Largely in response to Congress reducing the federal ACA individual mandate penalty to $0 (effective since 2019), several states have passed their own individual mandates. Similar to the ACA's federal mandate reporting requirements, each state's individual mandate, as applicable, generally requires employers to submit employee coverage reports and distribute statements to covered employees. Meaning, employers with employees located in the states with an individual mandate may have to comply with state individual mandate reporting requirements in addition to complying with federal reporting requirements.
Whether an employer is subject to state individual mandate reporting requirements generally depends on the following: 1) The state(s) in which employees reside. 2) Whether the plan is self-insured or fully insured. 3) Whether an employer is an Applicable Large Employer (ALE) who is subject to the ACA employer mandate.
As to the first factor, if an employer has employee(s) who reside in any of the states listed in the below table, the employer is subject to the state's individual mandate reporting requirement(s). (Importantly, an employee's residence state triggers the reporting requirement regardless of the employee's work location.)
As to the remaining factors, generally, insurers complete and file the required forms with the respective states for fully insured plans (except the District of Columbia). However, fully insured employers should confirm with their medical insurers regarding their intent to fulfill the state reporting requirements for the employers.
Below is a high-level overview of the state individual mandate reporting filing deadlines and employers' (ERs) relative reporting responsibility under a fully insured or self-insured plan.
| State Filing Due Date | Responsible Reporting Entity | ||
| Fully insured ERs | Self-insured ERs | ||
| CA | 3/31/23 (No penalty if filed on or before 5/31/23) | No | Yes |
| DC | 4/30/23 | ALE: Yes, Non-ALEs: No | Yes |
| MA | 1/31/23 | No, if insurer submits forms on behalf of ER | Yes |
| NJ | 3/31/23 | No, if insurer submits forms on behalf of ER | Yes |
| RI | 3/31/23 | No, if insurer submits forms on behalf of ER | Yes |
| VT | N/A | N/A | N/A |
Regarding the type of required forms, except in Massachusetts and under certain circumstances in New Jersey, all the other above states require copies of ACA Form 1095. Massachusetts requires a different form called Form MA 1099-HC.
For more information regarding the Massachusetts individual mandate reporting requirement (aka 'Minimum Creditable Coverage'), NFP's State Individual Mandate Reporting Requirements publication outlines each state's reporting requirements and the links to each state's reporting site. For copies, contact your NFP benefits consultant.