26 U.S.C. § 6055 — Reporting of health insurance coverage
submitted 16 years ago by Pub. L. 111-148 to r/title-26-INTERNAL-REVENUE-CODE · 803 words · no verdicts yet
People who provide minimum essential coverage must report identifying and coverage information. They must also give covered individuals statements, with an alternative request-based method and electronic delivery rules.
(a) In general. A person who provides "minimum essential coverage" to an individual during a calendar year must file a return at the time the Secretary* requires.
(b) Form and manner. (1) The return must use the Secretary’s form and include (A) the primary insured’s name, address, and TIN* and the name and TIN of every other covered person; (B) the dates each person had coverage during the year; (C) for health insurance coverage, whether it was a qualified health plan offered through an Exchange under section 1311 of the Patient Protection and Affordable Care Act and, for such a plan, any advance cost-sharing-reduction payment under section 1412 or section 1402, or premium tax credit under section 36B; and (D) other information the Secretary requires. If the filer cannot obtain an individual’s TIN, the Secretary may allow the full name and birth date instead. (2) Employer coverage. If the coverage is issuer health insurance through an employer group health plan, the return must also include (A) the maintaining employer’s name, address, and employer identification number; (B) any part of the premium the employer must pay; and (C), for a qualified small-group plan offered through an Exchange, information the Secretary requires to administer the section 45R credit.
(c) Statements. (1) The filer must give each person named in the return a written statement showing (A) the filer’s name and address and its information contact’s phone number and (B) the information reported about that individual. (2) It is due by January 31 of the following year. (3) Instead, the filer may give clear, conspicuous, accessible notice that a person may request the statement, and then must provide it by the later of January 31 or 30 days after the request. (3) An individual is treated as consenting to electronic delivery if the individual previously affirmatively consented to receive it electronically from the filer; that does not apply after written revocation.
(d) Government coverage. For coverage provided by a governmental unit or its agency or instrumentality, the officer or employee* who made the coverage agreement, or the properly designated person, must file the returns and statements. (e) "Minimum essential coverage" has the meaning given by section 5000A(f). This section does not define that term.
Every person who provides minimum essential coverage to an individual during a calendar year shall, at such time as the Secretary* may prescribe, make a return described in subsection (b).
A return is described in this subsection if such return—
is in such form as the Secretary may prescribe, and
contains—
the name, address and TIN* of the primary insured and the name and TIN of each other individual obtaining coverage under the policy,
the dates during which such individual was covered under minimum essential coverage during the calendar year,
in the case of minimum essential coverage which consists of health insurance coverage, information concerning—
whether or not the coverage is a qualified health plan offered through an Exchange established under section 1311 of the Patient Protection and Affordable Care Act, and
in the case of a qualified health plan, the amount (if any) of any advance payment under section 1412 of the Patient Protection and Affordable Care Act of any cost-sharing reduction under section 1402 of such Act or of any premium tax credit under section 36B with respect to such coverage, and
such other information as the Secretary may require.
For purposes of subparagraph (B)(i), in the case of any individual whose name is required to be set forth in a return under subsection (a), if the person required to make a return under such subsection is unable to collect information on the TINs of such individuals, the Secretary may allow the individual’s full name and date of birth to be substituted for the name and TIN.
If minimum essential coverage provided to an individual under subsection (a) consists of health insurance coverage of a health insurance issuer provided through a group health plan of an employer, a return described in this subsection shall include—
the name, address, and employer identification number of the employer maintaining the plan,
the portion of the premium (if any) required to be paid by the employer, and
if the health insurance coverage is a qualified health plan in the small group market offered through an Exchange, such other information as the Secretary may require for administration of the credit under section 45R (relating to credit for employee* health insurance expenses of small employers).
Every person required to make a return under subsection (a) shall furnish to each individual whose name is required to be set forth in such return a written statement showing—
the name and address of the person required to make such return and the phone number of the information contact for such person, and
the information required to be shown on the return with respect to such individual.
The written statement required under paragraph (1) shall be furnished on or before January 31 of the year following the calendar year for which the return under subsection (a) was required to be made.
For purposes of this subsection, any person required to make a return under subsection (a) shall be treated as timely furnishing the written statement required under paragraph (1) if—
such person provides clear, conspicuous, and accessible notice (at such time and in such manner as the Secretary may provide) that any individual to whom a statement would otherwise be required to be furnished under paragraph (1) may request a copy of such statement, and
such person, on request of any such individual, furnishes a copy of such statement to such individual not later than the later of—
January 31 of the year following the calendar year for which the return under subsection (a) was required to be made, or
30 days after the date of such request.
An individual shall be deemed to have consented to receive the statement under this subsection in electronic form if such individual has affirmatively consented at any prior time, to the person required to make such statement, to receive such statement in electronic form. The preceding sentence shall not apply if the individual revokes such consent in writing.
In the case of coverage provided by any governmental unit or any agency or instrumentality thereof, the officer or employee who enters into the agreement to provide such coverage (or the person appropriately designated for purposes of this section) shall make the returns and statements required by this section.
For purposes of this section, the term “minimum essential coverage” has the meaning given such term by section 5000A(f).
Source credit: (Added Pub. L. 111–148, title I, § 1502(a), Mar. 23, 2010, 124 Stat. 250; Pub. L. 118–167, § 2(a), Dec. 23, 2024, 138 Stat. 2584; Pub. L. 118–168, §§ 2(a), 3(b), Dec. 23, 2024, 138 Stat. 2586.)
- 2010Enacted · Pub. L. 111-148 · 124 Stat. 250
- 2024Amended · Pub. L. 118-167 · 138 Stat. 2584
- 2024Amended · Pub. L. 118-168 · 138 Stat. 2586
A history note hasn’t been published yet. The record shows enactment by Pub. L. 111-148 on 2010-03-23.
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