All Western Region Brokers: ACA: Minimum Essential Coverage (MEC) Reporting Requirements for Insurers and Health Plans (ACA Section 6055)
Under Section 6055 of the ACA, entities that provide minimum essential coverage, including health plans, insurance carriers and self-insured groups, must
- Report data to the IRS about the coverage for each enrolled individual, including spouses and children using Form 1095-B.
- Issue annual statements to “responsible individuals” (this is usually the subscriber) about their coverage that can be used as documentation for tax purposes.
MEC reporting begins in 2016 for the 2015 tax year. Beginning in 2016, Health Net must issue statements to responsible individuals by January 31 of each year and report data to the IRS by February 28 of each year (March 31 of each year if filing information electronically).
Health Plans may either send a “1095-B form” (a link to the draft form is provided below) or issue a substitute statement with all of the required information.
Individuals will be required to report their coverage on their Federal Income Tax form and use the completed statements to show that they have maintained minimum essential coverage throughout the year for themselves and their dependents. Individuals who don’t maintain minimum essential coverage may be subject to a tax penalty under the ACA’s Individual mandate.
What Health Net is Doing
- Health Net will be compliant with IRS reporting and the requirement to send statements to responsible individuals beginning in 2016.
- Health Net will report to the IRS for all commercial business with the exception of Individual On Exchange. Please note that we are not required to report for government programs including state health plans, Medicare, and Medicaid/MediCal.
- The IRS reporting will include each of the covered individual’s name and tax identification number (TIN) or Social Security number (SSN), along with the months for which that individual was enrolled for at least one day of coverage and entitled to receive benefits.
- If we do not have the covered individual’s TIN/SSN, Health Net must make three attempts to obtain it. The first attempt is upon enrollment, and after that, Health Net will make two annual solicitations.
- The IRS will allow Health Plans to send the covered individual’s name and birth date if the TIN/SSN is not obtained.
Please encourage your clients and their employees of the importance of having subscribers provide TINs/SSNs for themselves and their family members.
Additional Information – IRS Forms
Below is a document containing links to the IRS reporting and individual statement information for your reference (IRS to finalize forms and instructions).
- Health Net members affected by Cranston, Carr and Ferguson Fires in California receiving assistance from Health Net
- Medical Loss Ratio (MLR) annual survey process underway at Health Net
- Health Net awards $1.5 million to help close insurance gap, improve quality of care and enhance health outcomes
- Oregon/Washington: Eclipsed by health care changes? See Health Net’s 2018 vision
- Health Net Earns 2017 Innovation in Advancing Health Equity Award