Preparing for Creating 1095-C Forms

File maintenance functions and parameters are available in Coins ERP+ for use in creating ACA Monthly Statistics records. If you have not already done so, and to avoid interruption of your daily processes, be sure to populate these files and parameters in accordance with the instructions defined in OA_CE-HR010_AffordableCareAct.

If you are maintaining Health Insurance Plans and Enrollments in Human Resources, be sure you have reviewed your setup in HR before processing 1095-C records.

An overview of the files in HR that accommodate ACA processing is discussed in this section.

An ACA Determination Group lookup type show in the image below is found in Human Resources > Administration > ACA Processing > ACA Lookup Codes. These can assist you in grouping employees for analysis and compliance under ACA.

You must define at least one Determination Group, and a blank group can be added, but there is no requirement to have more than one group defined. This file is merely a tool to assist you in managing your data.

The ACA Determination Group is entered on the ACA Compliance tab of the Personnel Workbench in HR.

ACA Determination Group File

An ACA Employment Status lookup type shown in the image below is found in Human Resources > Administration > ACA Processing > ACA Lookup Codes. It tracks an employee’s employment status as it relates to the Affordable Care Act.

Under the Employer Shared Responsibility provisions of the ACA, employers must count Full-time employees and their equivalents when measuring compliance. The ACA Employment Status file is another tool provided in HR to assist employers in grouping data. Coins ERP+ also uses this value when trying to assign Offer of Coverage Codes and Safe Harbor Codes to employees when generating Monthly ACA Statistics.

ACA Employment Status File

The ACA Employment Status value is entered on the ACA Compliance tab of the Personnel Workbench.

An ACA 4980H Safe Harbor Code lookup type is found in Human Resources > Administration > ACA Processing > ACA Lookup Codes. It holds a list of Safe Harbor Codes used for ACA Reporting, as prescribed by the IRS. Set them up exactly as shown in the image below.

ACA 4980H Safe Harbor Codes File

The ACA Offer of Coverage Codes lookup type is found in Human Resources > Administration > ACA Processing > ACA Lookup Codes. It holds a list of Offer of Coverage Codes used for ACA Reporting, as prescribed by the IRS. Set them up exactly as shown below.

ACA Offer of Coverage Codes

The ACA Master Maintenance File shown in the image below is used to define the values that should be used when compiling ACA Reporting data. It is found in the Administration > ACA Processing section of the HR module or in the Administration > ACA Processing section of the Payroll module.

Typically, you create a new ACA Master Record for each ACA Reporting Year. The Effective Date of the new Master File Record must be less than or equal to the first day of the ACA reporting year. The first day of the reporting year is usually January 1. If you need to make a mid-year change, be sure the Effective Date is the first day of the month (or earlier) when the change is to take effect.

Enter the Federal Poverty Guidelines for Single Individual level for an Individual (1-person household) and Affordability Percentage for the reporting year under ACA. This information is used to measure affordability of coverage under ACA.

Enter the Health Plan Coverage Code which represents Employee Only Coverage. This value is used to find the Lowest Cost of Employee Only Coverage and report it in Box 15 of the 1095-C Form.

Enter the Valid Earnings Categories which are included when determining Hours of Service. They are used to accumulate wages in the ACA Monthly Statistics File. This value is informational only, but could be a useful tool if you have a varying workforce and need to perform measurements and analysis for ACA or any other reason.

Also enter the ACA Enrollment Status codes created for Full Time, Seasonal, Variable Hour (Temporary), and Part Time employees. The Employment Status is also used to determine Safe Harbor Codes when generating ACA data in Coins ERP+.

ACA Master Maintenance File

An ACA Master File record must exist with an Effective Date that is less than or equal to the first day of the reporting year (usually January 1).

The ACA Measurement/Stability Maintenance File shown below is used to define the values that can be used for custom reports that perform measurements and workforce analysis under ACA. This file is found on the ACA Processing Menu in HR and Payroll under Administration. Currently, there are no standard reports that use this file.

ACA Measurement/Stability Maintenance File

The HR Plan Workbench through Benefits Enrollment – Health Plans sections only apply to clients who are using Benefit Enrollments in the Human Resources module.

The HR Plan Workbench contains fields used in ACA processing.

The browse screen of the HR Plan Workbench includes a Plan is Subject to ACA Compliance field, as shown in the image below. When checked, the plan is looked at when generating ACA statistics.

Browse Screen

The Details tab of the Plan Workbench contains a Plan is subject to Affordable Care Act Compliance field allowing you to indicate that the plan is subject to the ACA Compliance provisions.

HR Plan Workbench – Details Tab

When this field is checked, and the record is saved, you will see an ACA Information tab. You must use this tab to indicate which plans comply with Minimum Value Requirements (MV), Minimum Essential Coverage requirements (MEC), and whether coverage is offered to Spouses or Dependents.

