How should ALEs report coverage of family members who elect COBRA separately?

Question: Our company, an applicable large employer (ALE) under the Affordable Care Act, sponsors a self-insured health plan. As an ALE, how should we report coverage of family members who elect COBRA separately from the departing employees?

Answer: An employer that sponsors a self-insured group health plan is obligated under Internal Revenue Code Section 6055 to report coverage information for all enrollees in the health plan, including nonemployees (such as COBRA beneficiaries).

COBRA-qualified beneficiaries may include the spouse (or former spouse) and dependents of a current or former employee. Each qualified beneficiary generally will be entitled to make an independent election to enroll in COBRA coverage. For example, a divorce would be a qualifying event, and the former spouse would have a right to elect COBRA. In this instance, the plan sponsor would have to report coverage information if the former spouse enrolled in COBRA.

The Sec. 6055 reporting obligation applies to all coverage providers and isn’t dependent on your status as an ALE. Enrollment information generally is reported on Form 1095-B. However, as an ALE, you also have an obligation to report offers of coverage under Internal Revenue Code Section 6056 for any employee who was a full-time employee for any month during a tax year. Sec. 6056 reporting is done on Form 1095-C. For nonemployees, ALEs with self-insured health plans may report enrollment information either on Form 1095-B or Form 1095-C.

An illustration

To illustrate, assume that an employee and her spouse are both enrolled in your company’s plan from January through May. In May, the couple divorces and the employee’s now-former spouse loses eligibility for coverage under the plan. But this ex-spouse is offered and elects COBRA coverage for June through December.

In Part III of Form 1095-C addressed to the employee, you should report that the employee was enrolled in coverage from January through December. The employee’s Form 1095-C should also indicate that the spouse had coverage through the employee for January through May. For the period June through December, the former spouse should receive a separate form reporting COBRA enrollment under your company’s plan. You may report this ex-spouse’s COBRA enrollment on Form 1095-B or Form 1095-C.

Expanded complexities

For ALEs, providing and reporting health care coverage is complex under normal circumstances. When COBRA is added to the mix, the complexities expand. Work with your benefits advisors to handle the challenge.

© 2018

Published in Healthcare

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