2021 Guidance for Health Coverage Providers Under the Health Insurance Market Preservation Act
The New Jersey Health Insurance Market Preservation Act (Market Preservation Act) requires third-party reporting to verify health coverage information supplied by individual payers of New Jersey’s Income Tax.
Employers, insurers and other coverage providers, please note that for the 2020 tax year, you must:
- By March 31, 2021, transmit 1095 health coverage forms to the New Jersey Division of Taxation. By March 2, 2021, provide a 1095 form for each primary enrollee who was a New Jersey resident and to whom the filer provided minimum essential coverage in all or part of 2020. This applies to both part-year and full-year New Jersey residents. A part-year resident is a primary enrollee who was domiciled in New Jersey for at least 15 days in any month.
- Ensure that New Jersey receives the appropriate NJ-1095, 1095-B or 1095-C forms. The State currently expects to accept NJ-1095 forms, fully completed federal 1095-B and 1095-C forms, and/or 1095-C forms with parts I and III completed.
New Jersey’s 1095-C Requirements Differ From Federal Requirements
1095-C forms with only Parts I and II completed will not meet any New Jersey filing requirements. You should transmit these forms only if you cannot separate them from a file that includes other required forms that do meet filing requirements.
- Use the right schema and forms. New Jersey will accept the 1095 forms that the IRS will require for the 2020 Tax Year. 1095-B and 1095-C . ) New Jersey also will accept the NJ-1095 form. New Jersey expects to post a link to the NJ-1095 form for 2020 in advance of the filing deadline.
- Ensure that each primary enrollee who was a New Jersey resident or part-year New Jersey resident in 2020 receives at least one 1095 form that includes health coverage information. You do not have to send separate 1095 forms to spouses, dependents, or adult children of primary enrollees.
- Meet the March 2, 2021, deadline for sending 1095s to primary enrollees. No further deadline extension is expected.
If you have any questions, contact us.
New Jersey 1095-B Requirements Differ From Federal Requirements:
New Jersey does not follow all IRS practices on 1095-B distribution. The IRS allows some coverage providers to notify primary enrollees that a 1095-B form is available if they request it. In contrast, New Jersey requires that a 1095 form be sent to each primary enrollee.
The requirement to file is not limited to businesses that withhold New Jersey payroll taxes. If you are an out-of-State employer who provides health coverage, transmit to us any required 1095 document for each New Jersey resident you employ. Insurers, government agencies, exchanges, multiemployer plans, and all others responsible for reporting Minimum Essential Coverage on behalf of New Jersey residents also must file the required information with the State.
Out-of-state employers and other coverage providers have the same filing requirements as in-state businesses and insurance companies.
Guidance on What Forms Are Required From Whom
New Jersey does not require coverage providers to transmit 1094 forms, though we will accept them if a coverage provider sends them as part of a larger file that includes 1095 forms.
New Jersey will accept the NJ-1095 form from any filer. The State also will accept filings of federal 1095-C forms, Employer-Provided Health Insurance Offer and Coverage, if Parts I and III are completed or the form is fully completed. Filers of fully completed Form 1095-B. Health Coverage, also can use that form for New Jersey filings.
Insurers Must File for Coverage Obtained on New Jersey’s State Health Insurance Exchange
Insurers who provide coverage through policies sold on the New Jersey’s GetCoveredNJ exchange or any other exchange must provide a 1095-B or NJ-1095 to the New Jersey Division of Taxation for any primary enrollee who purchases coverage. A 1095 form also must be sent to each primary enrollee.
Guidance on Forms Sent to New Jersey:
Coverage providers and employers who file more than 100 1095 forms can send files containing data pertaining only to part-year and full-year residents of New Jersey. However, the Division of Taxation also will accept files that include data about individuals who are not residents of New Jersey. Filers who provide information on non-residents of New Jersey should consult privacy and other laws pertaining to residents of other States before sending any sensitive or personal data about non-residents to New Jersey.
Larger files can send these forms in the XML format sent to the IRS, as long as the files are fully completed 1095-B or 1095-C forms. They can also be sent using the pipe delimited flat text format. State of New Jersey requirements are not met by 1095-C forms with only Parts I and II completed. Do not send 1095-C forms with only Parts I and II completed unless they are part of a larger file that includes files that do meet New Jersey requirements.
Requirements for filings vary depending on whether an employer is fully insured, self-insured, or a participant in a multiemployer plan. The size of a company also affects reporting requirements, as detailed below:
- Single-Company, Applicable Large Employers (ALEs). ALEs generally are companies that employed an average of at least 50 full-time-equivalent employees on business days during the preceding calendar year. Health coverage provider (the insurer) files 1095 for each covered member of the plan. If an insurer will not meet its obligation, an employer is required to send the files itself. A fully completed federal 1095-B or an NJ-1095 meets New Jersey requirements.
- Single-Company, Not an Applicable Large Employer (Non-ALE). Non-ALEs generally are companies that employed an average of fewer than 50 full-time equivalent employees on business days during the preceding calendar year. Health coverage provider (the insurer) files a 1095-B or NJ-1095 for each covered member of the plan. If the insurer does not meet its obligation to file, the employer must send 1095 forms.
