1. US Affordable Care Act Year-End Processing Guide
  2. Work With Employee Offer and Coverage Setup (P08117)

Work With Employee Offer and Coverage Setup (P08117)

Access the Employee Offer and Coverage Setup Revisions form.

Plan ID

Enter the Plan ID that identifies the reportable benefit plan. Examples of benefits are Employee Health Insurance, 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.

When an employee has benefits enrollment records, the system looks for a setup record for the enrollment Plan or Plan and Plan Option.

Plan Option

Enter a code from the Plan Additional Options 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.

If your benefit plans are set up with Plan Options, your Offer and Coverage Setup must also be setup to include Plan Options.

PDBA Code

Enter a code that defines the benefit or deduction associated with a reportable offer of coverage.

Deductions and benefits are numbered from 1000 to 9999.

When you are not using Benefits Administration to enroll employees, but instead, you are processing health insurance coverage through union setup or DBA setup, you can associate Line 14 - 16 values to DBAs.

Union Code

Enter a value from UDC 06/UN that represents the union or plan in which the employee or group of employees work or participate.

When you are setting up Line 14 - 17 values to DBAs, you can optionally include a Union Code. When the system looks at DBA Transaction History Detail (F0719), the Union Code on the record will also be considered.

Employee Number

Enter the employee number, tax ID, or alternate number, depending on the employee number mode that is set up in the Payroll Constants for company 00000.

Offer and coverage setup at the employee level overrides setup at the Plan or DBA level.

ACA 1095-C Line Num

Enter a code that indicates the line number on Form 1095-C to which the Employee Offer and Coverage setup record pertains.

The value *All indicates that the record may contain values for any or all three lines.

Note: When using the value *ALL to establish a record with values for all three lines, you must be careful to 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, you can set up only for specific line numbers.
Effective From

Enter the date on which the offer and coverage setup becomes effective. This field is used generically throughout the system. It could be a lease effective date, a price or cost effective date, a currency effective date, a tax rate effective date, or whatever is appropriate.

Note: This date must be the first day of the month.
Effective Thru

Enter the date on which the offer and coverage setup becomes inactive. This field is used generically throughout the system. It could be a lease effective date, a price or cost effective date, a currency effective date, a tax rate effective date, or whatever is appropriate.

Note: This date must be the last day of the month.
ACA Offer of Coverage Code

Enter the IRS-defined Code Series 1 code that specifies the type of coverage, if any, offered to an employee, the employee's spouse, and the employee's dependents.

The Offer of Coverage code is reported in Line 14 of Section II the Form 1095-C.

ACA Lowest Cost 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 Lowest Cost Monthly Premium is reported in Line 15 of Section II of the Form 1095-C.

The value in this field is set to zero when the employee is offered coverage but is not required to contribute to the premium.

Note: Enter the Lowest Cost Monthly Premium only when the Offer of Coverage Code for the month is 1B, 1C, 1D or 1E.
ACA Safe Harbor Code

Enter the IRS-defined Code Series 2 code to report that one of the following situations applied to the employee:

  • The employee was not employed.

  • The employee was not a full-time employee.

  • The employee enrolled for the minimum essential coverage offered.

  • The employee was in a Limited Non-Assessment Period.

  • Non-calendar year transition relief applied to the employee.

  • The employee met one of the 4980H affordability safe harbors.

  • The employer was eligible for multiemployer interim rule relief.

The Safe Harbor Code is reported in Line 16 of Part II of the Form 1095-C.