2026 Newfront ACA Employer Mandate and ACA Reporting Guide
The ACA Employer Mandate & ACA Reporting
2026 Edition
Audio
Presented by: Brian Gilmore | Lead Benefits Counsel, VP
Guide Topics
The ACA Employer Mandate
Plus the Associated ACA Reporting Requirements
• The ACA employer mandate rules are frequently also referred to as the “employer shared responsibility” or “pay or play” rules—these are synonymous!
• There are two potential employer mandate penalties the “A Penalty” and the “B Penalty” from IRC §4980H(a) and §4980(b)
• Employers report whether they are subject to either penalty in the §6056 ACA reporting via Forms 1094-C and 1095-C
• Without the good faith relief, properly completing the ACA reporting with the correct codes, etc. takes on additional importance to avoid potential penalties
ACA Employer Mandate and Reporting Topics for Discussion:
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Applicable Large Employers: ALE status determines whether employers are subject to these rules
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Employer Mandate Penalties: Reviewing the A Penalty and B Penalty potential liabilities
2
3
Full-Time Employee Status: The monthly measurement method and look-back measurement method
ACA Reporting: Understanding the §6055 and §6056 reporting structure via Forms 1094-C and 1095-C, plus new relief
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The ACA Employer Mandate
Applicable Large Employer (ALE)
The ACA’s Employer Mandate: Basic Rules and Terminology
IRC §4980H Penalties First Applied as of January 1, 2015
Generally requires applicable large employers to offer minimum essential coverage that is affordable and provides minimum value to all full-time employees (and their children to age 26) to avoid potential penalties.
- Applicable Large Employer: Generally an average of at least 50 full-time employees (including full-time equivalents) in the preceding calendar year for all members of controlled group
- Minimum Essential Coverage (MEC): Includes virtually any employer-sponsored major-medical coverage (but not dental, vision, health FSA, EAP, disability, etc.)
- Affordable: Employee share of the premium for the lowest cost self-only plan option that provides minimum value does not exceed 9.96% (2026 indexed amount) of employee’s income under one of three safe harbor approaches
- Minimum Value (MV): The percentage of the total allowed costs of benefits provided under the plan is no less than 60 percent (aka 60% actuarial value, at least as rich Bronze-level plan), and the plan provides substantial coerage of inpatient hosptial services and physician services
- Full-Time Employees: Employees averaging at least 30 hours of service per week under:
- The Look-Back Measurement Method OR
- The Monthly Measurement Method
Applicable Large Employer Status: Calculation
An employer is an applicable large employer (ALE) in the current year if it employed (along with all members of its controlled group) an average of at least 50 full-time employees (including full-time equivalent employees) on business days during the preceding calendar year. For purposes of determining whether an employer is an ALE, the employer must convert part-time employees into full-time equivalents. • Note: Special rules apply for seasonal
• Note: Special rules apply for seasonal workers and certain veterans.
Calculate the number of full-time employees for each calendar month in the preceding calendar year. For purposes of this calculation only, full-time employee means those who worked at least 120 hours of service in a month. (Note that for all other purposes under the employer mandate rules, full-time is 130 hours of service per month)
Calculate the number of full-time equivalents for each calendar month in the preceding calendar year as follows: A. Calculate the aggregate hours of service in a month for employees who are
A. Calculate the aggregate hours of service in a month for employees who are not full-time employees for that month (i.e., did not work at least 120 hours of service in that month). B. Divide the total hours of service from Step A by 120. The result is the number
2
B. Divide the total hours of service from Step A by 120. The result is the number of full-time equivalent employees for the month.
Add the number of full-time employees and full-time equivalents obtained in Steps 1 and 2 for each month of the preceding calendar year.
3
Add up the 12 monthly numbers from Step 3 and divide the sum by 12. This is the average number of full-time employees (including full-time equivalents) for the preceding calendar year.
Applicable Large Employer Status: Examples
| Example 1 | Example 2 |
|---|---|
| Employer's controlled group averaged43 full-time employees(including full-time equivalents)in2025. | Employer's controlled group averaged55 full-time employees(including full-time equivalents)in2025. |
| Result: | Result: |
| Employer is not an ALE in2026 | Employer is an ALE in2026 |
| What does the result mean? | What does the result mean? |
| Employer is not subject to the employer mandate(no potential§4980H penalties)in2026 | |
| Employer is not subject to ACA reporting(§6055/§6056 via Forms1094-C and1095-C)for the2026 calendar year that is reported at the beginning of2027 | |
| Note:§6055 reporting via Forms1094-Band1095-Bwill apply if the employer offered a self-insured medical plan | Employer is subject to potential employer mandate penalties(under§4980H)in2026 |
| Employer is subject to ACA reporting(§6055/§6056 via Forms1094-Cand1095-C)for the2026 calendar year that is reported at the beginning of2027 |
Employer Mandate Penalties
The ACA’s Employer Mandate §4980H Penalties
| §4980H(a)—The“A Penalty” Aka: The“Sledgehammer Penalty” | §4980H(b)—The“B Penalty”
Aka: The“Tack Hammer Penalty” | | --- | --- | | Failure to offer MEC to at least 95% of all full-time employees (and their children to age 26) The A Penalty is triggered by at least one such full-time employee who is not offered MEC enrolling in subsidized exchange coverage 2026 A Penalty liability is $3,340 annualized ($278.33/month) multiplied by all full-time employees 30 full-time employee reduction from multiplier | Applies where the employer is not subject to the A penalty Failure to:
- Offer coverage that's affordable;
- Offer coverage that provides MV; or
- Offer MEC to a full-time employee (where employer offers at a sufficient percentage to avoid A Penalty liability) The B Penalty is triggered by any such full-time employee enrolling in subsidized exchange coverage 2026 B Penalty liability is $5,010 annualized ($417.50/month) multiplied by each such full-time employee who enrolls in subsidized exchange coverage Note that although the B Penalty amount is higher ($5,010 vs. $3,340), the multiplier is generally much lower (only those full-time employees not offered affordable/minimum value coverage who enroll in subsidized exchange coverage) |
• 30 full-time employee reduction from multiplier
The ACA’s Employer Mandate §4980H Penalties
| §4980H(a)—The“A Penalty” Aka: The“Sledgehammer Penalty” | §4980H(b)—The“B Penalty”
Aka: The“Tack Hammer Penalty” | | --- | --- | | Simplified Version | Simplified Version | | • To avoid the“A Penalty”must offer MEC to at least 95% of full-time employees and their children to age 26 • 2026 A Penalty liability is $3,340 annualized ($278.33/month) multiplied by all full-time employees (reduced by first 30) | • To avoid the“B Penalty”,the offer of MEC must: • Be affordable;and • Provide minimum value(MV) • 2026 B Penalty liability is $5,010 annualized($417.50/month) multiplied by each such full-time employee who enrolls in subsidized exchange coverage |
• To avoid the “A Penalty” must offer MEC to at least 95% of full-time employees and their children to age 26
• 2026 A Penalty liability is $3,340 annualized ($278.33/month) multiplied by all full-time employees (reduced by first 30)
The ACA’s Employer Mandate §4980H Penalties
| §4980H(a)一The“A Penalty” Aka: The“Sledgehammer Penalty” | §4980H(b)一The“B Penalty”
Aka: The“Tack Hammer Penalty” | | --- | --- | | Historical Penalties | Historical Penalties | | 2025:$2,900 2024:$2,970 2023:$2,880 2022:$2,750 2021:$2,570 2020:$2,500 2019:$2,320 2018:$2,320 2017:$2,260 2016:$2,160 2015:$2,080 | 2025:$4,350 2024:$4,460 2023:$4,320 2022:$4,120 2021:$4,060 2020:$3,860 2019:$3,750 2018:$3,480 2017:$3,390 2016:$3,240 2015:$3,120 |
The “A Penalty” With Multiple Entities
“ALEM” Defined
• Subsidiaries and related entities with different EINs in an ALE’s controlled group are referred to as an “Applicable Large Employer Member,” or “ALEM”
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• The controlled group itself is referred to as the “Aggregated ALE Group” (consisting of multiple ALEMs)
ALE Status is Aggregated, Penalties are Separated
● ALE status is an aggregated count among all members of the controlled group, but “A Penalty” calculations are siloed to each specific member (ALEM)
● For employers with multiple corporate entities (generally multiple separate EINs) within the controlled group, the A Penalty will apply separately to each entity (ALEM)
● Means the 95% test for the A Penalty applies to each ALEM independently
● If any ALEM fails to offer coverage to at least 95% of that ALEM’s full-time employees, the A Penalty applies to that ALEM
● The A Penalty calculation is based only on the full-time employees of that ALEM
The “A Penalty” With Multiple Entities
Example
- ALE Big Co. (1,000 EEs) acquires non-ALE Lil’ Co. (40 EEs)
- Big Co. and Lil’ Co. keep separate EINs and separate corporate entities
Result
- Lil’ Co. becomes an ALEM subject to employer mandate as of the close
- If Lil’ Co. fails to offer coverage to at least 95% of Lil Co.’s full-time employees in any subsequent month, Lil’ Co. will be subject the A Penalty based only on the number of Lil’ Co.’s full-time employees (Big Co.’s full-time employees are not part of calculation)
- 30-employee reduction will be a small proportional amount (in relation to overall controlled group number of employees, which is dominated by Big Co.)
