SmartFusion Modules -> Human Resources -> Insurance And Benefits -> Reports -> IRS Forms 1094-B and 1095-B

Assumptions

  • Employees are configured in payroll
  • Benefits are configured in I&B
  • Employees have benefits with health type attributes assigned in I&B master with effective/end dates that fall within the reporting year (if both dates are null, the employee will be excluded)
  • Employees have IRS benefit codes configured in the employee-benefit detail
  • Employees may have dependents defined on their employee-benefit detail
  • The dependent has an SSN or Date of birth and the start/end dates of coverage fall within the reporting year (if both dates are null or both the SSN and DoB are blank, the dependent will be excluded)
  • Based on the 'Origin of the Policy' report selection, only employees with the respective benefit type configured should have 1095B's printed for them. See IRS Forms 1094-B and 1095-B for details

Who gets a 1095-B?

Employer Sponsored Plan (B)

GIVEN An Employee Has a Health Benefit

AND the Employee's Health Benefit Start and End dates overlap the Reporting Year
AND The user selects 'B - Employer Sponsored Plan' for "Origin of the Policy"

WHEN the user clicks print
THEN a 1095-B needs to be printed for each employee

WERE a health benefit with the 'self insured' attribute is true

Multi Employer Plan (E)

GIVEN An Employee Has a Health Benefit

AND the Employee's Health Benefit Start and End dates overlap the Reporting Year
AND The user selects 'E - Multiemployer' for "Origin of the Policy"

WHEN the user clicks print
THEN a 1095-B needs to be printed for each employee

WHERE a health benefit with the 'multiemployer' attribute is true

Government-sponsored program (C)
Individual market insurance (D)
Other designated minimum essential coverage (F)

GIVEN An Employee Has a Health Benefit

AND the Employee's Health Benefit Start and End dates overlap the Reporting Year
AND The user selects C, D, or F for "Origin of the Policy"

WHEN the user clicks print

THEN a 1095-B needs to be printed for each employee

WHERE a health benefit with the 'multiemployer' attribute is false
AND 'self insured' attribute is false

Small Business Health Options Program (SHOP) (A)

We do not support option A because none of our current clients fall under that category

1095-B Fields

Void (left blank)
Corrected - Populated from checkbox on report selections tab

Part 1 Responsible Individual

box 1 Name of Responsible Individual (employee)
box 2 Social Security Number (employee)
box 3 Date of Birth (employee)
box 4 Street Address (employee)
box 5 City or Town (employee)
box 6 State or Province (employee)
box 7 Country and Zip (employee)
box 8 Letter identifying origin of the policy (User Selection)
box 9 Small Business Health Options Program Market Place Identifier

Part 2 Employer Sponsored Coverage

This section is always left blank.

Why: This section is only filled out by Insurance Carriers who enter 'A' or 'B' in box 8. Self Insured Employers (SmartFusion Organizations) will never complete part II.

See the IRS Instructions for additional detail see pp.12 here: https://www.irs.gov/pub/irs-pdf/i109495b.pdf

Part 3

box 16 Filers Name (organization system settings)
box 17 EIN (organization system settings)
box 18 Contact Telephone (report selection user input)
box 19 Street Address (organization system settings)
box 20 City or Town (organization system settings)
box 21 State (organization system settings)
box 22 Zip (organization system settings)

Part 4

Configuration Note:   
Benefits where the employee has 'Declined Offer of Coverage' (see [Payroll Enter/Edit Employee Master](Page/1396)) are not included in part 4

Covered individuals (employee and dependents) ordered alphabetically by last name.

boxes 23-40
a Name of Covered Individuals (employee and/or dependent's name)
b SSN (employee and/or dependent's SSN)
c DOB - if no SSN (employee and/or dependent's DOB)
d Covered all 12 months (calculated based on benefit's start and end dates)

GIVEN a covered individual has a health benefit for 1 day in all 12 months of the reporting calendar year
THEN mark true
ELSE fill in the months of coverage (e)

e Months covered

GIVEN a covered individual has a health benefit for 1 day in all the month of the reporting calendar year
THEN mark true
ELSE leave blank

Dependents

Since dependents are employee-benefit attributes, the same dependent may appear on multiple benefits In a reporting year and will be reported accordingly.

Example:

Jane is on Dad's insurance benefit A from jan 1 -> march 1
The organization uses a new benefit code for the next enrollment period, benefit B
Jane continues on Dad's insurance from march 1 -> dec 31
Jane's box d should be true