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What about my employees who did not accept health insurance coverage?

ACA is a reporting of health insurance that was offered to the employee. It does not report if the employee accepted the health insurance offer. So, ACA reporting tells the government who the organization offered health insurance to.

The government requires ACA reporting because they want to know who is using the marketplace to shop for health insurance and who is being offered health insurance because they don't feel like they have another option. ACA reporting tells the government if full-time employees (30 hours or more) were offered health insurance. 

What about self insured vs. not self insured?

Typically, there are more people who are not self insured than people who are self insured. Idaho and New Mexico are two exceptions because they use pools instead of using something like BlueCross or BlueSheild to administer their health plan. The pools count as self insured. If an employee is self insured, the employee or the pool pays their own health insurance claims. 

Self insured individuals do not have a third party to send them a 1094/5 form. Self insured individuals need to report that they have health insurance and if they cover any dependents. There are additional steps for reporting ACA information for self-insured individuals. 

What is the difference between the 1094-B/C and 1095-B/C?

Form 1094-B/C is the coversheet. Form 1095-B/C is the individual form that is sent to the employee. It works just like the W-2s. Use the B form if you have less than 49 employees. Use the C form if you have 50 or more employees. 

Warning: Benefit Pay Code Exists

This warning may be displayed when you're adding a health insurance pay code to an employee in Human Resources. It means your trying to add another pay code to the employee that is already there. In the case of health insurance pay codes, seeing this warning is a good thing because the employee has a health insurance pay code. 

How do I download and install the latest version of Connect?

Open Connect System Management > Installation > Install Program Updates. To complete the ACA Checklist, you need to be running 2024.11.141 or later.

How do I update my user rights?

If this is your first time using the Government Reporting module, you may need to update the user rights for the user who will complete the ACA Checklist. User rights are located in Connect System Management > Security > Setup/Modify User Rights. You may need an IT/IS administrator to update user security.

Watch a video that shows you how to update your user rights for ACA, Government Reporting, Human Resources, and Timekeeping (3m0s).

What do the substitute ACA forms look like?

You can use the official ACA form or the Caselle substitute ACA form to send to your employees. Do not use the Caselle substitute ACA form to submit the ACA form to the IRS. If you want to send the official ACA form to your employees, you'll need to purchase the official ACA forms.

Substitute ACA Form for Employees Only

What does the Employer-Provided Health Insurance Offer and Coverage Form (Form 1095-C) look like?

You can print this form or order it. Form 1095-C must follow this layout, it must be 11 inches by 8.5 inches (landscape orientation), and it must fill the entire page.

Form 1095-C

Who needs to file electronically?

Organizations filing ten or more information returns (1095s + 1099s + W-2s) will need to file 1095s electronically. 

To file electronically, you will need the Electronic Reporting module for W-2s, 1099s, and ACA. For more information, contact your Client Relationship Manager (CRM) at (800) 243-8275. 

What if I have a TCC from a prior year?

The IRS is using a new two-factor authentication called Secure Access. You will need to register for a new TCC to file ACA. Go to the e-Services website to register for a new TCC.

If you have a TCC for filing electronic ACA from a prior year, you do not need to register for a new TCC. You can use the TCC to file the electronic ACA for the current reporting year.

How do I show when an employee declines coverage?

Employees who waive coverage will need an ACA Form, just like the employees who have coverage. The 1095 Form will show the timeframe when the employee was offered coverage. This will not affect the employee's choice to waive coverage.

The self insured classification is based on the employer. If the employee has Blue Cross/Blue Shield that pays claim, or the employer pays the claim, or the employer is part of a pool of employers that pay the claim, the employee status is self insured.

How do I know if my organization is self insured?

Contact your health insurance provider to verify if your organization is self insured.  

How do I use positions to support ACA?

Go to Step 3. Set up Human Resources to learn how to set up positions to support ACA. 

How do I set up benefits for a terminated employee?

See the section titled Adding Health Benefits to Terminated Employees.

How do I handle an employee who terminates coverage during the year?

If the employee is terminating coverage because the employee is terminated, Connect will mark them as not having offer of coverage the month after the employee was terminated.

For example, if the employee is terminated on October 15th, the employee will show as having coverage for the month of October. However, the terminated employee will not show coverage in November and December.

On the other hand, if an employee ended coverage because the employee went from full time to part time, you can terminate the pay code and change the ACA record to show that the employee does not have coverage.