Determining Employees’ Full-Time Status
Determining Employee’s Full-Time Status
ALEs subject to the ACA employer mandate rules generally must apply either measurement method to determine employees’ full-time status:
● The monthly measurement method is generally recommended for employers with all or almost all full-time workforce
● The look-back measurement method is generally recommended for employers with a significant population of employees who may fluctuate above and below 30 hours per week
There Are Two Different Measurement Methods:
The Monthly Measurement Method (MMM)
The Look-Back Measurement Method (LBMM)
● Full details: https://www.newfront.com/ blog/the-aca-look-backmeasurement-method
Determining Full-Time Status: The LBMM
Under the look-back measurement method (LBMM), employers test whether an employee averages 30 hours of service per week in a measurement period to lock in fulltime or part-time status for the associated stability period. Employers can also place new variable hour, seasonal, and part-time employees in an initial measurement period prior to reaching full-time status.
● Full details: https://www.newfront.com/blog/theaca-look-back-measurement-method
Ongoing Employees Generally, if the LBMM is used for one employee to determine full-
Generally, if the LBMM is used for one employee to determine fulltime status, it must be used for all employees
● Exception:
Employer can choose separate measurement methods for:
● Hourly vs. salaried
● Employees in different states
● Union vs. non-union
● Employees in different union groups
● Typical Structure (Calendar Plan Year):
● Measurement period: 11/1 – 10/31
● Administrative period: 11/1 – 12/31
● Note: The 90-day administrative period limit prohibits measurement period running from 10/1. Many employers therefore use 10/15 or 11/1 as a starting point for the standard measurement period.
● Stability period: 1/1 – 12/31
Determining Full-Time Status: The Look-Back Measurement Method
Stability Period Keeps Status “stable” Even After Reduction in Hours
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• The LBMM will therefore preserve full-time status for at least the remainder of the current stability period (generally plan year) for those employees who tested as full-time during the prior measurement period
Key Points Under the Look-Back Measurement Method:
Retaining Full-Time Status
1
An employee who is in a stability period as full-time and experiences a change in employment status to working part-time hours or going on a leave will nonetheless remain full-time for ACA purposes the duration of the current stability period. The employee’s full-time status is kept “stable” for the entire stability period regardless of how many hours per week the employee is currently working.
Losing Full-Time Status
2
Employees who do not average at least 30 hours of service over the full standard measurement period (i.e., generally do not reach 1,560 hours of service in the typical 12-month standard measurement period) can be removed from coverage as of the start of the new stability period (generally the start of the new plan year) because the employee will be treated as part-time for ACA purposes for the duration of that stability period. This will be a COBRA qualifying event as of the end of the plan year in which the employee loses coverage (loss of coverage caused by a reduction in hours). 17
LBMM: New Hires
When to Offer Coverage Under the LBMM
• New full-time employees must be offered coverage by the first day of the fourth full calendar month of employment to avoid potential penalties
• New variable hour, seasonal, and part-time employees may be placed in an initial measurement period before being treated as full-time
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Typical Structure for New Variable/Seasonal/Part-Time Employee
• Combined duration of initial measurement period and initial administrative period cannot exceed 13 months (plus a partial month for mid-month hires)
Example:
● Hired on March 15, 2026
● Initial administrative period: 3/15/26 – 3/31/26 (front-end of split administrative period)
● Initial measurement period: 4/1/26 – 3/31/27
● Initial administrative period: 4/1/27 – 4/30/27 (back-end of split administrative period)
● Initial stability period: 5/1/27 – 4/30/28
New Hires: Utilizing the LBMM
| New Full-Time Employee | New Variable Hour Employee | New Seasonal Employee | New Part-Time Employee |
|---|---|---|---|
| An employee who is reasonably expected at the employee's start date to be a full-time employee (i.e., average 30 hours of service per week)and is not a seasonal employee. | The employer cannot determine at new hire's start date whether the employee is reasonably expected to complete on average at least 30 hours of service per week during the initial measurement period. | An employee who is hired into a position for which the customary annual employment is six months or less. | An employee who is reasonably expected to average less than 30 hours of service per week during the initial measurement period. |
| Factors include whether the prior person in the position averaged 30 hours of service per week,and whether the job was advertised/communicated as requiring 30 hours of service per week. | |||
| Employer mandate penalties do not start until after the employee has completed a limited non-assessment period. | |||
| No penalties will apply until the first day of the fourth full calendar month of employment-if the employee is still employed on that | This occurs because the employee's hours are expected to be variable or otherwise uncertain. | ||
| May apply an initial measurement period and initial administrative period before offering coverage in initial stability period(if the variable hour employee tested as full-time during the initial measurement period). | |||
| Limit on combined length of initial measurement period and initial administrative period is 13 months(plus a partial month for a mid-month hire). | The period should begin each calendar year in approximately the same part of the year,such as summer or winter. | ||
| In certain unusual circumstances,the employee can still be considered seasonal if the employment period is extended beyond its customary duration(e.g.,ski instructor works seven months in heavy snow winter). | |||
| Same initial measurement and initial administrative period rules apply. | Same initial measurement and initial administrative period rules apply. | ||
| As with variable hour and seasonal employees,the employer will not need to offer coverage to avoid employer mandate penalties if the part-time employee does notA.test as full-time during the initial measurement period,orB.remain employed long enough to reach the initial stability period. |
An employee who is reasonably expected at the employee’s start date to be a full-time employee (i.e., average 30 hours of service per week)—and is not a seasonal employee.
assessment period. ● No penalties will apply until the first day of the fourth full calendar month of employment—if the employee is still employed on that day.
● Factors include whether the prior person in the position averaged 30 hours of service per week, and whether the job was advertised/communicated as requiring 30 hours of service per week. Employer mandate penalties do
Determining Full-Time Status: The MMM
Full-Time Status:
Under the monthly measurement method (MMM), an employee’s status as full-time or part-time is determined on a monthly basis by the employee’s hours of service for each calendar month. This method does not provide the predictability of the look-back measurement method. Employers will not know whether
Employers will not know whether employees are full-time until the month is complete, and all hours recorded. However, for primarily full-time workforces this method avoids significant complexity.
● Full details: https://www.newfront.com/blog/the-aca-
https://www.newfront.com/blog/the-acamonthly-measurement-method
Ongoing Employees
● Full-time status is determined by actual hours of service performed in that month
● There is no look-back period to lock in an employee’s status as full-time or part-time
● Use the monthly measurement method when it is clear that employees working at least 130 hours of service in any given calendar month will be offered coverage (e.g., all full-time workforce)
Advantages:
● Administrative simplicity for workforces with generally stable hours
● Limited non-assessment period available the first time an employee works full-time in a month
Disadvantages:
● No predictability as to full-time/part-time status for the plan year because it is determined monthly
● Not feasible for workforces with a significant population that regularly fluctuates above and below 130 hours Can’t determine hours of service in the month until it has been completed
● No initial measurement period available to delay offering coverage to new variable/seasonal/part-time hires
Monthly Measurement Method
New Hires
- Three-month rule: Can be applied only once per period of employment.
