Benefit Notices and ACA Reporting: What to Send and When

Offering health coverage brings a steady stream of paperwork. Some notices go out when someone is hired, some go out every year, some only when something changes, and tax reporting runs on its own calendar. None of it is hard on its own. The trouble comes when nobody owns the calendar.

This guide groups the main federal notices and reports by when they're due, using the U.S. Department of Labor's Reporting and Disclosure Guide (December 2022 edition), CMS and IRS instructions. It's a general overview, not a complete list. Your insurer, payroll provider or administrator may handle some items for you, so confirm in writing who sends what.

This is general information, not legal, tax or insurance advice. For questions about your plan, contact the DOL's Employee Benefits Security Administration (EBSA) at 1-866-444-3272, a benefits attorney, or a CPA or enrolled agent for tax reporting.

At hiring and enrollment

• Marketplace coverage options notice. Employers covered by the Fair Labor Standards Act (FLSA) must give every new employee a written notice about the Health Insurance Marketplace. That includes part-timers and people not eligible for the plan. DOL Technical Release 2013-02 explains that the FLSA covers most firms with at least $500,000 in annual dollar volume of business, plus certain other employers such as hospitals and schools. The DOL posts model notices, updated in February 2024, for employers that offer a plan and for those that don't.
• HIPAA special enrollment notice. The DOL guide says employees eligible for the group health plan must get this notice at or before the time they are first offered the chance to enroll. It explains their right to enroll within 30 days after losing other coverage, marriage, birth, adoption or placement for adoption.
• Summary of Benefits and Coverage (SBC) and Uniform Glossary. The SBC is a standard template that summarizes the plan's benefits and costs. According to the DOL guide, it is provided with enrollment materials and at renewal. Special enrollees get it by the date the SPD is due, and anyone who asks gets it within 7 days.
• COBRA general notice and the SPD. These are due within 90 days of coverage. See our guides to COBRA and to ERISA plan documents and SPDs for details.

Every year

The DOL guide lists several notices that repeat every year:

• CHIP premium assistance notice. Employers must tell all employees, whether or not they are enrolled or eligible, about possible premium assistance available in their state. The DOL guide lists it as annual and provides a model notice.
• Women's Health and Cancer Rights Act notice. This describes required coverage for mastectomy-related reconstruction, prostheses and complications. It goes out at enrollment and annually.
• Medicare Part D creditable coverage notice. If your plan includes prescription drug coverage, CMS requires a written notice, before October 15 each year, to Medicare-eligible people covered by the plan. The notice tells them whether your drug coverage is "creditable," meaning it is expected to pay on average as much as standard Medicare drug coverage. CMS also requires an online disclosure to CMS within 60 days after the start of each plan year.

The Part D notice matters to employees. CMS explains that people who go 63 days or longer without creditable drug coverage after their initial enrollment period can face a late enrollment penalty. Employees with Medicare questions can get free one-on-one help from their State Health Insurance Assistance Program (SHIP) or at Medicare.gov.

When something changes

• Mid-year SBC changes. If a material change would affect the SBC's content and isn't part of a renewal, the DOL guide says participants must be notified within 60 days before the change takes effect.
• Plan amendments and reductions. A summary of material modifications is generally due within 210 days after the end of the plan year in which the change is adopted. A material reduction in group health benefits generally requires notice within 60 days.
• Wellness programs. If the plan offers a health-contingent wellness program with a reward, any plan materials that describe it must say that a reasonable alternative standard is available, or that the standard may be waived.

Tax-year reporting for applicable large employers

If you're an applicable large employer, generally one with at least 50 full-time employees including equivalents, you file Form 1094-C and a Form 1095-C for each employee who was full-time in any month. The IRS Instructions for Forms 1094-C and 1095-C (2025) set these calendar year 2025 dates:

• File with the IRS by March 2, 2026, on paper, or by March 31, 2026, if filing electronically.
• The deadline for furnishing Form 1095-C to employees is automatically extended from January 31, 2026, to March 2, 2026.
• You must file electronically if you file 10 or more information returns during the year, counting certain other information returns too, unless you get a waiver.

The same instructions describe a new alternative way to furnish statements in some situations, by posting a clear website notice and providing the form on request. The conditions are specific, so read that section carefully or ask your tax professional before relying on it. If your coverage is insured, the instructions say the insurer furnishes coverage information to enrolled employees. In that case, you don't complete Part III of Form 1095-C for those employees.

Reporting for smaller employers

If you're not an ALE, you generally have no Form 1095-C. The IRS explains that self-insured employers, like insurers, are providers of minimum essential coverage and report it on Forms 1094-B and 1095-B. If your plan is insured, the insurer usually handles that.

You may also see Box 12, code DD, on Form W-2, which shows the cost of employer-sponsored health coverage. The IRS says this reporting "does not mean that the coverage is taxable." Under IRS transition relief, it is optional for employers that filed fewer than 250 Forms W-2 for the preceding calendar year.

Protect the data while you're at it

Benefit and tax forms carry Social Security numbers, so they attract criminals. The IRS warns that criminals "target businesses and payroll companies by email to steal Form W-2 data." Verify any emailed request for employee tax or benefit records by phone, using a number you already know, before sending anything.

Key takeaways

• Give FLSA-covered new hires the Marketplace notice, and give plan-eligible employees the HIPAA special enrollment notice, the SBC and the SPD on time.
• Every year, send the CHIP and Women's Health and Cancer Rights Act notices. If you offer drug coverage, send the Medicare Part D notice before October 15, as CMS requires.
• For calendar year 2025, ALEs had until March 2, 2026, to furnish Forms 1095-C and to file paper returns, and until March 31, 2026, to file electronically, per the IRS instructions.
• Put every notice on one calendar with a named owner, whether that's you, your insurer, your payroll provider or your administrator.

Sources

• U.S. Department of Labor, EBSA, Reporting and Disclosure Guide for Employee Benefit Plans (December 2022)
• U.S. Department of Labor, EBSA, Technical Release 2013-02 (notice of coverage options)
• U.S. Department of Labor, Notice to Employees of Coverage Options
• Centers for Medicare & Medicaid Services, Creditable Coverage
• Internal Revenue Service, Instructions for Forms 1094-C and 1095-C (2025)
• Internal Revenue Service, Information reporting by providers of minimum essential coverage
• Internal Revenue Service, Form W-2 reporting of employer-sponsored health coverage
• Internal Revenue Service, Recognize tax scams and fraud