Instructions For Forms 1094-B And 1095-B - 2017 (Page 2 of 7) in pdf

In addition, health insurance issuers and carriers aren't

employees only if that government employer isn't subject

required to file Form 1095-B to report coverage in

to the employer shared responsibility provisions, which

individual market qualified health plans that individuals

would require reporting on Form 1095-C. The Instructions

enroll in through Health Insurance Marketplaces. This

for Forms 1094-C and 1095-C contain further information

coverage generally is reported by Marketplaces on Form

on reporting options for government entities.

1095-A. However, health insurance issuers are required

Government-Sponsored Programs

to file Form 1095-B to report on coverage for employees

obtained through the Small Business Health Options

The following government-sponsored programs are

Program (SHOP). For coverage in 2017 (filing in 2018),

minimum essential coverage.

health insurance issuers and carriers are encouraged (but

1. Medicare Part A.

not required) to report coverage in catastrophic health

plans enrolled in through the Marketplace.

2. Medicaid, except for the following programs:

a. Optional coverage of family planning services.

Eligible Employer-Sponsored Plans

Eligible employer-sponsored plans are minimum essential

b. Optional coverage of tuberculosis-related

coverage and include:

services.

1. Group health insurance coverage for employees

c. Coverage of pregnancy-related services.

under:

d. Coverage of medical emergency services.

a. A governmental plan, such as the Federal

e. Coverage of medically needy individuals.

Employees Health Benefits program.

f. Coverage under a section 1115 demonstration

b. An insured plan or coverage offered in the small or

waiver program.

large group market within a state.

3. The Children’s Health Insurance Program (CHIP).

c. A grandfathered health plan offered in a group

market.

4. The TRICARE program, except for the following

options:

2. A self-insured group health plan for employees.

a. Coverage on a space-available basis in a military

As noted earlier, minimum essential coverage doesn't

treatment facility for individuals who aren't eligible

include coverage consisting solely of excepted benefits.

for TRICARE coverage for private sector care.

Excepted benefits include vision and dental coverage not

part of a comprehensive health insurance plan, workers’

b. Coverage for a line of duty-related injury, illness,

compensation coverage, and coverage limited to a

or disease for individuals who have left active

specified disease or illness.

duty.

Health insurance issuers or carriers will file Form

5. Coverage administered by the Department of

1095-B for all insured employer coverage. Plan sponsors

Veterans Affairs that is:

are responsible for reporting self-insured employer

a. Coverage consisting of the medical benefits

coverage. Plan sponsors that are employers subject to the

package for eligible veterans.

employer shared responsibility provisions generally must

report the coverage on Form 1095-C and other plan

b. CHAMPVA.

sponsors (such as employers not subject to the employer

c. Comprehensive health care for children suffering

shared responsibility provisions and sponsors of

from spina bifida who are the children of Vietnam

multiemployer plans) report the coverage on Form

veterans and veterans of covered service in

1095-B.

Korea.

Plan sponsors of self-insured employer coverage

6. Coverage for Peace Corps volunteers.

include:

Each participating employer (for its own covered

7. The Nonappropriated Fund Health Benefits Program

individuals) in a plan or arrangement established or

of the Department of Defense.

maintained by more than one employer;

In general, the government agency sponsoring the

The association, committee, joint board of trustees, or

program will file Form 1095-B. The state agency that

similar group of representatives who establish or

administers a Medicaid or CHIP program will file Form

maintain a multiemployer plan;

1095-B for coverage under those programs. However,

The employee organization for a plan or arrangement

Medicaid and CHIP agencies in U.S. possessions or

maintained solely by an employee organization; and

territories (American Samoa, the Commonwealth of the

Each participating employer (for its own employees)

Northern Mariana Islands, Guam, Puerto Rico, and the

for a plan or arrangement maintained by a Multiple

U.S. Virgin Islands) aren’t required to report Medicaid or

Employer Welfare Arrangement.

CHIP coverage on Form 1095-B.

A government employer may designate another

government entity to report coverage of its employees.

When coverage under the Nonappropriated Fund

Generally, a designated government entity will file Form

Health Benefits Program of the Department of Defense or

1095-B on behalf of a government employer that sponsors

TRICARE is reported on Form 1095-B, Part I, line 8, filers

or maintains a self-insured group health plan for its

should use code C (government-sponsored program).

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Instructions for Forms 1094-B and 1095-B (2017)

Instructions For Forms 1094-B And 1095-B - 2017 Page 2

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