Reporting, ALEs, and DGEs
Why do I need to report?
The Patient Protection and Affordable Care Act (ACA) specifies that any employer, without exception, with 50 or more full-time equivalent employees must offer adequate and affordable coverage to all full-time employees or will be subject to penalties.
These penalties are triggered in two (2) ways:
- If one employee receives the Premium Health Care Credit the employer may be subject to the Employer Shared Responsibility. This penalty is assessed by the IRS and is similar to an unemployment claim, until a credit is provided, there would be no claim against the company. You will have a certain amount of time to show that you have offered affordable coverage or be assessed the penalty.
- An employer who does not file the Information Returns by the required due date will be assessed the failure to file penalty.
How do I know if I need to report?
If your business has been determined to be an Applicable Large Employer, it is required that you report on the 1095/1094-C forms.
If you are considered a small business, you may be exempt from the ACA provisions unless your business offers insurance under a self-funded plan. Then the required information returns will be reported using the 1095/1094-B forms.
Full-Time Equivalent (FTE) Chart
Use the chart and/or calculator below to quickly determine which forms you need to file.
| Fully Insured | Self-Funded | |||
| < 50 FTE's | > 50 FTE's | < 50 FTE's | > 50 FTE's | |
| Form(s) to employees | No reporting requirements | 1095-C (Parts I & II only) |
1095-B | 1095-C (All Parts) |
| Form(s) to IRS | No reporting requirements | 1094-C (with copies of all forms 1095) |
1094-B (with copies of all forms 1095) |
1094-C (with copies of all forms 1095) |
How do I determine if I'm an Applicable Large Employer (ALE)?
If you employ 50 or more Full-Time, or Full-Time Equivalents , your business is considered an ALE. The IRS provides Look-Back Rules to help determine status, seasonal worker exception, and IRS Affordable Care Act Tax Provisions Questions and Answers.
Affordable Care Act (ACA) Full-Time Employee Calculator
We have provided a monthly calculator for you.
To aid in determining if your company is required to report under the
Affordable Care Act (ACA), the following information is required.
***This is not intended as tax advice and you should consult your accountant or HR Specialist to confirm these results.***
What type of health coverage is sponsored by your company?
Are you part of an Aggregated Group?
What is a Designated Government Entity?
A Designated Government Entity (DGE) is:
“a person or persons that are part of or related to the Governmental Unit that is the ALE Member and that is appropriately designated for purposes of these reporting requirements.”
Nevertheless, “the Governmental Unit must ensure that among the multiple Forms 1094-C filed by or on behalf of the Governmental Unit transmitting Forms 1095-C for the Governmental Unit’s employees, one of the filed Forms 1094-C is designated as the Authoritative Transmittal and reports aggregate employer-level data for the Governmental Unit, as required in Parts II, III, and IV of Form 1094-C.”
Here’s the given example:
County is an ALE made up of ALE Members School District, Police District, and County General Office. School District designates the state to report on behalf of the teachers and reports for itself for its remaining full-time employees. In this case, either the School District or the state must file an Authoritative Transmittal reporting aggregate employer-level data for all full-time employees of the School District.