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


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:
1. Group health insurance coverage for employees
c. Coverage of pregnancy-related services.
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
4. The TRICARE program, except for the following
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.
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
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
Plan sponsors of self-insured employer coverage
6. Coverage for Peace Corps volunteers.
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).
Instructions for Forms 1094-B and 1095-B (2017)


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