Understanding ACA Reporting Requirements
If you’re an employer or broker supporting a small group health plan, you’ve likely heard of the Affordable Care Act (ACA). This guide breaks down what ACA reporting is, who needs to do it, and how Sana helps!
What is ACA Reporting?
ACA reporting is how employers share information with the IRS about the health coverage they offer to employees.
It’s helps the IRS enforce two main ACA rules:
- Employer Mandate: Certain employers must offer health coverage to full-time employees.
- Individual Mandate: Individuals are generally required to have health coverage (note: there’s no federal penalty today, though some states still enforce this.)
Who Needs to Report?
ACA reporting requirements vary based on employer size:
Applicable Large Employers (ALEs)
Who this is: Employers with 50 or more full-time employees (including full-time equivalents) in the previous calendar year.
What’s required:
- File IRS Forms 1094-C and 1095-C
Why:
- To show that eligible employees were offered minimum essential coverage
Small Employers (Fewer than 50 FTEs)
Most small employers do not need to complete ACA reporting.
Exception: If you offer self-funded coverage (including Sana’s level-funded plans), ACA reporting is required.
What’s required:
- File Form 1095-B (plus a 1094-B transmittal)
- Covers all individuals enrolled in the self-funded plan
How Does Sana Help?
If you're a Sana Admin using a level-funded plan, your company is technically self-funded. Here's what that means for you:
- We help with the heavy lifting. Sana partners with a third-party vendor to prepare and distribute the 1095-B forms to employees and file them with the IRS.
- No action needed from your employees. They’ll receive a copy of their form for their records.
- You’ll get notified when reporting is complete.
Important note for ALEs:
If your group is an Applicable Large Employer, Sana does not file 1095-C or 1094-C forms. You’re responsible for completing that portion of ACA reporting.
Key ACA Reporting Deadlines
For the most up-to-date deadlines, refer directly to IRS guidance.
FAQ
What’s the difference between 1095-B and 1095-C?
- 1095-B: Used by insurance carriers or small self-funded employers.
- 1095-C: Used by ALEs to report coverage they offered to employees.
How do I know if I’m an ALE?
- Add up your full-time employees + full-time equivalents from the previous calendar year.
- If the total is 50 or more, you’re an ALE and must file 1095-C/1094-C.
Can brokers help with ACA reporting?
Absolutely. Brokers often support their clients by coordinating reporting vendors, checking ALE status, and answering general compliance questions. Sana works directly with brokers to make this process smoother.
Do employees need their ACA forms to file taxes?
Not usually. These forms are informational. Employees can file their taxes without them but should keep them for their records.
Need Help?
For questions about your company’s ACA reporting responsibilities or how Sana supports your group, reach out to your Sana Customer Success Manager or contact support@sanabenefits.com.