If the employee waives coverage, for example, because their spouse has a job that offers better coverage and it was a qualifying event, Connect will show the offer of coverage.  

If the employee is self-insured, make the change in the ACA record to show coverage was waived. You would change the ACA record instead of the employee record in Human Resources, because the employee still has the benefit.

What if I forgot my Receipt ID?

You can use your Transmission ID to check your submission status.

What if I use last year's form to submit this year's ACA?

If you use the forms for 2023 to submit information for 2024, the IRS will file the return for 2023. We recommend using the forms for the current filing year.

Why can’t I see the ACA routines, reports, and forms?

First, have you downloaded the latest version of Caselle? You’ll need to be running version 2024.11.141 or higher will include the ACA routines, reports, and forms.

Second, have you updated the user security settings for the user who will be completing the ACA Checklist? The user will not be able to access the ACA routines, reports, and forms unless you update the user security settings in Timekeeping, Payroll, W-2 and 1099 Reporting, and Human Resources.

How do I know if my employee’s are ACA compliant?

You can use the options in Timekeeping to define the ACA Measurement Method.

What is the waiting period?

The waiting period is the number of days before an employee receives benefits. The IRS mandates the waiting period is not more than 90 days.

Where is the ACA Checklist?

There are no changes to the ACA Year-end Checklist for 2024. Right-click on the link and the select Save Link As or Save Target As to save the XML to your computer. 

2023 ACA Year-end Checklist [XML] [PDF]

Are the Human Resource and Timekeeping applications required to create Form 1094 B and C?

Yes, because Human Resources stores the employee’s ACA information and Timekeeping determines if the employee is full-time or part-time.

What if my organization has more than one insurance provider?

For example, if your organization has ETNA and Blue Cross/Blue Shield, you will need to set up a health insurance “benefit” record for each health insurance provider in the Human Resources.

Could you please send us the information we will need to complete the benefits section for Forms 1094 and 1095?

If your organization is using Human Resources, the Human Resources application stores all of the information you’ll need to complete the benefits section for Forms 1094 and 1095. If you would like additional information, you can find it at www.irs.gov/Affordable-Care-Act/Employers

Do we need to fill in the benefit record even if we are fully insured?

Yes, you will need to the benefit information in Human Resources if you are fully insured or self insured.

If you have two different health providers in one year, do you add both providers to the employee’s record?

Yes! Because your organization changed the providers mid-year. You need to provide proof that the employee had coverage and that the organization offered coverage.

What if I have one health care provider who has three different levels?

You can set up the different levels when you set up the benefits record for the health care provider in Human Resources. For example, add Single, Dependent, Family.

When I entered “Health Insurance” in the Description field in Human Resources, I receive an error message that says the title is not unique. What’s going on?

First, make sure the Health Insurance record has not already been created.

Second, if you are creating a health insurance record for more than one provider add the provider’s name to the description. For example, Health Insurance - ETNA, Health Insurance - Blue Cross/Blue Shield, and so on.

What if I have an employee who has been denied coverage, but the organization did offer coverage?

You’ll want to set up a level on the health insurance benefits record in Human Resources for Denied Coverage. When you set up the level, do not link it to a pay code. Giving an employee a Denied Coverage level will not affect the employee’s pay check.

As a side note, denied coverage is the same as waived coverage. Either title is acceptable.

How does Connect use override rates?

If you make a change to the employee benefit amounts, Connect will update pay code and vice versa.

What if an employee changed coverage but the change wasn’t recorded until later?

You can use the dates in the employee’s record to adjust the coverage start and end dates.

Do I need to order blank ACA forms?

It depends. 

• If you are filing 1095s electronically... No, you do not need to order blank ACA forms because you can use the substitute or printable 1095 C forms to print the 1095 employee copy. 

• If you are not filing 1095s electronically... then, yes, you will need to purchase preprinted ACA forms. 

What if I use NatPay to post payroll information online? Will NatPay post 1094/1095 Forms for us as well?

NatPay will post for you, but you will need to contact your Client Relationship Manager (CRM) at (800) 243-8275 to purchase this service.

Do we have the ACA Checklist?

ACA Year-end Checklist [XML]

Can I set up the HR Benefits without the ACA?

Absolutely. Yes, you can set the HR Benefits at any time.

Do I need to close the Payroll Year-end Checklist before I run the ACA Checklist?

