1095 Documents for 2016 Tax Year

Information on the 2016 changes to 1095 Documents for Optima Health

As you are aware, the Affordable Care Act (ACA) requires every issuer of health insurance to report certain information to the Internal Revenue Services (IRS), and individuals to report coverage information on their annual income tax filing.

For the 2016 tax year, Optima Health will mail 1095-B tax form to all individuals covered by our fully insured health plans, including employer-sponsored and individual & family plans sold off the Health Insurance Marketplace. The deadline for individuals to receive their 1095-B form is January 31, 2017. We will also report this information to the IRS by the electronic filing deadline of March 31, 2017. Paper filing deadline is February 28, 2017.

Self-funded groups:

    • Large self-funded groups and BusinessEDGE® groups with 50 or more employees: Optima Health will provide a data file that will contain all the fields in Section III of the 1095-C for each of your employees and dependents covered by the group health plan for at least one day in 2016. The comma delimited text file will be available around the first week of January 2017 and can easily be imported into Excel, Access, SQL, or various other tools so that you may develop the required 1095-C forms for your employees and report the information to the IRS. Test files will be available November 21, 2016.
    • BusinessEDGE® groups with less than 50 employees: Optima Health will provide a data file that will contain all the fields in the 1095-B and relevant information for each of your employees and dependents covered by the group health plan for at least one day in 2016. The comma delimited text file will be available around the first week of January 2017 and can easily be imported into Excel, Access, SQL, or various other tools so that you may develop the required 1095-B forms for your employees and report the information to the IRS. Test files will be available November 21, 2016.

For more information on insurer and employer reporting requirements view the Frequently Asked Questions

Please contact your Optima Health representative if you have any questions.