This chapter contains the following topics:
Section 2.1, "Understanding Base Data-Setup for AIR Year-End Processing"
Section 2.4, "Setting Up Employee Offer and Coverage (Line 14-16 of Form1095-C)"
Section 2.5, "Setting Up Manifest Information Revision (P08213)"
Before you print the Affordable Care Act Health Coverage Returns (AIR) year-end government forms, you need to verify that the required information is available in the system and is set up correctly. To support the requirements for producing health coverage information returns, the system uses data from various tables throughout Human Capital Management, including Human Resources, Benefits, and Payroll.
If the data required to complete the returns is not available on your system, you have the option to add or import the data.
Before you begin setting up data for Affordable Care Act (ACA) Information returns, verify the following:
Employee setup
Verify the format of employee names and addresses in the Address Book system to ensure that the information you report to the government and to the employees is accurate. You can find an employee name from the Address Book Who's Who file (F0111) and the employee address from the Address By Date file (F0116).
Company Setup
Verify the format of the company names and addresses in the Address Book system for the reporting companies to ensure that the information you report to the government and to the employees is accurate. You can find an employer name from the Mailing Name in the Address Book Who's Who file (F0111) and the employer address from the Address By Date file (F0116) for the address book record associated with the reporting company. You can search for the contact telephone number from a processing option for the Form 1095-C Print (P085192) or, if left blank, it takes a value from the 1094-C Transmittal file (F08121).
Note:
If you are using the Parent Address field in the Corporate Tax ID's for the home company, the name and address used is associated with the parent (reporting) company, not the home company.The Reporting Company must be set up in Company Numbers and Names file (F0010). The Company Address Number is retrieved from the Company Numbers and Names file (F0010).
Dependents information
Note:
If you are not using the required Payroll and Human Resources systems or a certain feature of the system that is required for ACA Information Returns, then you might not have all of required data in the system to produce Information Returns. The system provides the ability to import data into certain ACA tables as well as to the reporting workfiles. You also have the ability to add, edit or delete information in the reporting workfiles.This section provides an overview of data setup and discusses how to:
Add company members to ALE.
Generate ACA Hours of Service report.
Verify ACA employee eligibility.
The ALE ID To Home Company X-Ref program allows multiple Home Companies to be grouped together under the same ALE ID, which effectively creates an Aggregated ALE Group. Each individual employer in an Aggregated ALE Group is referred to as an ALE Member.
The system stores the ALE information in the ALE ID To Home Company Cross Reference file (F08116).
For more information about adding company members to ALE, see ”Creating ALE ID To Home Company X-Ref” in the JD Edwards World Human Resources Guide.
As a part of producing ACA Health Coverage Information Returns, employees who should receive Form 1095-C must have an Employee ACA Eligibility record or records that indicate the employee's full-time or non-full-time eligibility status, for each month of the reporting year, under ACA provisions. You may optionally use the Hours of Service report process to create Employee ACA Eligibility records, whether or not you are actually measuring hours of service, according to ACA provisions, to determine eligibility.
Run the ACA Hours of Service Report (P08416) in proof or final mode to generate the hours of service report. You use this report to determine which employees meet the ACA hours of service threshold and should be considered full-time under ACA provisions.
The Hours of Service report is used to measure an employee's hours of service for a prior period in order to determine eligibility for an offer of health coverage in a future period under ACA provisions. You can use the Hours of Service report as a preliminary step prior to benefits enrollment periods. The Hours of Service report can also generate ACA Employee Eligibility records that indicate an employee's ACA eligibility status.
ACA Employee Eligibility records are referenced by the ACA Health Coverage Information Returns process to determine an employee's full-time or non-full-time status for each month of the year. This information is required to determine which employees should receive a Form 1095-C and also to determine certain code values for Form 1095-C, Part II, Line 14 and Line 16. You can also manually enter ACA Employee Eligibility information.
For more information about generating the ACA Hours of Service report, see ”ACA Hours of Service (Proof and Final) Mode (P08416)” in the JD Edwards World Human Resources Guide.
A Limited Non-Assessment period (LNAP) refers to a period during which an ALE Member is not subject to an assessable payment under section 4980H(a) and in some cases under 4980H9(b), for a full-time employee, regardless of whether that employee is offered health coverage during that period.
The period of non-assessment and the reason for non-assessment are new values that have been included in the ACA Employee Eligibility table. LNAP information is used to determine the appropriate code value for Form 1095-C, Part II, Line16.
