1094/1095 Overview and Setup

This documentation will cover year-end setup for 1095s and 1094s.  The Affordable Care Act requires employers with at least 50 full-time workers to offer their employees’ health insurance and each year, those employers must send a statement -- Form 1095-C -- to all employees eligible for coverage.

The statement provides details about:

  • the coverage offered to the employee
  • the lowest-cost premium available to the employee
  • and the months of the year when the coverage was available

All employees eligible for coverage should get a 1095-C, regardless of whether they participated in the employer’s health plan.

Employers also need to send this coverage information to the IRS. When they do, they also file Form 1094-C.  This form is essentially a “cover sheet” for the 1095-C forms. It provides information about:

  • the employer -- including address, phone number, employer identification number
  • how many employees it has
  • the name of a contact person
  • and how many 1095-C forms are being sent

For Tempworks to be able to accurately print these forms, we require employers to enter in some survey information regarding your specific health insurance plans within the year-end worksheet. 

Note- if you choose to print your 1095 C forms with us then your 1094 forms are filed by us on your behalf.  As of right now, the deadline for 1095 Cs is March 2nd and the deadline for 1094 Cs is March 31st.

To enter this survey information, please navigate to pay/bill > other > 1094-c/1095-c.  This documentation covers how to setup this survey information for 1094s/1095s – but questions relating to what specific information should be entered in this section should be directed to your benefits administrator otherwise you can address this during your data integrity check or email us at yearend@tempworks.com.

To add a new 1094/1095 record, select the ‘+’ icon in the upper right hand corner.  If your plan start date is after January 1st, you will need to add your plan information for the 2015 prior to adding the current year. The year selection drop-down with default to the current year, 2016, but 2015 is also available to choose from. 

Select the EINC and branch this survey is associated with.  If all branches follow the same health insurance plan, you can leave branch blank.  If the plans are different, for instance if your temp coverage differs from internal staff coverage you will need to select the correct corresponding branch. 

Note – the Is Primary button is used for 1094s that are a part of an ALE group and should be set at the company FEIN level.  Your primary surveys should always be completed first.  If this is the first entry of an ALE group, leave ALE group blank to create a new “group ID”, and then any future entites can be added or linked to this group.

The company information section pulls from the information that is entered in administration > employers > employer setup, but this section is editable if anything needs to appear differently on the 1094s.  Contact information also defaults from what is entered in employer setup but can also be updated.

Once selecting ‘Save’, you will be brought into the 1095/1094 worksheet.  This is where you will answer questions relating to your specific health insurance plans.  You can select the edit pencil to the right of the EINC to return to this screen if anything does need to be changed.

  • What is the full legal name of your business entity?  This auto-populates from the screen prior, which pulls from employer setup, but can still be edited in this area.
  • Are you an Applicable Large Employer (ALE)?  An applicable large employer is any company or organization that has an average of at least 50 full-time employees or "full-time equivalents" or "FTE." For the purposes of the Affordable Care Act, a full-time employee is someone who works at least 30 hours a week.
    • Yes
    • No > Do you have more ALE members, which are not in Tempworks?  Basically do you have businesses outside of Tempworks.  If so, select the edit pencil to add in these businesses.  You will be prompted to enter the business name as well as EIN.
  • Are you self-funded?  Self-funded plans are chosen by employers (usually larger) that operate their own health plan as opposed to purchasing a fully-insured plan from an insurance carrier.
  • What is your plan start date?  Typically, this will be the first of the year.  However, if you had a mid-year plan start date, say April 1st 2016, you will need to fill out a survey for 2015 coverage prior to creating a 2016 record.  If your plan start date is after the first of the year, there is a conditional question that will appear prompting you to enter the previous year’s employer ID (hence the 2015 survey will need to be added first).
  • What logic should Tempworks use to determine the employees’ original employment status? 
    • Treat all employees as full time from their hire date
    • Treat all employees as part-time/variable upon hire and only count as full-time if they met the determination method you selected in the survey
    • Use the selections made in the Employee Record/ACA status field without respect to transactional data.  In the event that the ACA status field is blank, we will need to know what you would like the default to be (full-time, part-time, variable).
  • Which method did you use to determine full-time status?

Lookback

How many days are included in the lookback period you used to determine FTE status?

