Who: Under New Jersey’s Individual Mandate, employers have additional requirements when it comes to 1095 reporting. Employers who are sitused in New Jersey or who employed someone who was a resident of New Jersey or whose dependent was a resident of New Jersey for at least 15 days of the calendar year must comply by sending 1095 forms to the New Jersey government via the MFT SecureTransport in addition to the Federal requirement, if applicable.
What: The New Jersey government has now explicitly stated that it is the employer’s responsibility to create, mail, and file these forms. This applies regardless of employer size (Applicable Large Employer status) or insured status (fully-insured or self-insured). Some carriers have advised that they will be completing the filing requirements on behalf of certain employers. It is advised that employers check with their carriers but ultimately be prepared to satisfy the requirements on their own. Additionally, New Jersey has advised that they will accept 1095-C forms only if they are fully completed, meaning parts I, II, and III are complete. This is unusual as the federal filings typically only require fully-insured Applicable Large Employers (ALEs) to complete parts I and II of the 1095-C.
In general, New Jersey anticipates the following filing scheme:
Employer Size & Coverage Type | New Jersey State Reporting | Member-Level Reporting |
Fully-Insured ALE | The employer files the 1095-B or 1095-C for each covered member. | Employer must send their 1095-B or 1095-C to the employee. |
Self-Insured ALE | The employer files the 1095-B or 1095-C for each covered member. | Employer must send their 1095-B or 1095-C to the employee. |
Fully-Insured Non-ALE | The employer files the 1095-B or 1095-C for each covered member. | Employer must send their 1095-B or 1095-C to the employee. |
Self-Insured Non-ALE | The employer files the 1095-B or 1095-C for each covered member. | Employer must send their 1095-B or 1095-C to the employee. |
Multi-Employer Plan (Either Fully or Self- Insured) | The plan sponsor should file a 1095-B for each covered employee. The employer or the plan sponsor would then send the forms to both the New Jersey and federal governments. | Employer or plan sponsor would provide the forms to the employees. |
NOTE: The state only requires one 1095 to be received. It does not require both the insurer and employer to file with the State.
In addition, 1095-C forms which only have parts I and II completed will not meet any New Jersey filing requirements. New Jersey requires the 1095-C forms to be fully completed, meaning parts I, II, and III are to be completed.
When: Forms are due to be distributed to employees by March 2, 2023. Forms cannot simply be made available on an employee portal or other platform; they must be mailed to the employee. Forms are due to the New Jersey government in electronic form by March 31, 2023.
ADDITIONAL INFORMATION
While the employer is expected to file in all cases now, certain carriers have advised that they will be meeting the requirements on behalf of certain employers. Below is a list of what each carrier has advised.
New Jersey 1095 Mandate Reporting
Carrier | Filing with the State? |
|---|---|
Aetna | Filing for Aetna Funding Advantage (AFA) plans with 2-50 members. |
AmeriHealth NJ | Filing for fully-insured groups only (all sizes). |
Cigna | Filing for fully-insured groups only (all sizes). |
Emblem | Filing for fully-insured groups only (all sizes). |
Horizon Blue Cross Blue Shield of New Jersey | Filing for fully-insured groups only (all sizes). |
Independence Blue Cross | Filing for fully-insured groups only (all sizes). |
National General | Will not be reporting for any groups but will offer a tool for employers to use in their reporting. |
Oscar | Will not file for any groups or provide any materials. |
Oxford/UnitedHealthcare | Filing for fully-insured groups only (all sizes) |
UHC AllSavers | All Savers does not file on behalf of the employer but will create forms for alternative funding groups with 49 or fewer lives which will be available in January. Forms are available on the website for employers, not submitted or distributed by All Savers. |
Note: only applies for groups which are with the same carrier as last year. 12/29/2022
Federal 1095 Reporting
Conversely to the New Jersey 1095 reporting requirements, the actions of the carrier do not influence what the employer is required to do to meet their own reporting obligations for the federal requirements.
The federal reporting requirements vary based solely on whether a group is fully-insured or self-insured, and whether they are an ALE or not. The below outlines how each employer type should be filing:
IF ALE:
Form | Who is Responsible For? | Send to Whom? |
|---|---|---|
1094-B | Carrier | IRS |
1095-B | Carrier | IRS, Employee* |
1094-C | Employer | IRS |
1095-C | Employer | IRS, Employee* |
*individual should keep for proof of enrollment for tax forms
If Fully-insured ALE | If Self-Insured ALE |
|---|---|
| 1. Employer to fill out 1095-C Parts I, II and III |
2. Send to Employees | 2. Send to Employees |
3. Send to IRS with fully-completed 1094-C | 3. Send to IRS with fully-completed 1094-C |
IF Non-ALE
If Fully-insured | If Self Insured (or Partially Self-Funded) |
|---|---|
Carrier completes the 1094-B and 1095-B Forms; there are no requirements for the employer on the Federal level. | Employer must complete the 1094-B and 1095-B Forms, then distribute the 1095 to employees and submit the 1094 and 1095 to the IRS. |
The information contained herein is for informational purposes only and does not constitute financial, accounting, actuarial, or legal advice as to any particular matter. The reader should consult with a legal or other professional advisor before commencing a course of action. Acting upon information herein does not create an attorney-client relationship.
Comments