Fully Insured Employer Participating in a Multiemployer Plan. A plan sponsor (generally a board of trustees) files 1095-B or NJ-1095 forms for enrolled individuals. If the plan sponsor does not meet its obligation to file, the employer must send 1095 forms.
Fully insured employers should:
- Contact their insurer or multi-employer plan to discuss New Jersey’s 1095 filing requirements well in advance of filing deadlines.
- Confirm that their insurer or multi-employer plan will file the required forms and meet the applicable deadlines.
- Understand that an employer must file if its insurer or multi-employer plan does not file the required 1095 forms on time
- Single-Company, Applicable Large Employers (ALEs). ALEs generally are companies that employed an average of at least 50 or more full-time equivalent employees on business days during the preceding calendar year: Employer files a fully completed 1095-C, 1095-B or NJ-1095 form for each person who was a full-time employee for at least one month of the calendar year and for any employee who was enrolled in the self-insured plan. ALE members that offer employer-sponsored, self-insured health coverage to non-employees may use Form 1095-B or NJ-1095 for these non-employees, or ALEs may file a 1095-C using Code 1G in Part II, to report for non-employees. For this purpose, a non-employee includes a non-employee director, an individual who was a retired employee during the entire year, or a non-employee COBRA beneficiary. This also applies to a former employee who terminated employment during a previous year.
- Single Company, Not an Applicable Large Employer (Non-ALE). Non-ALEs generally are companies that employed an average of fewer than 50 full-time equivalent employees on business days during the preceding calendar year. Self-insured employer files a 1095-B or NJ-1095 for each covered employee.
- Self-Insured Employer Participating in a Multiemployer Plan. A plan sponsor (generally a board of trustees) files a 1095-B or NJ-1095 for each covered employee. If the plan sponsor neglects to meet its obligation, the employer must file the forms itself.
Self-Insured Employers Participating in Multi-Employer Plans Should:
- Contact their multi-employer plan to discuss New Jersey’s 1095 filing requirements in advance of filing deadlines
- Confirm that the multi-employer plan will file the required forms and meet the applicable deadlines.
- Understand that an employer will share liability if its multi-employer plan does not file the required 1095 forms on time. Employers must send 1095 forms to New Jersey if insurers do not meet their requirements.
Under New Jersey’s Health Insurance Market Preservation Act , insurers, employers, government agencies, multiemployer plans, and other entities that provide health insurance must submit required information returns to New Jersey reporting on individuals’ health insurance coverage.
There is no paper filing option available.
Insurers or Employers can file 1095 forms in two ways:
- Registered filers can use the Division of Revenue and Enterprise Services' (DORES) MFT SecureTransport (Axway) service. MFT (Axway) is the required system for filers of 50 or more forms. Taxpayers who have MFT SecureTransport (Axway) service user credentials use them to submit the required health insurance coverage returns. If you do not have a MFT SecureTransport (Axway) service account, or need technical specifications and guidance, contact DORES. Once DORES receives your request and authorizes your account, you can expect to receive instructions on how to submit your health insurance coverage returns. If you already have a MFT SecureTransport (Axway) service account, you can use the same account to transmit the 1095 files provided the filename starts with NJHIM. New Jersey will accept returns submitted in bulk filing by users of MFT (Axway). A company responsible for submitting files for multiple companies can establish a single MFT SecureTransport (Axway) Account and submit a single file containing the information for the various companies in an XML format or in a pipe delimited flat text format that is currently under development. Files must be under 12 MB (12,000 KB) in size and may be split into multiple files. If you intend to refile the same file when corrections are needed, you must still remain under the 12 MB limit. We will not accept files in a zipped file format. You will receive a submission receipt upon successful transmission which will serve as the acknowledgement. This receipt will be sent to the email associated with the MFT SecureTransport (Axway) Account.
- As an alternative to MFT SecureTransport (Axway), coverage providers with under 50 forms must file using Form NJ-1095. The NJ-1095 is a valid substitution for forms 1095-B and 1095-C. Filing instructions and the NJ-1095 for all years are available.
If you are required to submit a correction file to the IRS, New Jersey will also require you to submit the correction file. Size limits for MFT (Axway) filings are at 12 MB for both initial filings and corrections.
XML Schemas and other information for transmitters are provided for tax year 2020. Please see the Generic XML Templates: Form 1095B and Form 1095C to view samples of the minimum information that New Jersey needs to successfully process a 1094B/1095B or 1094C/1095C file submission, with our required XML formatting. In particular, the XML opening tags and closing tags must be formatted precisely as in our samples. Your file may include additional fields, as long as our required fields are included with the required formatting. The sample has several scenarios, including annual and monthly coverage, employees/responsible individuals with and without dependents, and a dependent without a Social Security Number. Note that New Jersey is seeking a record of all Covered Individuals; if you have no Covered Individuals to report, you do not need to submit a 1094/1095. If you send your data in xml format, you must submit the file as a xml file (and not as a .txt file).
New Jersey will also accept with a pipe delimited flat text format through Axway. You must follow the pipe delimited flat text format schema or your submission will be rejected. If you send your data following this text format, you must submit the file as a .txt file.