- Applies when an employee first works at least 130 hours of service in a calendar month.
- This might be the first month of employment or a subsequent month.
- First month working 130 hours of service triggers the three-month rule.
- Creates a limited non-assessment period of two full calendar months following the end of that first calendar month.
- Think of this limited non-assessment as providing relief during the plan’s waiting period for coverage after the employee triggers eligibility by working full time for a month.
Monthly Measurement Method
Example
- Employee is hired in January
- Employee works 125 hours of service for January and February (130 is full-time)
- Employee works 135 hours of service in March
Result
- March full-time work triggers:
- Eligibility for the health plan, and
- The three-month rule’s limited non-assessment period
- Employer will need to offer coverage to the employee within its waiting period per the terms of the plan
- Limited non-assessment period accommodates maximum potential waiting period by not imposing employer mandate penalties for the months of March, April, May
- Employer must offer coverage that is affordable and provides minimum value by the first day of June to avoid penalties for March through May and beyond
Contingent Workforce
Temps/Interns/Short-Term EEs
There are no special employer mandate rules for temps, interns, or short-term employees
“The Treasury Department and the IRS continue to be concerned about the potential for abuse of any exception for short-term employees through the use of initial training period positions or other methods intended to artificially divide the tenure of an employee into one or more short-term employment positions in order to avoid application of section 4980H. For these reasons, the final regulations do not adopt any special provisions applicable to short-term employees.”
This means the same rules will apply to short-term employees as any other new hire
In some cases, not offering coverage to these short-term employees may subject the employer to potential employer
mandate penalties under §4980H. • More details: Health Coverage for Temps and Interns
Strategies for Temps and Interns
More details: Health Coverage for Temps and Interns
Offer Coverage on the Same Basis as Regular Full-Time Employees
Delay Offer of Coverage to First Day of Fourth Full Calendar Month
Limit Medical Plan Option(s) Offered
Exclude Health Benefits Other than Medical (e.g., Dental/Vision)
Exclude Spouses (but not Children!)
Seasonal Employee 13+ Month Initial Measurement/Administrative Period (LBMM Only)
Combination of Above Options
Utilizing an Outside Staffing Firm
Threshold Issue
Threshold issue is whether the temp hired through a temp agency is a “common-law employee” of your company or the temp agency.
Treas. Reg. §54.4980H-1(a)(15): “The term employee means an individual who is an employee under the common-law standard.”
This means ER mandate penalties will apply only if the temp is your company’s common-law employee: “Under the common law standard, an employment relationship exists when the person for whom the services are performed has the right to control and direct the individual who performs the services, not only as to the result to be accomplished by the work but also as to the details and means by which that result is accomplished. Under the common law standard, an employment relationship exists if an employee is subject to the will and control of the employer not only as to what shall be done but how it shall be done. In this connection, it is not necessary that the employer actually direct or control the manner in which the services are performed; it is sufficient if the employer has the right to do so.”
Three Factors to Determine the Employment Relationship
The IRS makes clear in preamble to final regulations that in the “typical case,” the temp will be a common-law employee of the company hiring the temp—not the outside staffing firm.
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Behavioral Control
Right to direct and control work
Financial Control
Right to direct or control financial and business aspects
Relationship of the Parties
Facts and circumstances of arrangement
Utilizing an Outside Staffing Firm
Assuming the worker from the staffing firm is your common-law employee, your company must offer coverage to
avoid penalties in the same manner as a standard employee on your payroll.
However, the rules establish a procedure where an offer of coverage by the outside staffing firm will be treated as an
offer of coverage by the company:
Treas. Reg. §54.4980H-4(b)(2):
“(2) Offer of coverage on behalf of another entity…For an offer of coverage to an employee performing services for an employer that is a client of a staffing firm, in cases in which the staffing firm is not the common law employer of the individual and the staffing firm makes an offer of coverage to the employee on behalf of the client employer under a plan established or maintained by the staffing firm, the offer is treated as made by the client employer for purposes of section 4980H only if the fee the client employer would pay to the staffing firm for an employee enrolled in health coverage under the plan is higher than the fee the client employer would pay the staffing firm for the same employee if that employee did not enroll in health coverage under the plan.”
Utilizing an Outside Staffing Firm
Note: Flat fee increase for all employees is not sufficient here—fee must increase only for those who enroll
● Make sure your contract with the staffing firm is updated to reflect this requirement.
● Full details: https://www.newfront.com/blog/acaemployer-mandate-and-outside-staffingfirms-2
Two Requirements:
The company must pay an increased fee to the staffing firm for each employee who enrolls in the outside firm’s offer of coverage
Leaves and Rehires
Leaves of Absence
| Paid Leave of Absence | Unpaid Leave | “Special” Unpaid Leave |
|---|---|---|
| Paid leave is considered hours of service for purposes of employer mandate. | An unpaid leave of absence that does not qualify as “special unpaid leave”. | Unpaid leave that is: |
| Subject to FMLA | ||
| Subject to USERRA; or | ||
| On account of jury duty | ||
| This is because with paid leave, the employee is entitled to payment for a period during which no duties are performed due to the leave of absence. | ||
| Means that a period of paid leave will be treated the same as a period of active employment duties. | ||
| When using the look-back measurement method, the employee will have hours of service credited in the measurement period for the duration of the paid leave as if active or on paid vacation. | In this case, the employee will not receive any hours of service credit. | |
| When using the look-back measurement method, the employee will have no hours of service for the duration of the unpaid leave. | ||
| If the employee is at or near 30 hours per week when active, the period of unpaid leave could cause the average over the course of the full measurement period to dip below 30—resulting in the employee being treated as part-time for the associated stability period. | When using look-back measurement method, two options for addressing special unpaid leave: | |
| Excluded Period: Exclude the period of special unpaid leave from the measurement period computation by determining the employee's average hours of service without the period of special unpaid leave. | ||
| OR | ||
| Imputed Hours: Credit the employee with hours of service during the period of special unpaid leave at a rate equal to the average |
● This is because with paid leave, the employee is entitled to payment for a period during which no duties are performed due to the leave of absence.
● When using the look-back measurement method, the employee will have hours of service credited in the measurement period for the duration of the paid leave as if active or on paid vacation.
● If the employee is at or near 30 hours per week when active, the period of unpaid leave could cause the average over the course of the full measurement period to dip below 30—resulting in the employee being treated as part-time for the associated stability period.
● When using the look-back measurement method, the employee will have no hours of service for the duration of the unpaid leave.
● When using look-back measurement method, two options for addressing special unpaid leave:
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● Excluded Period: Exclude the period of special unpaid leave from the measurement period computation by determining the employee’s average hours of service without the period of special unpaid leave.
● Imputed Hours: Credit the employee with hours of service during the period of special unpaid leave at a rate equal to the average weekly hours of service for weeks that were not part of the special unpaid leave.
