Group and Retail
Jan. 26, 2022
Applies to Group and Retail.
The Affordable Care Act set reporting requirements related to minimum essential coverage. Individuals no longer have to show proof of health coverage, but insurers and employers are still required to report to the Internal Revenue Service (IRS) about the coverage they provide or offer.
Do you have questions about this year’s forms or other 1095-related questions? Check out the 1095 Q&As below.
Q: Which forms do Blue Cross and Blue Shield of Texas (BCBSTX) provide?
A: BCBSTX produces 1095-B forms for Fully Insured Group and off-exchange Retail members. The IRS doesn’t require insurers to automatically mail 1095-B forms to members, so we don’t mail forms to members unless they request a copy.
Like last year, those forms are available on Blue Access for MembersSM (BAMSM). Members can also call the number on their ID card to request a physical copy or visit our web page.
Q: When will the forms for the 2021 tax year be available?
A: The 2021 1095-B forms are available now in BAM.
Q: What are the different 1095 forms?
A: There are three different types of 1095 forms and reporting:
1095-A
- 1095-A form: Provided by the Health Insurance Marketplace to members of on-exchange Retail plans to show the minimum essential coverage they had during the year.
- 1095-A reporting: Sent by the Marketplace to the IRS.
1095-B
- 1095-B form: Provided by the insurer to Fully Insured and off-exchange Retail members to show the minimum essential coverage they had during the year.
- 1095-B reporting: Sent by the insurer; it tells the IRS information about who had minimum essential coverage during the year.
1095-C
- 1095-C form: Provided by an ASO group to their members to show the minimum essential coverage they had during the year.
- 1095-C reporting: Sent by the applicable Large Group employer.
- Fully insured and ASO: Both use the 1095-C form to tell the IRS who was offered coverage for the year.
- For an ASO group: This reporting also tells the IRS which of their employees had minimum essential coverage.
Q: What reporting does BCBSTX send to the IRS?
A: BCBSTX sends the 1095-B reporting to the IRS, using the 1094-B electronic transmittal form. Note: Because we send the 1095-B data in aggregate electronically, we can’t send groups copies of the transmission.
Q: Does BCBSTX handle 1095-C reporting for groups?
A: No – and here’s why:
- For both Fully Insured and ASO groups, we wouldn’t know which of their employees an applicable large employer offered coverage to, we only know who we covered.
- ASO groups are responsible for reporting to the IRS about their employees’ minimum essential coverage.
Q: Does BCBSTX handle 1095 reporting for other states?
A: For Fully Insured groups: We file forms with the IRS and states that require 1095-B reporting. For the 2021 tax year, this includes Washington, D.C., New Jersey, Rhode Island and California.
Background: Since the 2015 tax year, Section 6055 of the Affordable Care Act has required insurers to issue 1095-B forms to document minimum essential coverage. We have provided forms to Fully Insured and off-exchange Retail members whom we covered for at least one day of the prior tax year. We also issued reporting to the IRS. The Individual Mandate penalty was repealed by the Tax Cuts and Jobs Act, effective with the 2019 tax year.