Types of Insurance Programs
⦁ Fully Insured
⦁ A company buys insurance from another company (an insurance carrier or captive)
⦁ The employer must provide a 1095-C with Part 1 and 2 data
⦁ The provider must provide a 1095-B or Part 3 of the 1095-C
⦁ Self-Insured
⦁ A company funds its own insurance and offers it directly to its own employees
⦁ The employer must provide a 1095-C with Parts 1, 2, and 3 data
⦁ The employer must be able to produce a complete list of employee enrollment data for each month of the calendar year
⦁ Captives
⦁ A small insurance company that is privately owned by one or more companies
⦁ The captive itself is usually self-insured and will have a TPA (Third Party Administrator)
⦁ The captive is the provider, not the employer and will provide a 1095-B with coverage info
⦁ Union Welfare Funds
⦁ A company has a contractual arrangement with a union which includes the union providing and managing their own insurance fund which pays claims and may determine eligibility
⦁ The employer will provide a 1095-C with Part 1 and 2 data
⦁ The welfare fund will provide a 1095-B with coverage info (Part 3)
⦁ Individual Plans
⦁ The company does not provide insurance to the employee and the employee purchases their own personal plan
⦁ The insurance provider will provide the individual a 1095-B
⦁ If this is a health marketplace exchange plan, they will also provide the individual with a 1095-A