Benefit Plan Workbench – ACA Information Tab

Coins ERP+ uses the information contained in the HR Plan Workbench to try to determine Offer of Coverage Codes and Safe Harbor Codes to apply to the Monthly Statistic and 1095-C data for each employee.

The ACA Coverage Termination Reason lookup type, shown below, is found in Human Resources > Administration > ACA Processing > ACA Lookup Codes. It contains the list of reasons that existing coverage has been terminated. Although there is no requirement under ACA to maintain this information, Coins has opted to provide the ability for you to capture this data.

The ACA Coverage Termination Reason is automatically entered on the employee’s health plan enrollment record when the record is ended.

ACA Coverage Termination Reason File

The ACA Declined Coverage Reason lookup type is found in Human Resources > Administration > ACA Processing > ACA Lookup Codes. It contains the list of reasons that an offer of coverage has been declined by the employee. Although there is no requirement under ACA to maintain this information, Coins has opted to provide the ability for you to capture this data.

The ACA Declined Coverage Reason is entered on a benefit enrollment into a plan that has been designated as subject to ACA Compliance. Blank values are allowed if you do not wish to track this information in Coins ERP+.

ACA Declined Coverage Reason File

You can use the ACA Compliance tab on the HR Personnel Workbench to enter the ACA Determination Group, ACA Employment Status, and Safe Harbor Code for your employees.

Under the Employer Shared Responsibility provisions of the ACA, employers are required to identify their full-time and full-time equivalent employees. Therefore, the ACA Employment Status is used to generate ACA Monthly Statistics records for 1095-C Reporting, but the other values, along with the Ongoing Employee checkbox, can be omitted or set generically since they are used for custom reporting.

Some employers have chosen not to enter hours in Payroll for salaried employees. If Payroll is not capturing hours worked, you may check the Enter ACA Compliance Hours checkbox and enter a person’s normal monthly hours of service.

You can use the Exclude from ACA Reporting checkbox to prevent ACA Monthly Statistics records and 1095-Cs from being created for certain personnel.

HR Personnel Workbench

Two HR parameters in the Human Resource module can assist you in tracking ACA Termination Reasons when coverage has been end-dated.

HR Parameters

ACAAUTOREAS - Holds the default ACA Coverage Termination Reason added to an enrollment that has been end-dated because a new enrollment was added. New enrollments can be automatically created in Coins ERP+ using the Create Benefit Enrollments utility when new rates are added, or when a user adds a new enrollment into a plan in the same Enrollment Group or to a new Coverage Code or Rate Class for the same plan.

ACACOVTERMREAS - Holds the default ACA Coverage Termination Reason applied to an enrollment that is end-dated due to termination of employment.

If you leave these fields blank, you must add a blank record to the ACA Coverage Termination Reason. SeeACA Coverage Termination Reason File for more information on ACA Coverage Termination Reasons.

Affordable Care Act Compliance fields are available in Benefit Plan Enrollments on the HR Personnel Workbench for plans subject to ACA compliance.

This section describes Elected, Declined, and End-dated enrollments. While most users prefer to only enter Elected enrollments, the Affordable Care Act has made it necessary for Coins ERP+ users to also track Declined enrollments.

A Declined Enrollment record represents an Offer of Coverage. In order for the Monthly Generate ACA Statistics Data to recognize a person who has been offered coverage, Coins ERP+ must find an Elected or Declined enrollment on file for the employee.

Some users create a Benefit Plan called WAIVED that is used for Declined enrollments. This is optional but does supply additional reporting capabilities.

When adding a new Elected enrollment, you can indicate if the health plan enrollment is affordable, or if it is not affordable, which Safe Harbor Code applies.

Personnel Workbench – Benefits Enrollment – Elected Enrollments

When adding a Declined enrollment, you are prompted to indicate if the offer of coverage was affordable. Coins ERP+ also allows you to enter a Declined Coverage Reason. This field is informational only and was added to help you keep track of reasons an offer of coverage has been declined.

Personnel Workbench – Benefits Enrollment – Declined Enrollments

When ending an existing Elected or Declined enrollment, you can indicate the reason for termination of coverage. If an enrollment is end-dated by the system due to termination or a new enrollment, this field is automatically populated from HR parameters.

Personnel Workbench – Benefits Enrollment – End-Dated Enrollments

The Affordable Care Act Compliance tab is found in Payroll > Global Setup > Unions. It holds information about the Health Insurance plans administered by collective bargaining unions. If an employee is associated with a collective bargaining union, the Monthly Generate ACA Statistics Data uses the information contained in the Unions File to populate the Offer of Coverage Code and Safe Harbor Code for the employee.

When a person is associated with a union designated as compliant with ACA, the Monthly Statistics Record reflects that the employee is associated with a multi-employer plan for any month the employee has wages with the company.

If the Unions File does not reflect that the union is ACA Compliant, the employee is deemed to have not been offered coverage. Employers then have the option of correcting the Monthly Statistics File prior to reporting if the information is not correct.

Unions File