Lookback is how Enterprise tracks things.  So if they’ve been using the ACA employer setup in Enterprise, you most likely use lookback.  Max lookback period is 365 days, which is basically the standard measurement period in the admin area of Enterprise.  If you choose lookback and hire someone as part time, you will enter this measuring period (let’s say 365 days) and after 365 days you average their hours.  If they meet the 30 hour threshold then you have to offer them insurance and have up to 90 days (or whatever your administrative aka waiting period is) to offer them insurance.

Monthly 130- Under the monthly measurement method, the employer determines if an employee is a full-time employee on a month-by-month basis by looking at whether the employee has at least 130 hours of service for each month. 

Monthly 120/150 - Monthly 120/150 is very similar to monthly 130.  The difference is that you consider 120 hours full time when the month has 4 weeks and 150 hours as full time when the month has 5 weeks.

Good brief summary of the two types can be found here: https://www.irs.gov/affordable-care-act/employers/identifying-full-time-employees

  • How many employees did you have that were classified as Full Time Employees (FTEs) for at least one month during the calendar year?
    • 0-49
    • 50-99    
    • 100+
  • What is your waiting period for new hires to be eligible for insurance?
    • No waiting period, immediate enrollment
    • Enrollment after a certain number of days
      • How many days are included in waiting period?
    • Enrollment on a particular day of the month following a waiting period
      • On what day of the month are employees eligible for insurance?
      • How many days are included in waiting period?
  • What is the best type of insurance you offer to all FTEs?
    • Employee – minimum essential coverage providing minimum value
    • Employee + Dependent(s) – minimum essential coverage providing minimum value
    • Employee + Spouse – minimum essential coverage providing minimum value
    • Employee + Spouse + Dependent(s) – minimum essential coverage providing minimum value
    • Minimum essential coverage not providing minimum value
    • No coverage offered
    • Qualifying value
  • Which Safe Harbor rule did your company use? 
    • Federal Poverty Level
      • What was the employee’s cost per week for this adjustment?
    • Form W2 – Use 9.5% of gross
    • Form W2 – Use Tempworks adjustment(s)
      • Select the adjustment(s) you would like to use
    • None
      • What was employee’s cost of coverage?
    • Rate of Pay – Employee’s state minimum wage
    • Rate of Pay – Federal minimum wage
    • Rate of Pay – Fixed value
      • What pay rate did you use for your rate of pay calculations?

Note – Form W2 (Use Tempworks Adjustments) should only be used if you split between the employee and dependents cost.  If these were lumped together you should not use this option because then we would not be reporting the lowest coverage cost.

Once all survey information has been filled out and saved, the “Generate 1095” button will become available.  Once 1095 data has been generated, you can run the 1095 Verification 2016 report located on the right-hand side of Enterprise.  You can run this prior to importing the benefits administrator file to see a rough estimate of how many employees can expect to receive a 1095 but it won’t show accurate coverage data until the ben admin file is imported.  Once the ben admin files have been imported, please look over these reports in detail and make sure all information is accurate.  If something does not look right, you can update survey answers at any time and re-generate 1095 data.  The report will update once data has been re-generated.  

Benefits Admin files are also uploaded from this area.  These files from your insurers are used in conjunction with your survey responses for 1094 reporting.  To import the file, click the button “Import” and select from the drop-down menu the correct import format.  There will be four options to choose from – there will be two format types for self-funded and two for non self-funded.  Once the file format option has been selected, select the file location where your benefit admin file is located and select “Import File”.   We recommend you send you benefits administrator in the acceptable formats (which depends on whether you are self-funded or not) as soon as possible so they can be prepared to provide you the data in the correct format.  If they provide you data in a different format, you will need to convert it to one of the acceptable file formats or the import will fail. 

Example:  If you are fully insured (not self-funded), send your benefits administrator the non self-funded format 1 and non self-funded format 2 and tell them they can give you data in either format (we don’t need two files).  We need this data imported by Jan 9. 

Once verified data is correct, the 1095s will be printed and mailed to your employees and the 1094s will be filed and sent by us on your behalf.

Individual 1095s can now be printed directly from the employee's record in Enterprise for 2016 and on.  The 1095 will appear only after the 1095c worksheets have been filled out.  The option to print an individual 1095 form is located under Employee > Actions Menu > Reprint Wage Summary forms.

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