OR
Returning From a LOA and Rehires
| Break in Service: 13 or more consecutive weeks | Break in Service: Rule of Parity | No Break in Service:
Continuing Employee | | --- | --- | --- | | Where the employee did not have an hour of service for the company for a period of at least 13 consecutive weeks. | Rule of parity applies where the break in service is at least four consecutive weeks, but shorter than 13 consecutive weeks (26 weeks for educational organization). | Where the period of leave (or period between termination and rehire) is not a break in service, the returning employee must be treated as a “continuing employee”. | | ·Upon return from leave,the employee can be treated as a new employee. ·The same principles in this case would apply to a new hire. ·If full time,must offer coverage no later than the first day of the fourth full calendar month to avoid penalties. ·If variable hour,seasonal,或 part-time,employer can put the returning employee through a new initial measurement period before offering coverage. ·Note that the break period must be 26 weeks to treat the employee as a new employee if the employer is an educational organization. | ·Under the rule of parity,a break in service occurs if the employee's period with no credited hours of service is longer than the employee's immediately preceding period of employment. ·For example,employee works three weeks for an employer prior to going on unpaid leave(not“special”)of ten weeks. ·The ten-week period with no hours of service is a)at least four weeks long,and b)longer than the immediately preceding three-week period of employment. ·Under the rule of parity,this is a break in service,and the employer may treat the employee as a new employee upon return. | ·Under the look-back measurement method,a continuing employee will return to the same status in the stability period. ·This means that if the continuing employee returns in a stability period in which the employee was being treated as full-time before the leave,the employee will be treated as full-time upon return and through the end of the stability period. ·Continuing full-time employees enrolled prior to termination must be offered coverage upon first day of return,or,if later,as soon as administratively practicable ·Rules deem first day of the calendar month following return to always comply under this standard. |
● Note that the break period must be 26 weeks to treat the employee as a new employee if the employer is an educational organization.
Hours of Service
General Hours of Service Rules
| Treas. Reg.§54.4980H-1(a)(24) defines an“hour of service” as follows: | Treas. Reg.§54.4980H-3(b) sets forth the calculation rules: |
|---|---|
| Active Duties:Each hour for which an employee is paid, or entitled to payment, for the performance of duties for the employer; andInactive Payments:Each hour for which an employee is paid, or entitled to payment by the employer for a period during which no duties are performed due to: VacationHolidayIllnessIncapacity(including disability),LayoffJury dutyMilitary duty,orLeave of absence | Hourly Employees:Actual Hours:Employer must calculate actual hours of service from records of hours worked and hours for which payment is made or dueGenerally straightforward data from payrollSpecial exceptions for hard to track hoursNon-Hourly Employees(e.g.,Salaried):1. Actual Hours:Use actual hours of service from records of hours worked and for which payment is made or due2.Days-Worked Equivalency:Employee is credited with eight hours of service for each day the employee is paid or entitled to pay; or3. Weeks-Worked Equivalency:Employee is credited with 40 hours of service for each week the employee is paid or entitled to pay |
• Active Duties: Each hour for which an employee is paid, or entitled to payment, for the performance of duties for the employer; and
• Vacation,
• Holiday,
• Actual Hours: Employer must calculate actual hours of service from records of hours worked and hours for which payment is made or due
• Illness,
• Military duty, or
• Leave of absence
• Layoff,
• Jury duty,
• Special exceptions for hard to track hours
Non-Hourly Employees (e.g., Salaried):
Actual Hours: Use actual hours of service from records of hours worked and for which payment is made or due;
Days-Worked Equivalency: Employee is credited with eight
hours of service for each day the employee is paid or entitled to pay; orWeeks-Worked Equivalency: Employee is credited with 40
hours of service for each week the employee is paid or entitled to pay
Employees on Leave: Inactive Payments and Hours of Service
| Included in Hours of Service | Excluded From Hours of Service |
|---|---|
| IRS confirmed that payments are generally deemed to be made by the employer regardless of whether the payment is made directly by the employer For example, payments made from an insurance carrier or trust fund to the employee are still considered made by the employer Most disability payments (other than state statutory plans) count as hours of service if the employee has not been terminated from employment Includes STD and LTD—even where benefit payments made by carrier | Workers' compensation paymentsUnemployment paymentsState disability payments(or voluntary replacements to comply with state STD requirementsCalifornia SDICalifornia Voluntary PlanStatutory disability plans(or private replacements)in HawaiiNew Jersey, New York,and Rhode IslandDisability plan payments made from arrangements to which the employer did not directly or indirectly contributeRequires that the premium was exclusively paid by employee after-tax contributions to qualify |
• For example, payments made from an insurance carrier or trust fund to the employee are still considered made by the employer
• Most disability payments (other than state statutory plans) count as hours of service if the employee has not been terminated from employment
●Statutory disability plans (or private replacements) in Hawaii, New Jersey, New York, and Rhode Island
Hours of Service—In the Weeds
Applying Non-Hourly Employee Methods
●Again, these are actual hours, days-worked equivalency (8 hours/day), and weeks-worked equivalency (40 hours/week). ●Employers are not required to use the same method for all non-hourly employees. ●May apply different methods to different categories of non-hourly employees as long as the categories are reasonable and consistently applied. ●Employers may change the method for each calendar year.
Prohibited Non-Hourly Employee Methods
- Method applied must “reflect generally” the hours actually worked and the hours for which payment is made or due.
- One employee: Can’t use an equivalency method that would “substantially understate” an employee’s hours to cause that employee to not be full-time.
- Group of employees: Can’t use an equivalency method that would understate the hours of a “substantial number of employees” (even if no particular employee’s hours are understated substantially or caused to lose full-time status).
- Example: Employer may not use a days-worked equivalency for an employee who works three 10-hour days per week. This would cause the employee to have 24 hours per week and be part-time instead of 30 hours actually worked and full-time status.
Hours of Service—In the Weeds
Excluded Types of Work
- Bona Fide Volunteers: Employees of a government entity or 501(c) whose compensation is limited to reimbursement for expenses or reasonable benefits and nominal fees
- Work-Study Students: Services performed as part of a work-study program
- All other types of student employees will have hours of service
- IRS feared that blanket exception for paid internships or externships would lead to potential abuse
- Service Outside the U.S.: Compensation that is not U.S. source income
- Vow of Poverty: Religious orders do not need to count service by members who are subject to a vow of poverty for tasks usually required of active members
Rules for Hard to Track Hours
- Adjunct Faculty: Employers may credit adjunct faculty with 2.25 hours of service per week for each hour of teaching or classroom time, 1.25 hours of service for class prep and grading, and one hour of service for office hours and faculty meetings.
- Layover Hours: Where the employee is not paid extra for the layover hours, the employer may credit the employee with 8 hours of service for each day the employee is required to stay away from home overnight—16 hours total for the two days encompassing an overnight stay.
- On-Call Hours: Must use a reasonable method to credit hours—includes requirement to credit hours for any paid on-call hours, or where the employee’s on-call time is substantially restricted.
Avoiding Penalties
2026 Affordability Safe Harbors: 9.96%
The employer mandate affordability safe harbors are indexed to a metric based on the rate of premium growth over the rate of CPI growth for the preceding year. For 2026, the applicable percentage increases to 9.96% (up from 9.02% in 2025). Full Details Available Here: The ACA Affordability Determination in 2026
- 2026 Federal Poverty Line Safe Harbor: 9.96% of the Federal Poverty Line
- Prior-Year Federal Poverty Line (Contiguous 48 States): $15,650
- 2026 Monthly Employee-Share of Premium for Lowest-Cost (Minimum Value) Plan Limit: $129.89
- Action Item: Always use this approach where the employer offers plan option at a cost that does not exceed $129.89/month
- 2026 Rate of Pay Safe Harbor: 9.96% of Rate of Pay
- Hourly Employees: 9.96% of Employee’s Hourly Rate of Pay x 130 Hours (regardless of actual hours of service)
- Salaried Employees: 9.96% of Employee’s Monthly Salary
- Action Item: Use this approach where the employer’s cheapest (minimum value) plan option costs employees more than $129.89/month
- 2026 Form W-2 Safe Harbor (Not Recommended): 9.96% of Box 1 Wages
- Disadvantage #1: Retrospective Determination—Form W-2 safe harbor provides no predictability because Box 1 unknown until January of following year (i.e., employer will not know until January 2027 whether it met the Form W-2 safe harbor for 2026)
- Disadvantage #2: Disregarded Compensation—Box 1 does not include many forms of compensation, including 401(k) deferrals and Section 125 salary reductions for health and welfare plan coverage
- Disadvantage #3: Fixed Premium—The employee-share of the premium must remain consistent as an amount or percentage for the full plan year, which means employers cannot make mid-year adjustments to address lower-than-anticipated Box 1 amounts
ACA Affordability: Opt-Out Credits
“Eligible Opt-Out Arrangement” Approach Avoids Affecting Affordability
“E
- Employers often offer employees an additional amount of taxable cash compensation if they waive the health plan
- Unless they are properly structured, these “opt-out credits” (aka “cash-in-lieu”) can cause the employer’s offer of coverage to fail to meet one of the ACA affordability safe harbors
- Opt-out credits that are not designed to qualify as an “eligible opt-out arrangement” must be added to the employee-share of the premium when determining affordability—this is not intuitive!
