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). Most data will populate accurately; however, there are some records that may require manual edits.

❏ 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 the month for which you want to extract data. In this example, we will use 09.

❏ In the Offer of Coverage field, indicate the offer of coverage for which you want to extract. In this example, we will use 1E (offer to Employee, Spouse and Dependents).

❏ In the Safe Harbor field, indicate the safe harbor code for for which you want to extract. In this example, we will use 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 and TRS ActiveCare Primary had the lowest premium for employee only coverage, the amount will be $161 for Jan – Aug and $192 for Sept – Dec. ($386-$225=$161 and $417-$225-$192.)

The below example provides a possible scenario of changes for this employee:

Offer of Coverage:

• 1H (No offer) for January through August assuming that the employee started at the LEA in late August.
• 1E (Offer to Employee, Spouse and Children) for September – December. This was extracted so no changes were made.

Employee Share:

• The Employee Share would be 0.00 for January – August since no coverage was offered as the employee started late August.
• $161.00 extracted for September – December, assuming the LEA's contribution was $225.00 and should not require a change.

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 with the assumption that the employee started late in August and did not enroll in coverage until September.
• 2C (Employee enrolled in coverage offered) for September – December

Covered Individuals:

• Selected Self-Insured as the LEA provided coverage.
• In the Plan Start Month, type 09 as the coverage started in September.
• Selected the Employee check box.
• Selected the September – December check boxes as those are the only months of coverage.