Health Coverage Reporting

Effective in 2019, the District of Columbia (D.C.) Individual Taxpayer Health Insurance Responsibility Requirement requires individuals residing in D.C. to maintain minimum essential coverage (MEC) or pay a penalty. To help administer the individual mandate, D.C. imposes a reporting requirement on every entity that provides MEC to an individual during a calendar year, similar to the ACA’s reporting requirements under Internal Revenue Code Sections 6055 and 6056.

Overview

D.C.’s individual mandate requires most individuals residing in D.C. to maintain MEC for each month of the year. Individuals who do not obtain acceptable health insurance coverage and do not qualify for an exemption will be penalized. The D.C. individual mandate largely mirrors the federal individual mandate requirement under the Affordable Care Act (ACA). The ACA’s individual mandate penalty was reduced to zero as of 2019, effectively eliminating the federal penalty.

Minimum Essential Coverage

For purposes of the D.C. individual mandate, MEC 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;
  • A grandfathered health plan;
  • The D.C. Immigrant Children’s Program;
  • A multiple employer welfare arrangement (MEWA), if the MEWA provided coverage in D.C. on Dec. 15, 2017, or complies with federal law applicable to MEWAs that were in place as of Dec. 15, 2017.

MEC does not include coverage that consists solely of excepted benefits, such as stand-alone vision or dental plans, long-term care insurance, supplemental or specified-disease coverage, and accident or disability insurance.

Reporting Requirement

To help administer the individual mandate penalty, D.C. imposes a reporting requirement on every entity that provides MEC to an individual during a calendar year, similar to the ACA’s reporting requirements under Internal Revenue Code Sections 6055 and 6056. For tax years beginning after 2019, the deadline for filing with OTR is 30 days after the IRS deadline for submitting Forms 1095-B or 1095-C, including any extensions granted by the IRS. The deadline for furnishing to individuals generally follows the same deadlines as the federal reporting requirements.

The D.C. reporting requirement applies to:

  • All employers who sponsor self-insured group health plans that covered at least one employee who was a D.C. resident during the applicable calendar year;
  • Employers or other sponsors of fully-insured employment-based health plans that covered at least 50 full-time employees, including at least one D.C. resident, during the applicable calendar year;
  • Persons or entities, including governmental agencies, that provided MEC to a D.C. resident during the applicable calendar year;
  • The D.C. Department of Health Care Finance; and
  • Insurance carriers licensed or otherwise authorized to offer MEC in D.C. during the applicable calendar year.

To satisfy this reporting requirement, reporting entities are required to electronically file the federal Forms 1094-C and 1095-C, or 1094-B and 1095-B, as applicable, through www.MyTax.DC.gov, using the OTR’s prescribed layouts and file formats. OTR published Notice 2019-04 to provide more information on this reporting requirement.

For all returns, the amount of any penalty for failure to file is a formula based on “the amount of tax required to be shown on the return.” Since “no amount of tax is required to shown” on the informational returns, no penalty is imposed for failure to file the informational returns. Similarly, no penalty applies for failure to furnish statements to individuals under the D.C. health coverage reporting requirement.