MLR Rebate - Form for Reporting Taxable Rebate

[rocknrolls2]

Assume company A is the group policyholder on Insurance Company L's medical insurance policy. Employee E participates in Company A's cafeteria plan, elects medical coverage under L's policy with A paying 60% of the total amount due and E paying 40% on a pre-tax basis. During 2014, L issues a medical loss ratio rebate to Company A in the amount of $10,000. If Company A elects to pay the rebate to those who were participating in the plan for the year the premiums giving rise to the premium were paid, even if they no longer participate in such plan or are no longer employed by A, on what tax form would A report the taxable rebate paid to E if s/he were a former employee during 2014? An active employee during 2014?