Setting Up and Managing Data Extraction for Forms 1094-C and 1095-C

Health Plan Table Page

HEALTH_PLAN_TABLE

Define ACA health plan attributes needed in forms, e.g. Self-Insured, Minimum Essential Coverage, and Lowest Cost Monthly Premium.

ACA Employee Eligibility Group Page

ACA_EMP_ELIG_GP

Group different ACA eligibility statuses into eligibility groupings for use in the data extraction processes.

ACA Offer of Coverage Page

ACA_CODE_SERIES1

Define eligible coverage codes for Code Series 1 and indicate whether to Report Employee Share of Lowest Cost for Self-only.

ACA Data Extract Definition Page

ACA_DATEXTR_DEF

Define a set of data extraction rules.

ACA Data Source Page

ACA_DATA_SOURCE

Define other data sources to be used in Excel-CI Load.

Health Provider Required

Select whether an employee must declare a health provider when enrolling in this plan through self-service.

Wait Period Days

Enter the number of days an employee must wait to be eligible for the plan.

Self-Insured Plan

Select this check box if the health plan is employer-sponsored self-insured health coverage.

Benefit Plan Coverage Value

Options include MEC and Minimum Value, MEC and Not Minimum Value, and Not Minimum Essential Coverage.

Lowest-Cost Monthly premium

This cost is the employee share of the lowest-cost monthly premium for self-only minimum essential coverage providing minimum value that is offered to the employee. (This field is only used for employees using the Base Benefits product.)

Employee Eligibility Group

Displays the name of the eligibility group. FLTM (Full Time) and NFLT (Not Full Time) are eligibility groups delivered with the system.

ACA Eligibility Status

Status: Eligible and Always Eligible are assigned to FLTM. Ineligible, To be determined, and Excluded are assigned to NFLT.

Code Series 1

Employee Offer of Coverage Codes (Code Series 1) published in IRS Instructions for 1095-C. The valid codes are 1A – 1I for tax year 2015.

Report Lowest-Cost Self-Only

Select this check box to indicate that Employee Share of Lowest Cost Monthly Premium is reported for the Code Series 1. For example, if code 1B, 1C, 1D, or 1E is reported on line 14 of Form 1095-C, the lowest self-only cost will be reported on line 15 of Form 1095-C. For this reason, for codes 1B, 1C, 1D, and 1E, the checkbox is selected.

Coverage Code

List coverage codes that are associated with certain Code Series 1 (e.g. 1B, 1C, 1D, or 1E).

Data Extract ID

Assign a Data Extract ID for each set of data extract rules.

Data Extract ID 1094C1095C is system delivered for extracting employer and employee data for Forms 1094-C and 1095-C.

Data Extract Options

Common As of Day in Month

Select the common date to be used for effective date extract of all monthly data.

The options available are First Day, Specified Day, or Last Day.

Specified As of Day

This edit box appears only when you select Specified Day from the Common As of Day in Month drop-down menu.

Specify the day to use for each month.

Eligible Plan Types

Plan Type

Select the plan types that are eligible for this extract.

Plan Start Month for Benefit Program

Benefit Program

Select the benefit program that is eligible for this extract.

Plan Start Month

Enter the start month for the benefits plan.

HRA Primary Residence Zip Code

Priority

Enter a number to define the priority of the address type to be used for the extract.

Address Type

Select the address type to be used for the extract. This includes values such as Home, Permanent, Mailing and Business.

Part III ALE Member Monthly Flags & Codes

ALE Member Monthly Data

Valid ALE Member Monthly Data options are:

• Aggregated Group Indicator

• Minimum Essential Coverage ID

• Sec 4980H Transition Relief ID

Sequence

Specify the order of processing in the main extraction process.

Box Identifier

Enter the box number or letter used in Form 1094-C and Form 1095-C.

Monthly Value Assignments

Priority

Specify the order of processing within the monthly data type.

Assign Value

Enter the value, count, or amount according to the corresponding monthly data type.

Default

Select this check box to use the Assign Value as default.

As of Day in Month

If specified, this As of Day in Month overrides Common As of Day in Month for effective date extract of this monthly data value assignment.

The options available are First Day, Specified Day or Last Day.

SQLID Object

Enter the SQL that defines the data subject to data extraction.

Part III ALE Member Monthly Counts

ALE Member Monthly Data

Valid ALE Member Monthly Data options are:

• Full-Time Employee Count

• MEC Employee Offer Count

• Total Employee Count

Monthly Count Assignments

Priority

Specify the order of processing within the monthly data type.

Assign Value

Enter the value, count, or amount according to the corresponding monthly data type.

Default

Select this check box to use the Assign Value as default.

As of Day in Month

If specified, this As of Day in Month overrides Common As of Day in Month for effective date extract of this monthly data value assignment.

The options available are First Day, Specified Day or Last Day.

As of Day

This edit box appears only when you select Specified Day from the As of Day in Month drop-down menu.

SQLID Criteria

Enter the SQL that defines the data subject to data extraction.

SQLID Update

Enter the SQL that will provide update to monthly data extraction.

Part II Employee Monthly Codes

Employee Monthly Data

Monthly codes to report for the employee. Valid options are:

• Offer of Coverage Code

• Safe Harbor & Other Relief Codes

Part II Employee Monthly Amounts

Employee Monthly Data

Monthly amounts to report for the employee. Valid option is Self-Only Lowest Premium Cost.

Covered Individual Monthly Flags

Monthly Dependent Data

Valid option is Months of Coverage.

ACA Data Source

Assign a source ID to identify the source of data loaded using Excel-CI Load.