving employers exposed to potential liabilities indefinitely. 

• Employers now have 90 days, instead of 30, to respond to IRS Letter 226J before any further action is taken.  This extension provides employers more time to investigate and address errors or missing information that often result in proposed penalties. 

• A six-year limit now applies to the IRS’s ability to assess penalties, starting from the later of: 

•  The due date of the 1095 Forms, or 

• The actual filing date.

Effective Dates

•  The Paperwork Burden Reduction Act applies to calendar years after 2023. 

•  The Employer Reporting Improvement Act applies to returns due after December 31, 2024. 

•  The distribution requirements for Forms 1095-B and 1095-C will no longer apply for returns due January 31, 2025, covering the 2024 calendar year. 

ACA Reporting is Still Required!

•  Employers must still prepare and file Forms 1095-B and 1095-C with the IRS, along with the associated Form 1094. 

•  These Acts only modify the distribution requirements for employees and covered individuals in group health plans. 

As always, if you have any questions, please reach out to your Rose Street Advisors’ Relationship Manager. 

Ben Cohen

CEBS | Employee Benefits Relationship Manager

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Top 4 Reasons Healthcare
Costs are Rising for 2025

We all know healthcare costs increase annually. Medical trend increases are based on higher costs for prescription drugs, advancement in medical technologies, reinsurance costs and regulatory changes. So, what are the reasons for the higher than normal premium rates as we approach 2025? The aftereffects of COVID are creeping into the system. 

Following is a few of the consequences of the pandemic:

1. Many of the experienced nurses who shouldered the responsibility of caring for COVID patients were burned out. 

These brave medical personnel, who normally would have continued to work in the industry longer; left the field of nursing, which created a shortage. Higher wages, bonuses and hiring traveling nurses were the only way to keep facilities staffed to take care of patients. This increased expenses at all hospitals.

2. Beginning in 2021 through 2023, inflation has more than doubled compared to the previous 20 years. 

 This has not only impacted interest rates but also the cost of goods and services provided by health care organizations.

3. Health insurance companies were previously locked into 3-5 year reimbursement contracts with hospitals that would not let the hospitals receive more money for their services.

As the contracts come to term, hospitals are looking to recoup their losses and want insurance carriers to pay more for services.

4. We are still seeing an increased use of healthcare post-pandemic by those who delayed treatment and are either catching up on their treatments or have a chronic condition that has progressed which has placed them in a worse state. 

The list above highlights some of the key reasons why we anticipate you will see higher than normal rate increases than in the past. If you have any questions or would like to have a conversation, please reach out to us at Rose Street Advisors.

Chris Werme

LIC | Employee Benefits Advisor

As an advisor, Chris partners with clients to develop benefit strategies that meet organizational goals, budgets and company culture. From his background in accounting, he has a talent in picking out trends arising from claims data, reviewing analytics and negotiating renewal pricing with underwriters that serve his client’s well. He is an advocate in the healthcare world for his clients and their employees. On a personal note, Chris enjoys family and friends, especially while traveling, playing golf or boating. He is also a ‘Proud Papa’ to three grandsons!.

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