Troubleshooting - Individual 1095-C Forms and Codes

📘

Blank Screen When Clicking Employee Report:

What is the group type? (Multi-ER, Hybrid Control Group, Regular Control Group, or Default)?

• If Regular Control Group, is the company assigned to that group?

• NO – Assign Group
• YES – Next question

📘

EE Not On Employee Reporting List:

Is EE Part-Time?

YES – Are plans Self-Insured?

• YES – Did EE enroll? (if No, no form is expected, if Yes contact your CRM)
• NO – No form is expected

NO – Check Transaction History - Was EE ever: Inactive, Terminated, COBRA, Retired?

• YES – Upload 500 changing employee’s status back to what it was in Transaction History using column FE (Effective Date of Data Change). Have date match original date. Upload a second 500 changing status back to expected Active Status with column FE (Effective Date of Data Change) showing the day AFTER previous Transaction. (Example: EE was marked Inactive on 8/4/2014 and marked Active on 6/1/2015. First 500 upload changes EE status to INACTIVE with Effective Date of Data Change 8/4/2014. Second 500 should have EE back as Active with Effective Date of Data Change as either 8/5/2014 if original was a mistake or 1/1/2015 if they became active prior to 6/1/2015)
• NO – What is EE DOH? Does it apply to the reporting year?

• DOH after reporting year - no form necessary
• DOH prior or in reporting year - check transaction history and confirm DOH has not changed. If it has no changed, contact your CRM for assistance.

📘

Divisions Have Differing EINs, but Only Company EIN is Populating on Forms:

What is the group type set as on Super Admin side? (Multi-ER, Hybrid Control Group, Regular Control Group, or Default)?

• If Default – Change to Hybrid Control or Multi-ER depending on which applies for the group.
• If Hybrid Control or Multi-ER – Confirm the expected Division EIN does NOT match the Master/Parent Company EIN

• If Division EIN does NOT match the Master/Parent Company EIN – contact your CRM
  • Regular Control Group – Divisions should not have differing EINs, if they do this group was not built properly and should be rebuilt

📘

Code 1H on line 14*:

Are plans marked YES to MEC/MVS on in Monthly Eligibility section of EE Profile in ACAManager?

NO - Are plans marked MEC/MVS under Company Plan Information?

• YES – Refresh Eligibility
• NO – Code 1H is expected. If plans meet MEC/MVS then mark plans as MEC/MVS and Refresh Eligibility

YES – Is EE currently eligible in bC4?

• NO – Terminated
  Other than “Ineligible employee status” is there another reason listed in bC4 why EE would not be eligible such as hours worked per week, Employee Class, division, or UDF?

• YES – code 1H is expected, update eligibility
• NO – Check Transaction History - Was EE previously in another EE class, division, or had less than needed hours worked (or some other reason piece of data that would make them ineligible for the plan such as salary change)?
  YES – Upload 500 changing EE back to how they were in Transaction history using column FE (Effective Date of Change) matching date in Transaction History. Upload a second 500 changing EE to what EE should have been using column FE (Effective Date of Data Change) as any date AFTER the previous date was made.
  • YES – Check Transaction History - Was EE ever: Inactive, Terminated, COBRA, Retired?
• YES – Upload 500 changing employee’s status back to what it was in Transaction History using column FE (Effective Date of Data Change). Have date match original date. Upload a second 500 changing status back to expected Active Status with column FE (Effective Date of Data Change) showing the day AFTER previous Transaction. (Example: EE was marked Inactive on 8/4/2014 and marked Active on 6/1/2015. First 500 upload changes EE status to INACTIVE with Effective Date of Data Change 8/4/2014. Second 500 should have EE back as Active with Effective Date of Data Change as either 8/5/2014 if original was a mistake or 1/1/2015 if they became active prior to 6/1/2015)
• NO – Is the plan Age Rated and is the EE rate entered? If Yes, contact your CRM, if No enter the age rates and refresh eligibility

• *bC4 will not let you go from one status to the same status and fix the day it is happening (such as Terminated to Terminated in order to update the date of Termination). You have to move the EE out of the current status/division/category/hours/etc. first and then change it to what is was supposed to be Effective the day it was supposed to have been effective. And then Refresh Eligibility

📘

Line 15 is Blank:

Is the lowest cost plan the EE is eligible for less than 9.5% of monthly FPL?

