Setting Up Benefit Plans and DBA Setup
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
Setting Up Benefits Plan
Complete the setup for benefit plans to identify:
Reportable health coverage plans
Self-insured plans
Waived health coverage plans
For more details, see 1095-C Offer and Coverage Report (P08519).
For more information about benefits plans, see the JD Edwards World Human Resources - Benefits Guide.
Reportable Health Coverage Plans
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.
Self-Insured Plans
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.
Waived Health Coverage Plans
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.
Setting Up DBAs
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
Reportable Health Coverage DBAs
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.
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.
Self-Insured DBAs
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.
Setup Without a Benefits Plan for Employees Who Have Waived Health Coverage
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.