Access the Employee Eligibility window (P081161) to review employee eligibility information created by the Hours of Service report. The ACA Hours of Service report indicates an employee's full-time eligibility status for each month of the reporting year. This status determines whether an employee is eligible for benefits coverage and should be offered coverage.
Note:
Each reportable employee needs an ACA Employee Eligibility record or records that indicate their eligibility status for each month of the reporting year.Note:
The ACA Employee Eligibility record provides the ability to indicate Limited Non-Assessment Period information (LNAP) for an employee. When the LNAP flag is checked, indicate the End Date of the LNAP and the Reason Code. The Effective Date of the ACA Employee Eligibility Record represents the start of the LNAP.For more information about LNAPs, see the IRS 2019 Instructions for Forms 1094-C and 1095-C under Definitions.
For more information about reviewing employee eligibility details, see ”Reviewing Employee Eligibility” in the JD Edwards World Human Resources Guide.
ACA Health Coverage Information Returns is primarily based on benefits and benefits enrollment information. Complete the benefit plans setup for health coverage information returns reporting. If you do not use the Benefits system for benefits enrollment, or you do not enroll all employees through benefits, you can use the deductions or benefits (DBAs) setup to indicate DBAs to report.
Set the benefits plan for:
Reportable health coverage plans
Self-insured plans
Waived health coverage plans
Complete the setup for benefit plans to identify:
Reportable health coverage plans
Self-insured plans
Waived health coverage plans
For more details, see Section 7.19, "1095-C Offer and Coverage Report (P08519)".
See Also:
For more information about benefits plans, see the JD Edwards World Human Resources - Benefits Guide.The system must determine which benefit plans are reportable health coverage plans and therefore which benefit enrollment records must be considered for reporting.
To identify a plan as reportable for health coverage information returns, use the Plan Master Plan Type field. You can use any User-defined Code (UDC) value for Plan Type, but the UDC value must have the value of M in the UDC Special Handling Description.
The system must determine which plans are self-insured plans and therefore when to check the self-insured plan box on Form 1095-C and to complete Part III - Covered Individuals.
To indicate that a plan is a self-insured plan, select a Category Code associated to the Plan Master that you define as the indicator for a Self-Insured Plan. Also, select the value that you are using to indicate that the plan is self-insured, and update the Category Code with that value.
The system must determine if an employee was offered health insurance coverage but declined it. On your waived or declined plan, to indicate that a plan is a non-participating plan, verify the Plan Description. The system determines a waived or declined plan from the value in the Description. For example, all Plans whose descriptions begin with W means that the employee was offered health coverage.
Complete the DBA setup to identify:
Reportable health coverage DBAs
Self-insured DBAs
Setup Without a Benefits Plan for Employees Who Have Waived Health Coverage
The system must determine which DBAs are reportable health coverage DBAs and therefore which deductions or benefit should be considered for reporting.
To identify a DBA as reportable for health coverage information returns, use a Category Code associated to the DBA in the DBA SetUp/Category Code Setup window that you have designated to identify reportable DBAs. Also, select the value that you are using to indicate that the plan is self-insured and update the Category Code with that value.
Note:
If you have a deduction and a benefit that represents an offer of health coverage, you can set up either the deduction or the benefit as the reportable health coverage DBA. You do not need to set up both the deduction and the benefit as reportable.The system must determine which DBAs are self-insured and therefore when to check the self-insured plan box on Form 1095-C and to complete Part III - Covered Individuals.
To indicate that a DBA is for self-insured coverage, select a Category Code associated to the DBA that you define as the indicator for a Self-Insured DBA. Also, select the value that you are using to indicate that the DBA is self-insured, and update the Category Code with that value.
When you are not using a benefits plan, and you want to indicate that an employee has waived health coverage offered, you must set up the employee with an eligibility code on the Employee Master form and a value that indicates that the health coverage is waived. You can choose any eligibility code from code 1 to 10. Also, to indicate the dates of the waived period, select two user-defined dates, one to indicate the start of the waive and one to indicate the end of the waive. If the waive plan eligibility code is set to the value Yes, and the dates are blank, then the system will assume that the waive covers the entire reporting year.
This section provides an overview of employee offer and coverage setup (information in lines 14, 15, and 16 on part II of Form 1095-C), and discusses how to:
Set up lines 14, 15, and 16 for reporting in Form 1095-C, Part II.
Add or update Employee Offer and Coverage Setup.
