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Form 1094-B Texas: What You Should Know

The self-insured status of an individual is determined based on the individual's AGI or adjusted gross income (AGI). The AGI is an annual figure derived by adding one's adjusted gross income to the number of dependents claimed on an individual's tax return. The AGI is the amount of an individual's income that a person must make or add up to in order to remain under the federal poverty guidelines. If your income is below the Federal Poverty Level, then for each person listed on your business tax return, there is a person who is considered either (a) someone who is self-insured or (b) someone who is dependent on family members in the case of an individual with no dependents and who does not have enough AGI, other than Social Security, to be considered tax-dependent. If someone is self-insured, then all their claims must be submitted through the plan. Any uncollected claims are reported on Form 1095-B. Any premiums and cost sharing must be listed in the appropriate box. For all self-insured plans, a Form 1095-B is also required to report premium and cost sharing information (if not already stated on Forms 1094-B and 1095-B (Parts IV and IV)). The self-insured status is reported in the same manner as for a fully protected individual. The only difference is that all claims are reported on a single 1094-P filed. This 1094-P will be used to report all self-insured and coverage information. Self-insured coverage claims are reported on a separate 1094-B or 1095-B file using the name of the insured health plan. The coverage will be listed in the same manner as for a fully insured individual — Form 1095-B or 1139-P. For a fully insured individual, the filing status must be Self-Employed or Self-Employed Individual. For a fully insured individual, a Form 1095-B to report and pay premiums and cost sharing must also be filed. If an individual is not self-employed or is self-employed through an AGI dependent group, then a Form 1095-B for coverage will be submitted. Form 1095-B (Part I) (for an individual insured through the plan) Form 1095-B (Part II) Each form 1095-B for a plan is due by February 15, 2012. The IRS will send you a reminder by February 15, 2012.

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