- For example, if the employer’s lowest-cost plan option is $100/month and the opt-out credit is $50/month, under the general rule the plan costs $150/month ($100/month premium plus $50/month opt-out credit) for affordability purposes to reflect the $50/month the employee forgoes by electing the health plan*
- *Note: The IRS has indefinitely delayed these eligible opt-out arrangement rules for arrangements in effect prior to 12/16/15
Eligible Opt-Out Arrangement Requirements:
- The opt-out credit is conditioned on the employee declining to enroll in the major medical plan; and
- The opt-out credit is conditioned on the employee providing reasonable evidence (including an employee attestation) annually that the employee and all members of the employee’s expected tax family have or will have minimum essential coverage under a group health plan (or Medicare/TRICARE) for the period the opt-out credit applies
ACA Affordability: Flex Credits
“Health Flex Contribution” Approach Treats Flex Credits as Employer Contribution
“E
- Some employers use a flex credit approach under the Section 125 cafeteria plan whereby employees may allocate a fixed amount of credits to different qualified benefits
- Often these flex credits can be allocated to non-health benefits or cashed-out as taxable income
- Unless the flex credits are properly structured, the flex credit amount available for employees to allocate to the health plan will be treated as an employee contribution for ACA affordability purposes
- Employers generally need to make the flex credits count as an employer contribution to meet one of the ACA affordability safe harbors—this requires that the flex credits qualify as “health flex contributions”
Health Flex Contributions Requirements:
- The employee may not opt to receive the amount as a taxable benefit (i.e., it is not a cashable flex credit);
- The employee may use the amount to pay for minimum essential coverage (i.e., the employee’s major medical plan); and
- The employee may use the amount exclusively for health coverage costs (e.g., medical, dental, vision, health FSA, HSA)
IRS Fixed the ACA “Family Glitch”
| The ACA Family Glitch | The Family Glitch“Fix” | The Cafeteria Plan“Fix” |
|---|---|---|
| ·The PTC subsidy structure was previously based only on cost of employee-only coverage | ||
| ·Employer mandate requires ALEs to offer coverage that is “affordable” to avoid B Penalties | ||
| ·Affordability is based solely on the employee-share of the premium for self-only coverage | ||
| ·Individuals do not have access to PTC subsidies for exchange coverage if employer offer of coverage is affordable | ||
| ·If the employer plan is affordable under employee-only standard, prior interpretation was that plan was affordable for all family members-even if cost was very expensive for family members | ·New regulations analyze affordability for each family member individually | |
| ·Means that if the employee is offered affordable self-only coverage, family members may now be treated as not having received affordable offer | ||
| ·This opens the door to family members having access to the PTC for subsidized exchange coverage | ||
| ·Does not affect the employer analysis from employer mandate perspective—penalty liability still based on whether employee-only coverage is affordable | ||
| ·Does not affect ACA reporting via Forms 1094-C/1095-C | ·IRS created a new Exchange-related permitted election change event to address family member PTC access | |
| ·Allows employees to revoke coverage for dependents to access PTC where: |
- Family member is eligible for SEP to enroll in Exchange coverage or seeking to enroll in Exchange during its open enrollment period;and
- Employee is revoking coverage for family member who will enroll in Exchange no later than the day immediately following the last day coverage revoked ·Employer may rely on employee's reasonable representation ·New event became available for cafeteria plan elections on or after January 1, 2023 ·Plan amendment required by end of plan year when adding to cafeteria plan |
Responding to Letters From the Exchange
Employer Exchange Notices Are the First Bite at the Apple!
• Notifies employers that the exchange has conditionally approved the employee for the Advance Premium Tax Credit (APTC)
• Commonly referred to as “exchange subsidies”
• These subsidies trigger ACA employer mandate penalties
• Employers care: Remove subsidy, remove §4980H penalty (no subsequent Letter 226J)
• Employees care: Remove subsidy, remove need to pay it back on tax return
| Employer Exchange Notice Approach | Employer Offered Affordable/MV MEC | Employer Did NOT Offer Affordable/MV MEC |
|---|---|---|
| Full-time Employee | Strongly Recommend Appeal | |
| Prevent ACA Employer Mandate§4980H Penalties | ||
| Prevent Repayment of APTC | Do Not Appeal | |
| Employer will receive Letter 226J with§4980H penalties | ||
| Part-time Employee | Consider Appeal | |
| Prevent Repayment of APTC | Do Not Appeal | |
| Nothing to Appeal here |
ACA Employer Mandate Penalties are Real
IRS Letter 226J
- Applicable Large Employers (ALEs) have been receiving ACA employer mandate penalty assessments since late 2017
- ALEs continue to be informed of prior year penalty assessments
- Many penalties are the result of ACA reporting errors on the Forms 1094-C and 1095-C
- Explanation of reporting errors and corrected codes usually removes penalties
Full Details Available Here:
- Keep relevant data because Letters 226J are generally for two years priorResponding to IRS Letter 226J
- Review full alert for details on how to respond to Letter 226J
ACA Reporting: Forms 1094-C & Form 1095-C
Background
The ACA Added Two New Tax Code Sections: §6055 & §6056
§6055
“E
- Requires providers of health coverage to report to the IRS and covered individuals that the persons were covered by “minimum essential coverage.”
- This will demonstrate that each person has satisfied their individual mandate, and therefore will not be subject to the tax penalty.
§6056
- Applies to “applicable large employers”—or “ALEs”—subject to the employer mandate rules—generally employers with at least 50 full-time employees, including full-time equivalent employees.
- This will be used to determine whether the employer is subject to any ER mandate penalties under §4980H.
- It will also be used to determine whether the individual is eligible for the premium tax credit on the Exchange.
Which Employers Need to Report?
Self-Insured Medical Plan
“E
- All employers with a self-insured medical plan (including level-funded plans) must report regardless of size
- Non-ALE employers under 50 full-time employees (plus full-time equivalents) will be reporting only for §6055 (minimum essential coverage) via Forms 1094-B and 1095-B
- Employers that are “applicable large employers” will report both for §6055 (minimum essential coverage) and §6056 (employer mandate) via Forms 1094-C and 1095-C
Insured Medical Plan
- Only “applicable large employers’ – those with 50 or more full-time employees (plus full-time equivalents).
- For insured plans, the insurance carrier reports for §6055 (minimum essential coverage) via 1095-B
- However, the insurance carrier will not report for §6056 (employer mandate)—that is always the employer’s responsibility via Forms 1094-C and 1095-C Full Details Available Here: The ACA Reporting Requirements in 2026
Which Employers Need to Report?
§6055 & §6056 Form 1094-C Forms 1095-C Part III (MEC): Yes
§6055 (MEC Only) Form 1094-B Forms 1095-B
Which Plans are Considered Self-Insured?
General Rule: Plans That are Not Fully Insured are Treated as Self-Insured for Compliance Purposes
It is helpful to think of the distinction among funding arrangements as follows:
• Fully Insured; and
• Not Fully Insured (including self-insured and level-funded)
Plans that are not fully insured (i.e., no insurance policy) are treated as a self-insured plan for compliance purposes.
Level-Funded Plans are Treated as Self-Insured Plans for Compliance Purposes
• These are arrangements where the employer pays a level fee each month to the TPA (includes an administrative fee, estimated cost for benefits, and a stop-loss premium)
Technical Definition of Self-Insured: §105
● “The term ‘self-insured medical reimbursement plan’ means a plan of an employer to reimburse employees for expenses referred to in subsection (b) for which reimbursement is not provided under a policy of accident and health insurance.”