The Offer and Coverage Setup (P08117) is used to enter and maintain the employee health coverage information for the Affordable Care Act. The data resides in the Offer and Coverage Setup file (F08117).
You can use the Offer and Coverage Setup (P08117) to set up values for lines 14, 15, and 16 of Form 1095-C, Part II.
Form 1095-C Part II Employee Offer and Coverage contains the following categories:
Line 14 - Offer of Coverage Code
Line 15 - Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage
Line 16 - Applicable Section 4980H Safe Harbor Code
You can enter and track the information in one of following three ways:
Plan ID/Plan Option
You must enter a Plan ID, but the addition of the Plan Option is optional. The Plan ID must exist in the Plan Master file (F08320). If you enter a Plan Option it must exist in the Plan Additional Options file (F083202).
DBA Code/Union Code
You must enter a DBA Code, but the addition of the Union Code is optional. The union code must be a valid UDC from the 07/UN UDC for data item UN. The DBA Code must exist in the Payroll Transaction Constants file (F069116) and must be greater than or equal to 1000, indicating that it is a deduction, a benefit, or an accrual.
Employee Number
You must enter a valid Employee ID in the Address Book Number. Setup entered at the Employee Number level is considered an Employee override.
When retrieving codes and values from Employee Offer and Coverage Setup, the system associates codes as follows:
Based on an employee's benefit enrollment (F08330), setup values are determined based on Plan or Plan Option setup.
Based on employee DBA Transaction history (F0719), setup values are determined based on DBA number, with or without Union Code.
Setup associated to an Employee number overrides other setup values.
The offer of coverage code that applies to an employee for each month of the year or for all 12 months of the year is reported on Form 1095-C, Part II, Line 14 in the All 12 Months column or in the Jan-Dec columns.
The amount that represents the Employee Share of Lowest Cost Monthly Premium for Self-Only Minimum Value Coverage that corresponds to the actual health coverage benefit that the employee enrolled in is reported on Form 1095-C, Part II, Line 15 in the All 12 Months column or in the Jan-Dec columns. Line15 is to be completed only if code 1B, 1C, 1D, or 1E is entered in line 14.
The reason for no offer of coverage is reported on Form 1095-C, Part II, Line 16 in the All 12 Months column or in the Jan-Dec columns. The reason for the gap could be several, including termination, leave of absence, transfer to another company, and so on.
To set up Offer and Coverage program Setup (P08117)
From Human Resources (G08), select Affordable Care Act
From Affordable Care Act (G08ACA), enter 29
From ACA Information Returns Setup (G08ACA41), select Offer and Coverage
In the Offer and Coverage program (P08117), complete the following fields:
| Field | Description |
|---|---|
| Plan ID | Enter an abbreviation or number that identifies a specific employee benefit. For example, Employee Health Insurance, Accidental Death and Dismemberment, Employee Stock Appreciation Rights, or Health Club Expense Reimbursement.
A benefit plan typically is associated with a deduction, a benefit, or an accrual. For example, a medical plan is a benefit that might also require a deduction to withhold premiums from an employee's pay. |
| Plan Option | Enter a value from the Plan Master Option table (F083202) that identifies any additional options available for a benefit plan. Additional options must have the same provider, policy number, and enrollment and eligibility rules as the benefit plan to which they are associated. |
| DBA Code | Enter a value that defines the type of pay, deduction, benefit, or accrual.
Pay types are numbered from 1 to 999. Deductions and benefits are numbered from 1000 to 9999. |
| Union Code | Enter a value from UDC 07/UN that represents the union or plan in which the employee or group of employees work or participate. |
| Employee No. | Enter the Address Book Number. |
| 1095-C Line | Enter a value that indicates the line number on Form 1095-C to which the employee Offer and Coverage setup record pertains.
Note: When using the value #ALL to establish a record with values for all three lines, do not create a conflicting or overlapping record for the same Plan/Plan Option, DBA/Union, or Employee for the same date range. This could lead to unpredictable results. If you are unsure about the use of *All, complete the set up only for specific line numbers. |
| From First Day of Month | Enter the first day of the month the record becomes effective. |
| Thru Last Day of Month | Enter the last day of the month the record is no longer effective. |
| Offer of Coverage | Enter the IRS-defined Code Series 1 that specifies the type of coverage, if any, offered to an employee, the employee's spouse, and the employee's dependents.
