1. United States Affordable Care Act Year-End Processing Guide
  2. Setting Up Employee Offer and Coverage (Line 14-16 of Form1095-C)

Setting Up Employee Offer and Coverage (Line 14-16 of Form1095-C)

This section provides an overview of employee offer and coverage setup (information in lines 14, 15, 16, and 17 on part II of Form 1095-C), and discusses how to:

  • Set up lines 14, 15, 16, and 17 for reporting in Form 1095-C, Part II.

  • Add or update Employee Offer and Coverage Setup.

Understanding 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

  • Line 17 - ZIP 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.

Working With Employee Offer and Coverage Setup (P08117)

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)

Navigation

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

  1. 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:

  • 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 multi-employer interim rule relief.

ZIP Code

Enter the applicable ZIP code your employer uses for determining the availability for an individual coverage HRA. If code 1L, 1M, or 1N is used in Line 14, the ZIP code will be for your primary residence location. If code 1O, 1P, or 1Q is used in Line 14, the ZIP code will be for your primary work location. Line 17 will be blank for any other code that is entered in Line 14.