You can close the Payroll Year-end Checklist before you run the ACA Checklist but you don’t have to. You do want to make sure the benefits have been added to the employees before you calculate the last payroll of the year. But you do not need to close the Payroll Year-end before you do your ACA Reporting. As long as you make sure you capture everyone for every month, you’re good to go.

What code do you use when the employee denies or waives coverage?

When an employee denies or waives coverage, you will use A as the Origin of Policy because your organization provided a qualifying offer and the employee refused the qualifying offer and chose to find a different health option.

What about temporary employees working less than 30 hours?

You do not need to provide temporary employees working less than 30 hours with a Form at all. It’s only employees who are FTE (Full-time Equivalent) employees.

Can we add retired employees to the Human Resources application for ACA Reporting?

Absolutely. Because then you will have different requirements for retired employees.

Does there need to be a Safe Harbor Code for every month of the year?

No, you do not need a Safe Harbor Code for every month of the year.

If you have a terminated employee on COBRA, do you include them?

Yes, you would include them.

How do you enter different Safe Harbor Codes for different months?

If you have the waiting period, you would enter the Safe Harbor code for the employee and then when the employee selects a health option, that’s when you would make the change to the Safe Harbor code.

If an employee waives coverage, what is the Safe Harbor code?

You would leave the Safe Harbor code blank. You may need to download the latest version of Caselle to choose the [blank].

If the employee is self-insured, do I need to enter the employee’s Social Security number?

The IRS prefers a Social Security number AND a date of birth. However, if a Social Security number is not available, a date of birth will be sufficient.

The ACA does not require the employee to list a spouse as a benefit. Why?

The ACA only “requires” that you offer insurance to the employee and the amounts reported on the 1095 are the employee-only cost of coverage. Spouses can be offered insurance but it is not required under the ACA.

Do I need to list all of an employee’s dependent’s in Part III?

For self-insured employers all individuals that were covered for any part of the year need to be listed. Only dependents that were covered during the year need to be listed on the form. If the spouse is offered coverage and needs to be reported in Part III then they will need to be marked as a lifetime dependent.

If an employee waives coverage do I need to list their dependents?

Yes.

Is a spouse a life-time dependent?

Yes. In Human Resources, check the Dependent checkbox and check the Lifetime checkbox. You'll want to check these checkboxes to set up a spouse. 

If the child is 25 and turns 26, what happens?

The child will be removed as a dependent from the employee’s list of dependents unless the child is set up as a lifetime dependent. The child who is 26 will not show up on future ACA reports.

If the employee waives coverage, how do you know if they have dependents?

You will need to ask the employee for that information.

Warning: No Benefits Available

This warning message displays when the Dependent checkbox is not selected on a dependent’s contact information. To fix the error, open the Contacts tab in Human Resources > Modify Existing Employees and select the checkbox titled Dependent.

Do I need to add start dates to the dependent’s benefits?

Use the start and end dates on the dependent’s benefits the same way that you use the begin and end dates on an employee’s benefits. When a benefit changes, enter the begin date when the dependent starts using the new benefit and the end date on the last date the old benefit was applied.

If I’m not using Timekeeping for all the employees, can I still use Timekeeping for ACA Reporting?

The waiting period and dates are in Timekeeping. If you already know who are your full-time equivalent employees, then you made not need to use Timekeeping to determine this information.

When do employees need to receive their ACA forms?

Employers must send the employee’s portion of the ACA Form to the employee no later than March 5, 2025.

Why can’t I click the links in the electronic checklist?

Make sure you have installed the latest version of Caselle. Next, check your user security settings to make sure you have permission to access the ACA reporting tools. If you are still having trouble, contact customer support for assistance at (800) 243-8275 or email us at support@caselle.com.

How do I report health insurance for a dependent when the employee died during the reporting year? 

It depends on the employee/employer relationship and who is the responsible person. You may need to report this information by hand on Form 1095-B, see question 17 in the IRS Questions and Answers about Information Reporting by Employers on Form 1094-C and Form 1095-C. 

202111, 2021Dec01

When do I need to create a test transmission file?

When you create an electronic file, you have the option of creating a "test" transmission type. You only need to create a test transmission file the first time you use a software application to submit an electronic file. If you have used Connect Government Reporting to create the electronic file for filing ACAs in a prior year, you do not need to create the test transmission file. However, if this is the first time you are using Connect Government Reporting for filing ACAs electronically, then you should create a test transmission file and follow the instructions for submitting a test transmission files to the IRS. 

202111, 2021Nov05

 

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