If the employee was not offered coverage, enter Code 1H in this field. |
| Monthly Premium | Enter the amount of the employee share of the lowest-cost monthly premium for self-only minimum essential coverage providing minimum value that is offered to the employee.
The value in this field is set to zero when the employee is offered coverage but is not required to contribute towards the premium. The monthly premium value can be entered only for 1B, 1C, 1D, 1E, 1J and 1K Offer and Coverage codes. |
| Safe Harbour | Use this processing option to specify the IRS-defined Code Series 2 to report that one of the following situations applied to the employee for all 12 months of the calendar year:
|
This section provides an overview of the manifest validation, and discusses how to validate the transmitter information.
When sending the electronic filing XML files to the IRS, two files are required for each transmission. The Form Data File contains the 1094-C and 1095-C information. Each Form Data File is accompanied by a Manifest File, which contains general transmitter information and overall attribute information about the Form Data File.
Note:
While filing the returns, you must use the Manifest XML file corresponding to the year that you are filing the returns. For example, if you are filing the returns for the year 2019, you must use the Manifest XML file corresponding to the year 2019 and not 2018.The Manifest Information program allows you to enter and maintain the manifest information to be used when creating transmissions. The data resides in the Manifest Information file (F08213) and will appear on the ACA Transmission record in F08211 as well as in the Manifest XML file.
The form data file and manifest file are included in an XML file. Once the required information is interactively entered, the client uses their Web Browser to browse for the respective XML file that contains Forms 1094-C and Forms 1095-C along with the XML file and uploads the files to the IRS.
You may add, change, or delete the records in this file.
Transmitters or Issuers must have an active IRS account and have been approved to transmit ACA Information Returns. Refer to the IRS publications AIR Submission Composition and Reference Guide and Publication 5165 for Electronically Filing Affordable Care Act (ACA) Information Returns for Software Developers and Transmitters.
The Transmitter, including Issuer, is required to log in to the IRS Integrated Enterprise Portal (IEP) and invoke the appropriate URL for AIR. AIR allows the Transmitter or Issuer to either transmit submissions to the IRS or retrieve Acknowledgements for those transmissions from the IRS. The transmitter shall select the option to transmit submissions to the IRS.
Before entering the Manifest information, you have to set up a Transformation Template in World Electronic Document Delivery (EDD) for transforming the JDE Source XML to the IRS XML format. The Manifest Information file (F08213) refers to this template.
To set up Manifest Information Revision (P08213)
From Human Resources (G08), select Affordable Care Act
From Affordable Care Act (G08ACA), select ACA Information Returns (G08AIR)
From ACA Information Returns (G08AIR), select Electronic Filing
From Electronic Filing, select Manifest Information Revision
In the Manifest Information Revision program (P08213), complete the following fields:
| Field | Description |
|---|---|
| Template Name | This is the name of the Transformation Template.
A Transformation Template contains the file names and paths of a Transformation Template File and a Transformation Output File. Enter the name of the Transformation Template you set up for transforming the JDE Source XML to the IRS format XML. |
| Template Type | Indicates the type of template, such as, XSL or BI Publisher.
For the Manifest, the Template Type is: 1: XSL Template |
| Transmitter Control Code (TCC) | A five-character code assigned to a transmitter by the IRS in order to file electronically. You must apply for and receive this code from the IRS.
The TCC is required and is part of the Unique Transmission ID. AIR will extract the TCC from the Unique Transmission ID. AIR verifies if the TCC exists, and if the TCC does not exist, or the TCC is in a state other than Active, the transmission will be rejected. |
| Transmitter EIN (TEIN) | Indicates the Employer Identification Number (EIN) of the transmitter. |
| Address Number | Enter the Address Book Number of the Transmitter. |
| Transmitter Foreign Entity Indicator | Indicates the transmitter is a foreign entity. Valid values are:
0 - Not a foreign entity 1 - Foreign entity |
| Prior Year Data Indicator | Indicates the transmitter is submitting prior year data. The IRS will validate the XML document against the prior year schema. Valid Values:
blank or 0 - Not submitting prior year data 1 - Submitting prior year data |
| Test File Indicator | Indicates the type of file to be processed. Valid values are:
T - ACA Assurance Test File P - Production File |
| Software Vendor | Identifies the software as being developed by a vendor as well as contact information. Values include, vendor indicator, contact first and last names, and contact phone number. |
| Software ID | The Software ID assigned to the software when it was registered with the IRS.
For JD Edwards World, this Software ID is 15A0000712. |