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Use the Personnel > Utilities > Extract Insurance Data to 1095 Data page to extract insurance data from the Personnel > Maintenance > Staff Demo > Insurance tab to the Personnel > Maintenance > ACA 1095 YTD Data maintenance page(s).

❏ Under Extract Option, select one of the following options:

• Insert new records from Staff Demo Insurance Records. - This option only inserts new information entered on the Staff Demo page since the last time 1095 data was extracted.
• Delete all existing records and insert all records from Staff Demo Insurance Records. - This option clears previously extracted 1095 data for the calendar year indicated and replaces it with the current data available in the Staff Demo insurance records.

❏ Under Plan Options, select Self-Insured Plans.

❏ Under Record Type, select ACA 1095-C.

❏ In the Calendar Year (YYYY) field, type the calendar year for which you want to extract data.

❏ In the Plan Start Month, type 09.

❏ In the Offer of Coverage field, select 1E (offer to Employee, Spouse and Dependents).

❏ In the Safe Harbor field, select 2C (Employee enrolled in coverage offered).

❏ Under Employees with Calendar YTD Data Who Do Not Have Staff Demo Insurance Records, select one of the following options:

• Pay Type 1-3 Employees (excludes subs)
• Pay Type 1-4 Employees

❏ Under Employee Share of Lowest Cost Monthly Premium, in the All field, type the set share of the lowest-cost monthly premium amount for employees in each pay type (1-4). This is the lowest premium the employee could have paid to obtain coverage.

For example, if your LEA pays $225 toward insurance for all employees, the amount will be $153 for Jan – Aug 2021 and $161 for Sept – Dec. ($378-$225=$153 and $386-$225-$161.)

Screenshot

In the example above, it was necessary to change the following:

Offer of Coverage:

• 1H (No offer) for January through August because Woody didn’t come to work for the district until late August
• 1E (Offer to Employee, Spouse and Children) for September – December. This was extracted so we didn’t have to change these months.

Employee Share:

• The Employee Share would be 0.00 for January – August since no coverage was offered
• $161.00 extracted for September – December, assuming the district’s contribution was $225.00 and shouldn’t need to be changed

Safe Harbor:

• 2A (Employee was not employed on any day of the month) for January – July,
• 2B (Employee was not a full-time employee and not enrolled in coverage for August because I assumed Woody started late in August and didn’t enroll until September
• 2C (Employee enrolled in coverage offered) for September – December

Selected Employee row.

Selected the September – December check boxes as those are the only months of coverage.