Technical Definition of Self-Insured: §105 Regulations
● Treas. Reg. §1.105-11(b)(1)(i): “A plan or arrangement is self-insured unless reimbursement is
● “A plan or arrangement is self-insured unless reimbursement is provided under an individual or group policy of accident or health insurance issued by a licensed insurance company….”
Remember: Level-Funded Plans Treated as Self-Insured
● Plans (including level-funded plans) that are not fully insured are treated as self-insured for compliance purposes Always apply self-insured plan rules to level-funded plans!
● Always apply self-insured plan rules to level-funded plans!
Form 1094-C
1094-C Transmittal Form
Think of this as the cover sheet for the Forms 1095-C.
- All ALEs must file a Form 1094-C
- If the ALE has multiple entities, each entity (ALEM) must file a separate Form 1094-C
- Must be one “Authoritative Transmittal” for each member of the controlled group. Information Reported
- Name, contact information, and EIN of the employer
- Whether the employer offered MEC to at least 95% of full-time employees for each month in the calendar year
- Total number of employees and full-time employees in each month
- Whether any streamlined reporting provisions apply
- e.g., Qualifying Offer Method
- e.g., 98% Offer Method
1094-C: Transmittal
Form
- Page 1
1094-C Transmittal
Form
- Page 2
1094-C Transmittal
Form
- Page 3
Multiple Entities
Full Details: ACA Reporting for Controlled Groups
Separate Forms 1094-C for Each ALEM “E
• Where an ALE has multiple corporate entities in the controlled group, there is an “Aggregated ALE Group”
• Each “Applicable Large Employer Member” (ALEM) in that group (generally each subsidiary or related entity in the controlled group that maintains a separate EIN) must file a separate Form 1094-C
• Required because each ALEM is separately subject to the “A Penalty” analysis
Required Entries for Each ALEM on the Form 1094-C
• Part II, Line 21: Answer “Yes” to question “Is ALE Member a member of an Aggregated ALE Group?”
• Part III, Column D: For each month in which the controlled group existed, the “Aggregated Group Indicator” box will be checked
• Employees of each ALEM must receive a Form 1095-C with that ALEM’s name/EIN (cannot simply use the parent EIN for all Forms 1095-C)
• If an employee works for more than one ALEM in any month, the ALEM for whom the employee worked the most hours of service will report as the employer
Form 1095-C
Form 1095-C: Offer Details and Coverage
- This form is completed for every full-time employee
- Self-insured plans also need to report all individuals covered (self-insured non-ALEs use Form 1095-B)
- Two main topics being reported:
1. §6055: Individuals covered by MEC for individual mandate compliance
- Self-insured plans only – Employers with fully insured plans leave Part III blank.
- For insured plans, the insurance carrier uses the Form 1095-B to report MEC.
- Requires Social Security Number (or reasonable efforts to obtain) for all covered individuals
2. §6056: Employer mandate compliance for §4980H penalties
- All ALEs must report on this – both self-insured and fully insured
- Requires detail as to plan’s offer of coverage to all full-time employees
Form 1095-C: Employer Offer Details and Coverage
Information Reported
Employee name, address, and Social Security Number Employer name, address, contact phone number, EIN
Offer of coverage details for each month of coverage:
- Was the employee offered coverage for each month?
- Was the offer affordable and did it provide minimum value?
- Did the offer include an offer of coverage for dependents?
- Monthly employee-share of the premium for the lowest cost plan option at employee-only tier that provides minimum value and was offered to the employee If an affordability or other §4980H safe harbor applies:
- Form W-2 affordability safe harbor
- Federal poverty line affordability safe harbor
- Rate of pay affordability safe harbor
- Limited non-assessment period Self-Insured: Part III includes name, SSN, and months of coverage for each covered individual (employee and dependents)
Form 1095-C: Employer Offer Details and Coverage
Part III Coverage Information – Self-insured Plans
Self-insured plans must include MEC coverage information in Part III of the Form 1095-C:
- Names of all covered individuals
- SSNs of all covered individuals
- Must make “reasonable efforts” to obtain the SSN for all covered individuals
- Requires three attempts to solicit the SSN:
1. Account Opened Solicitation: Initial solicitation upon the employee’s election to enroll the dependent
2. First Annual Solicitation: If not received, second solicitation within 75 days of the employee’s election to enroll the dependent 3. Second Annual Solicitation: If not received, third solicitation by December 31 of the year following the year the employee elected to enroll the dependent
- Enter date of birth for any covered individuals who don’t provide the SSN
- Months of coverage (not just offered coverage, but actually enrolled) for all covered individuals in the plan
Form 1095-C: Employer Offer Details and Coverage
Part III Coverage Information – COBRA Reporting
Self-insured plans must report the coverage information in Part III for everyone enrolled—including COBRA
- The Form 1095-C coding for terminated employees is one of the trickier areas of ACA reporting
- Terminated Employee Enrolled in COBRA: Months After Termination of Employment in Year of Termination
- Line 14: 1H (not offered coverage)
- Line 15: Blank
- Line 16: 2A (not employed)
- Part III: Enter coverage information for employee and dependents for all months of active/COBRA coverage
- Terminated Employee Enrolled in COBRA: Active Coverage Ended Previous Year
- Line 14: 1G (not an employee for all 12 months)
- Line 15: Blank
- Line 16: Blank
- Part III: Enter coverage information for employee and dependents for all months of COBRA coverage
- Note: Employer may choose to report for the former employee on a separate Form 1095-B instead
Form 1095-C
- Parts I & II
Form 1095-C
- Part III
Fully Insured Plan
Self-Insured Plan
(Note: Includes Level-Funded Plans)
Both Fully Insured &
Self-Insured Plans
(Note: Self-Insured Includes Level- Funded Plans)
Self-Insured Non-ALE
Plan
(Note: Includes Level-Funded Plans)
Streamlined ACA Reporting Methods
| Qualifying Offer Method | 98% Offer Method |
|---|---|
| An offer providing MEC to one or more full-time employees for all calendar months during the year for which the employee was full-time, provided: | |
| ·The offer meets the federal poverty line safe harbor for mainland U.S.; and | |
| ·The offer included an offer of MEC to the employee's spouse and dependents (if any) | For all months during which individuals were employees and not in a limited non-assessment period,the employer offered: |
| ·Affordable/MV coverage to at least 98% of its employees for whom it files a Form 1095-C;and | |
| ·MEC to those employees' dependents(children to age 26) | |
| Streamlined Effect | Streamlined Effect |
| Forms 1095-C,Part II: | |
| ·Line 14:Use Code 1A for each month in which the employee received a Qualifying Offer | |
| ·Line 15:Must Leave Blank | |
| ·Line 16:May Leave Blank(IRS guidance in instructions) | |
| Substitute Form: | |
| ·Permitted where employee received 12-month qualifying offer and not enrolled in self-insured coverage | |
| ·Substitute form generally not recommended because the employer must still provide Form 1095-C to the IRS | Form 1094-C,Part III: |
| ·The employer is not required to complete the full-time employee count section(Column(b)) | |
| ·Column(b) reports the number of full-time employees for each month in the calendar year | |
| ·Still required to complete a Form 1095-C for each full-time employee | |
| ·Is it worth it?Little benefit and certifying to 98% may backfire if employees inadvertently missed |
Deadlines and Penalties
ACA Reporting Deadlines Extension Stays, No More Good Faith Safe Harbor
Full Details: The ACA Reporting Requirements in 2026
Extended Deadline Is Here to Stay
• The IRS finalized regulations to make the 30-day extension permanent*
*New Furnishing Relief Available!
