Health Coverage Reporting


Beginning in 2020, California imposes a state individual mandate that requires individuals in California to maintain minimum essential coverage (MEC) or pay a penalty. The California law largely mirrors the federal individual mandate requirement under the Affordable Care Act (ACA) that was effectively eliminated, beginning in 2019.

To help administer the individual mandate, California law imposes a reporting requirement on every entity that provides MEC to an individual during a calendar year, similar to the ACA’s reporting requirement under Internal Revenue Code Section 6055.

Minimum Essential Coverage

For purposes of the California individual mandate, MEC generally has the same definition as under the ACA. MEC includes coverage under:

  • A government-sponsored program, such as coverage under the Medicare or Medicaid programs, the Children’s Health Insurance Program (CHIP), TRICARE and certain types of veterans’ health coverage;
  • An eligible employer-sponsored plan (including a self-funded plan, COBRA and retiree coverage), defined as any plan offered by an employer to an employee which is a governmental plan or a plan or coverage offered in the small or large group market within a state;
  • A health plan purchased in the individual market; or
  • A grandfathered health plan.

The University of California Student Health Insurance Plan and the University of California Voluntary Dependent Plan also constitute MEC for this purpose.

Reporting Requirement

To help administer the individual mandate, California law imposes a reporting requirement on every entity that provides MEC to an individual during a calendar year, similar to the ACA’s reporting requirement under Internal Revenue Code Section 6055. This reporting requirement applies to:

Employers or other sponsors of employment-based health plans, for employment-based MEC;

  • The State Department of Health Care Services and county welfare departments, for MEC under a state program;
  • Carriers licensed or otherwise authorized to offer health coverage, for MEC they provide that is not described above (including catastrophic plan coverage);
  • The Exchange, for individual health plans (except catastrophic plans) on the Exchange; and
  • Any other provider of MEC (including the University of California, for coverage under a student health insurance program).

Under this reporting requirement, entities that provide MEC will be required to provide the following information to covered individuals and the California Franchise Tax Board (FTB):

  • The name, address and Social Security number (SSN) or taxpayer identification number (TIN) of the primary insured, and the name and SSN or TIN of each other individual covered under the policy;
  • The dates during which those individuals were covered under MEC during the calendar year; and
  • Any other information the FTB may require.

The law specifically provides that the California reporting requirement may be satisfied by providing the same information that is currently reported under the federal Section 6055 reporting requirement, using the same federal forms (that is, Forms 1094-B and 1095-B, or 1094-C and 1095-C, as appropriate).

For this purpose, forms must be provided to the employee and any individual receiving MEC through an employer by Jan. 31 of the year following the calendar year to which the return relates. Forms must also be filed with the FTB by March 31 of the year following the calendar year to which the return relates. However, the California instructions for these forms provide that no penalty will be imposed under this requirement for forms filed with the FTB on or before May 31.

Penalties may apply for failure to report, up to $50 per individual who was provided health coverage.