State Health Coverage Reporting Requirements for Calendar Year 2023
Five states (California, Massachusetts, New Jersey, Rhode Island, and Vermont) and the District of Columbia have already enacted individual health insurance mandates with their own requirementsFive states (California, Massachusetts, New Jersey, Rhode Island, and Vermont) and the District of Columbia have already enacted individual health insurance mandates with their own requirements for:
~Furnishing information regarding health insurance coverage to residents of the state, and
~Filing that information with certain state agencies.
These requirements and deadlines may (or may not) align with the federal requirements. As described below, satisfying
the federal requirements may not satisfy the applicable state obligations. It is important to ensure both federal and state requirements (as applicable) are met.
It should be noted that the state reporting deadlines are subject to change if the states update their reporting information.
This information is current as of the date of publication.
Important issues to consider regarding furnishing and filing state-level health coverage information are as follows:
State residents — Employers with employees and other covered individuals residing in states with health coverage
mandates should ensure the state-level health insurance distribution and state-level filing requirements are satisfied.
Penalties may arise for late or incorrect filings with the state.
Forms
California, the District of Columbia, New Jersey, and Rhode Island use the federal Forms 1094/1095 (B, C)
for the state’s individual mandate reporting requirements.
Massachusetts requires MA Form 1099-HC to be furnished to Massachusetts residents and filed with the state by
January 31. In addition, Massachusetts requires employers with at least 6 employees residing in Massachusetts to
file the Health Insurance Responsibility Disclosure (“HIRD”) form.
Employers with fully insured plans
Carriers issuing policies in California, Massachusetts, New Jersey, and Rhode Island are generally obligated to issue
health coverage statements to plan members residing in the respective state and to file the required health coverage
information to that state agency.
The District of Columbia requires employers that sponsor a fully insured group health plan with at least 50 full-time
employees, including at least one employee who is a resident of the District, to file information returns with the
Office of Tax and Revenue (“OTR”).
It should be noted that a carrier may not automatically furnish a member statement and file with a state agency
for plan members residing outside of the policy issue/situs state.
Employers with fully insured plans issued out-of-state — Employers should confirm that the carrier will adhere
to the required state distribution and filing obligations for plan members that reside in a state with individual mandate
reporting obligations.
Employers with self-funded plans — Employers should confirm with their third-party administrator (“TPA”) or ACA
form preparation vendor that the required state distribution and filing obligations for plan members that reside in a
state with an individual mandate will be satisfied and whether any additional fees will be assessed.
For employers with fully insured plans that are written outside of a state with an individual mandate or a self-funded health plan, if the carrier or TPA will not furnish or file the forms with state residents or the applicable state agency, the employer may be required furnish and/or file. This may require involvement with your payroll provider or other ACA reporting vendor to coordinate.
Employer Action
Employers with employees and/or plan members residing in a state (and/or the District of Columbia) with individual mandate reporting requirements should confirm state reporting requirements with their carrier, TPA or ACA vendor to ensure federal as well as state-level reporting obligations will be met.