• 30-day extension applies only to the deadline for providing the forms to individuals*
• Deadlines to file with the IRS remain standard
• In prior years the IRS also provided the good faith enforcement safe harbor to avoid penalties for incorrect or incomplete information (generally $340 per return)
• Remember: No good-faith safe harbor available anymore—standard penalty scheme applies for incorrect information
• Remember: No option to file by paper anymore—going forward all employers must file electronically
2026 ACA Reporting Deadlines for ALEs
| Forms | Type of Distribution | Due Date |
|---|---|---|
| 2025 Forms 1095-C | Furnish to Individuals* | March 2,2026 |
| 2025 Forms 1094-C(+Copies of Forms 1095-C) | Electronically File with IRS | March 31,2026 |
Due Dates: 30-Day Extension to Furnish, No Longer Option to File by Paper
Full Details: The ACA Reporting Requirements in 2026
| Form 1095-C: To Employees | Forms 1094-C and 1095-C to the IRS: Electronic Only |
|---|---|
| *New Furnishing Relief Available! | |
| • Must be furnished by March2,2026 | |
| • Standard deadline is January31,but the new IRS final regulations make the 30-day extension from previous years permanently available going forward(great news!) | |
| • Unfortunate downside is they have also confirmed that the good faith enforcement safe harbor for incorrect/incomplete forms is no longer available | |
| • Note: The 30-day extension makes the deadline March2 for a non-leap year,March1 on a leap year | • Must be filed electronically byMarch31,2026 |
| • Employers must file electronically if filing10 or more returns(includingACA reporting,FormW-2,and1099,etc.)startingin2024—includes virtually all employers | |
| • Previous ability to file by paper where under250ACA form return threshold is now eliminated | |
| • More details:IRS Requires Electronic ACA Filing in2024 | |
| • Note:The filing deadline is extended on years when it fallson a weekend |
• Note: The 30-day extension makes the deadline March 2 for a non-leap year, March 1 on a leap year
New ACA Reporting and ER Mandate Relief Full Details: The ACA Reporting Requirements in 2026
| Form 1095-C Furnishing Relief: Paperwork Burden Reduction Act Passed End of 2024 | Employer Mandate Penalty Relief:
Employer Reporting Improvement Act Passed End of 2024 | | --- | --- | | ALEs No Longer Have to Furnish Forms 1095-C Instead, ALEs simply have to make the forms available upon request Two requirements for employers to take advantage of this alternative manner of furnishing statements:
- Notice of Availability:Provide employees with clear, conspicuous,and accessible notice that they may request a copy of the Form 1095-C;and
- Provision Upon Request:If the employee requests a copy,the employer must provide a copy by the later of a)January 31,or b)30 days after the date of the request See next slide for details such as how to provide the notice of availability | Additional Time to Respond to IRS Letter 226J New law provides employers with 90 days to respond to proposed ACA employer mandate penalty assessment in IRS Letter 226J Extends the period from the standard 30-day window that the IRS made available previously Employers can use additional time to respond to proposed assessment with information and documentation showing that the assessment should be reduced or eliminated(e.g.,because of an ACA reporting error) Statute of Limitations for Employer Mandate Penalties New law provides a six-year statute of limitations for any ACA employer mandate penalty assessment Previously the IRS took the position that there was no statute of limitations that applied in this context |
• Instead, ALEs simply have to make the forms available upon request
Two requirements for employers to take advantage of this “alternative manner of furnishing statements”:
- Notice of Availability: Provide employees with clear, conspicuous, and accessible notice that they may request a copy of the Form 1095-C; and
• See next slide for details such as how to provide the notice of availability
• Employers can use additional time to respond to proposed assessment with information and documentation showing that the assessment should be reduced or eliminated (e.g., because of an ACA reporting error)
Statute of Limitations for Employer Mandate Penalties
• New law provides a six-year statute of limitations for any ACA employer mandate penalty assessment
• Previously the IRS took the position that there was no statute of limitations that applied in this context
The New PBRA Alternative Manner of Furnishing Forms 1095-C
Full Details: The ACA Reporting Requirements in 2026
Clear Notice: Website Posting by Due Date
● Employer must provide a clear and conspicuous notice
● Must be in a location on its website that is reasonably accessible to all employees
● State that employees may receive a copy of the Form 1095-C upon request
● Notice must post to the website by the due date for furnishing the Form 1095-C, which is 30 days after January 31
Website Notice Details: Template Language
● Must be written in plan, nontechnical terms
● Using font size large enough and any visual clues or graphical features to call viewer’s attention
● Statement on website reading “Tax Information”
● Links to secondary page that includes a statement in capital letters “IMPORTANT HEALTH COVERAGE TAX DOCUMENTS”
● Explains how to request copy of the Form 1095-C
∞ ∞
Responding to Requests: Applicable Timeframes
● Notice must remain available on the website through October 15
● For 2025 Forms 1095-C, notice on website must remain posted until October 15, 2026
● If employee requests the Form 1095-C, employer must provide it by the later of:
January 31; or
January 31; or
30 days after the date of the request Employer may provide requested
● Employer may provide requested Form 1095-C by paper (hand delivery/mail) or electronically with affirmative consent (next slide)
Furnishing the Form 1095-C to Employees: Electronic Delivery Barriers
Full Details: Furnishing Forms 1095-C to Employees Electronically
| Option 1: Standard Paper Mailing (or Hand Delivery) | Option 2: Electronic Delivery |
|---|---|
| *New Furnishing Relief Available! | |
| ·The general rule is that the Form 1095-C must be furnished on paper by mail(or hand delivered)* | ·Employersmust obtain affirmative consentto furnish the Form 1095-C electronically |
| ·The form must be properly addressed and mailed on or before the due date | ·The consentmust relate specifically to receiving the Form 1095-C electronically |
| ·May truncate SSNs by replacing the first five digits with asterisks or Xs(but truncation not allowed on forms filed with IRS) | ·Individuals may consent on paper or electronically—if consent is on paper,the individual must confirm consent electronically |
| ·If mailed,must be sent to the employee's last known permanent address(or if no permanent address is known,to the employee's temporary address) | ·Electronic distribution after proper consent is permitted by email or by informing the individual how to access the statement on a website |
| Note:This is different than the standard ERISA electronic disclosure rules—requires specific Form 1095-C authorization! |
• If mailed, must be sent to the employee’s last known permanent address (or if no permanent address is known, to the employee’s temporary address)
ACA Reporting Penalties
Full Details: The ACA Reporting Requirements in 2026
Same Penalties Apply as for Forms W-2 (Penalty Amounts for Forms Furnished/Filed in 2026)
General penalty is $680 for each incorrect return ($340 for return furnished to individual, $340 for return filed with the IRS).
- Total fine not to exceed $4,098,500.
- Penalty reduced to $60 if the corrected return is filed within 30 days after the required filing date—total fine max reduced to $683,000.
- Penalty reduced to $130 if corrected by August 1 of the year in which the filing due—total fine max reduced to $2,049,000.
Special Good Faith Efforts Applied in Previous Years–No Longer Available
For the Forms 1094-C and 1095-C filed in previous years, a “good faith efforts” standard applied.
- The IRS would not impose the penalties described above if the employer could show that it made “good faith effort” to comply with the information reporting requirements.
- Applied to incorrect or incomplete information (including SSNs).
- IRS has confirmed the end of good faith transition relief confirmed in new final regulations
- Reasonable cause penalty relief is still available in some circumstances
- More details: ACA Reporting Penalties
ACA Reporting Penalties: Filing Failures
Full Details: ACA Reporting Penalties
No Filing: IRS Letter 5699
● Employers that fail to file their ACA reporting forms will receive an IRS Letter 5699
● Letter asks the employer several questions related to why the forms have not been filed
● Failure to respond will result in IRS Letter 5698 and eventually referral to IRS examiner to pursue penalties for failure to file/furnish
● Questions are generally inquiring as to whether the employer was an ALE and what the status is of their filing
● Employer has 30 days to respond
● Employers that do not timely file the ACA reporting forms will receive an IRS Notice 972CG informing them of the proposed penalties being imposed
● Employers have 45 days to respond to the Notice 972CG
● If employer agrees, they can simply respond with the payment
∞ ∞
● Employers that do not timely respond will receive a follow-up “Notice of Penalty Charge” bill that includes additional interest
● Those disagreeing will state the reason the penalties (in full or in part) should not apply
Reasonable Cause Relief: IRS Publication 1586
● “Reasonable cause” relief is available to potentially reduce or eliminate ACA reporting penalties
● Employer must show:
No willful neglect;
That it acted in a responsible manner both before and after the failure occurred; and
There were significant mitigating factors or events beyond its control
● Summary of the standard in IRS Publication 1586
The Individual Mandate is Dead, Long Live the (State) Individual Mandate
Multiple States Have Imposed State-Based Individual Mandates
- The ACA originally modelled its federal individual mandate (which took effect in 2014) on the state individual mandate first imposed in Massachusetts during the Governor Romney administration in 2006
- Since the removal of the ACA federal individual mandate tax penalty, a number of states have considered a state-based approach to protect the individual market risk profile
- These new state individual mandates typically mirror the tax penalty scheme previously applied under the ACA
- For example, California’s tax penalty is generally the greater of 2.5% of gross income over the filing threshold or $900/adult and $450/child
- States with individual mandates now include Massachusetts, California, New Jersey, Rhode Island, Vermont, and Washington D.C.