• YES – This is expected
• NO – Is code 1A on line 14?

• YES – blank 15 is expected
• NO – Is code 1H on line 14?
  • YES – blank 15 is expected
  • NO – Is the plan Age Rated and is the EE rate entered?
• YES – Contact your CRM
• NO – Enter the age rates and refresh eligibility

📘

Line 15 Populating Amounts EE Did Not Enroll In*:

Was the EE eligible for the plan? (Confirm in bC4 AND ACAManager Monthly Plan eligibility)

• YES – EE Only cost is expected
• NO – Is the Amount the Total Plan Cost instead of the EE Cost?

• YES – Check Spending Credits –
• NO – Contact your CRM

*Line 15 should be populating the lowest EE Only cost that the EE is eligible for

📘

Line 16 is Blank:

Is code 1A on line 14?
YES – Did EE Enroll?

• YES – confirm enrollment in bC4 - Confirmed Enrolled in the months showing blank – Contact your CRM

• NO – blank 16 is expected

NO – Is code 1H on line 14?

• YES – Are plans marked YES to MEC/MVS on in Monthly Eligibility section of EE Profile in ACAManager?
• NO - Are plans marked MEC/MVS under Company Plan Information?

• YES – Then you need to refresh eligibility
• NO – Then code is expected or mark plans as MEC/MVS and refresh eligibility
  • NO – EE not eligible for plans on EE Profile in ACAManager
    Confirm Eligibility for plans in bC4
    Check Transaction History – Was EE previously in another status (such as Inactive, Retired, COBRA, Terminated), EE class, division, or had less than needed hours worked (or some other reason piece of data that would make them ineligible for the plan such as salary change)?
• YES – Upload 500 changing EE back to how they were in Transaction history using column FE (Effective Date of Change) matching date in Transaction History. Upload a second 500 changing EE to what EE should have been using column FE (Effective Date of Data Change) as any date AFTER the previous date was made.
• NO – Contact your CRM

📘

Line 16 Populating 2B*:

Is the EE DOH the middle of the month?
YES – This code is expected
NO – Did the EE Terminate mid-month as well as their coverage (if enrolled)?

• YES – This code is expected
• NO – Coverage terminates end of month - Does coverage term the end of the same month EE termed? Or the month after?

• End of Same month – Confirm this is in bC4, in bC4 – Contact your CRM, not in bC4 – code is expected – Update bC4 accordingly and refresh eligibility
• Month after – the code is expected – confirm when coverage should have termed

NO – EE was still employed - Does the EE have less than 130 hours for that month?

• YES – Check Transaction History – Was EE ever PT?

• YES – Upload 500 changing EE back to how they were in Transaction history using column FE (Effective Date of Change) matching date in Transaction History. Upload a second 500 changing EE to what EE should have been using column FE (Effective Date of Data Change) as any date AFTER the previous date was made.
• NO – Contact your CRM
  • NO – Contact your CRM

*Line 16 should be populating 2B when an employee did not work the entire month and did not have coverage for the entire month

📘

COBRA/Retirees

If an EE elected COBRA or Retired during the middle of the reporting year and the plan was Self-Insured, you can expect to see 1H/2A in Part II and then see the boxes checked for the months they were covered in Part III.

• If the plans are fully-funded, you can expect a 1H/2A and the carrier will be providing that employee with a form showing the months they were covered under COBRA/Retired.

If an EE elected COBRA or was Retired and never Active for the reporting year and the plan was Self-Insured, you can expect to see 1G in line 14, a blank Line 15, and blank Line 16 in Part II and then see the boxes checked for the months they were covered in Part III. This also applies to Part Time employees that elected Self Insured coverage in the middle of the year, you can expect to see a 1G for the entire year and Part III showing what months the employee had coverage.

📘

Multi-er/Hybrid Control Group - Multiple Forms for EE All the Same:

If an EE changed Divisions, their coverage needs to reflect the dates of the division change, otherwise they will receive 2 forms with the same codes. (i.e. John Smith was in Division 1 from January 1 – June 15 and transferred to Division 2 on June 16. He did not lose coverage and did not need to complete a new waiting period. His coverage in bC4 should reflect as follows: Enrolled 1/1 – 6/15 and then Enrolled 6/16 – 12/31)