What About State Individual Mandate Reporting?
- States are mostly relying on the Forms 1095-B (carrier reporting for fully insured) and 1095-C (self-insured) to gather coverage information for residents
- Generally the carrier’s obligation to provide the Form 1095-B to the state where the plan is fully insured
- Generally the employer’s obligation to provide the Form 1095-C to the state where the plan is self-insured
- Note that some states have not provided the same 30-day extension available from IRS for furnishing Form 1095-C
- What happens if §6055 reporting is eliminated? States would devise their own forms, likely modelled after the Form 1099-HC in Massachusetts
State Individual Mandate Highlights
| State | Law | Effective date | Employer reporting requirements | Employee penalties |
|---|---|---|---|---|
| California | Individual MandateHealth Care Mandate WebsiteReporting Health Insurance Information | January 1,2020 | All self-insured employers regardless of size must submit forms1094-C and 1095-C if ALE,and 1094-B and 1095-B in non-ALE toFranchise tax Boardby March 31but will not be penalized if filed on or before May 31;Health insurers are required to submit form1095-B for all fully insured plans.Self-insured employers must provide 1095-C forms to employees by January 31.No penalty is imposed for failure to provide forms to individual by the deadline. Employers providing these statements to employees under theACA on or before the CA deadline,do not have to provide a second statement.For fully insured employers,the insurer is responsible for providing the 1095-B to employees by January 31.The penalty for not reporting is $50 per individual who was provided health coverage. | A taxpayer who does not have an exemption and does not have coverage will be subject to a penalty the higher of $900 per adult,and $450for each dependent child under 18,or up to2.5% of household income. |
| New Jersey | NJ Health MandateNJ Shared Responsibility Requirement | January 1,2019 | Reporting due March 31;self-insured employers required to filethe 1094-C transmittal form and 1095-C(or 1094-B/1095-B as applicable).Fully insured employers should check with carrier toensure carrier is filing,1095-C forms should be provided toemployees by March 1.No penalties for late filing | A taxpayer who does not have an exemption and does not have coverage will have a shared responsibility payment based on filing statusand household income,capped at thestatewide average annual premium for bronzehealth plans.The minimum penalty for anindividual taxpayer is $695 and the maximum is$4,284. |
| Massachusetts | Health Care Reform for Individuals | January 1,2007 | Insurance carriers and certain employers legally required to issueform MA 1099-HC no later than January 31 of the following year.Verify with the carrier if they are issuing the form.Employers with6 or more employees must also annually between11/15-12/15filea Health Insurance Responsibility Disclosure(HIRD).Failure toissue form MA 1099-HC could subject employer to penalties of$50per individual up to a maximum of$50,000 | Penalties apply only to residents age 18 andolder who are deemed able to afford healthinsurance but did not enroll and vary dependingon income,age,and family size.The penaltycannot exceed one-half of the least expensivemonthly premium available through theMassachusetts Health Connector (Connector). |
State Individual Mandate Highlights
| State | Law | Effective date | Employer reporting requirements | Employee penalties |
|---|---|---|---|---|
| Rhode Island | Health Coverage Mandate Reporting Requirements FAQ | January 1,2020 | Employers submit their ACA reporting forms or a state specific return to Rhode Island Division of Taxation. Employers must provide forms to employees March 1. Deadline for employer reporting to the state is March 31. Penalties reviewed and assessed on a case by case basis. For late furnishment and late filing. | Taxpayer who does not have an exemption and does not have coverage will have a shared responsibility payment (greater of $695/person;$347.50 for each child,or 2.5% of your household income) capped at the Rhode Island statewide average premium for bronze-level plans offered through the Rhode Island health benefits Exchange. |
| Vermont | Health Coverage Mandate | January 1,2020 | Currently no employer reporting or distribution requirements. | Enforcement mechanism to be determined. Currently no financial penalty for failing to maintain coverage under the Vermont law. Individuals are required to indicate on their state income tax return whether they had MEC for each month of the year. |
| Washington DC | Individual Taxpayer Health Insurance Responsibility Requirement Washington DC FAQ | January 1,2019 | Employers must electronically submit their ACA reporting forms through www.MyTax.DC.gov to Washington DC by April 30;1095 Forms to employees by March 1.No penalties for late filing or failure to furnish forms. | A taxpayer who does not have an exemption and does not have coverage will have a shared responsibility payment (greater of $795/person;$397.50 for each child,up to a maximum of $2,385,or 2.5% of your household income over the federal tax whiling threshold) capped at the average premiums for bronze level health plans available on DC Health Link. |
A taxpayer who does not have an exemption and does not have coverage will have a shared responsibility payment (greater of $795/person; $397.50 for each child, up to a maximum of $2,385, or 2.5% of your household income over the federal tax whiling threshold) capped at the average premiums for bronze level health plans available on DC Health Link.
Wrap-up
Takeaways
The ACA Employer Mandate & ACA Reporting
Three Key Points to Remember
| 1 | There are two ACA Employer Mandate Penalties: The A Penalty and the B Penalty. Employers need to ensure they are never in a position where the A Penalty could apply. This penalty is potentially enormous, and employers should never have to “play” and “pay”. Keep track of full-time employees (including contingent workforce) to ensure the 95% threshold is never jeopardized. The B Penalty is much smaller and therefore not a significant concern if it applies to only a few employees. |
|---|---|
| 2 | The ACA full-time employee determination is perhaps the most complex area of the Employer Mandate. Although many ACA reporting vendors dismiss it out of hand, the monthly measurement method is a great way to avoid most of this complexity for all or nearly all full-time workforces. Otherwise, the look-back measurement method is generally the better approach to ensure predictability of employees' full-time status for the stability period (typically aligned with plan year). |
| 3 | The ACA reporting exhibition season is over, and now the real games begin. The end of the IRS's good faith safe harbor and loss of ability to file by paper (both available in prior years) puts a renewed emphasis on ensuring correct (and timely) completion of the Forms 1094-C and 1095-C. Employers are strongly advised to work with an ACA reporting vendor (payroll, ben admin, stand-alone) to properly address ACA hours tracking (measurement, administrative, stability periods for LBMM) and ACA reporting (incluidng the electronic filing requirements). |
The ACA reporting exhibition season is over, and now the real games begin. The end of the IRS’s good faith safe harbor and loss of ability to file by paper (both available in prior years) puts a renewed emphasis on ensuring correct (and timely) completion of the Forms 1094-C and 1095-C. Employers are strongly advised to work with an ACA reporting vendor (payroll, ben admin, stand-alone) to properly address ACA hours tracking (measurement, administrative, stability periods for LBMM) and ACA reporting (incluidng the electronic filing requirements).
Content Disclaimer
The ACA Employer Mandate & ACA Reporting
The intent of this analysis is to provide the recipient with general information regarding the status of, and/or potential concerns related to, the recipient’s current employee benefits issues. This analysis does not necessarily fully address the recipient’s specific issue, and it should not be construed as, nor is it intended to provide, legal advice. Furthermore, this message does not establish an attorney-client relationship. Questions regarding specific issues should be addressed to the person(s) who provide legal advice to the recipient regarding employee benefits issues (e.g., the recipient’s general counsel
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Thank you
Brian Gilmore
Lead Benefits Counsel, VP
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