New IRS guidance on health care employer mandate looks to 2014 start date

Under the new health care law, starting in 2014, “large” employers with more than 50 full-time employees will be subject to stiff monetary penalties if they do not provide affordable and minimum essential health coverage. With less than eleven months before this “play or pay” provision is fully effective, the IRS continues to release critical details on what constitutes an “applicable large employer,” “full-time employee,” “affordable coverage,” and “minimum health coverage.”  Most recently, the IRS issued proposed reliance regulations that provide employers with the most comprehensive explanation of their obligations and options to date.


Under the Patient Protection and Affordable Care Act (PPACA) the federal government has made it possible for certain workers who do not otherwise have access to affordable health insurance coverage to obtain a tax credit that would help them pay the costs of their health care premiums. This credit applies to low-income workers whether employed by a small, mid-size or large employer or self-employed.  Under Code Sec. 4980H as added by the PPACA, however, an “applicable large employer” is subject to a shared responsibility payment (an assessable payment) after December 31, 2013 if any of its full-time employees are certified to receive an applicable premium tax credit or cost-sharing reduction and either:

  • The employer does not offer to its full-time employees and their dependents the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan (Code Sec. 4980H(a)); or
  • The employer offers its full-time employees and their dependents the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan that with respect to a full-time employee who has been certified for the advance payment of an applicable premium tax credit or cost-sharing reduction either is unaffordable relative to an employee’s household income or does not provide minimum value (Code Sec. 4980H(b)).

The Code Sec. 4980H(b) penalty applies to coverage that is “unaffordable,” meaning that the coverage costs more than 9.5 percent of the employee’s household income. Since employers may not be able to determine household income, the proposed regs provide three affordability safe harbors: the Form W-2 safe harbor (based on employee wages); the rate of pay safe harbor (based on hourly or monthly pay rates); and the federal poverty line safe harbor, the IRS explained.

The employer cannot be liable under both Code Secs. 4980H(a) and 4980H(b). Furthermore, the penalty cannot exceed the payment amount that would have been imposed under Code Sec. 4980H(a) if the employee had failed to offer coverage to its full-time employees.

Proposed reliance regs

The proposed reliance regs further clarify what employees are considered “full-time employees” for the purpose of the statute. This distinction is important because the number of full-time employees determines who is an applicable large employer, subject to the affordable coverage requirements and, potentially, the per-employee shared responsibility payment. The proposed reliance regs provide additional guidance on who is a full-time employee, and covers gray areas such as the treatment of seasonal employees.

Other guidance under the regs covers whether employers who have only become applicable large employers in the current year are exempt from the shared responsibility payment. (Generally, they are not.) The proposed reliance regulations also provide certain relief to employers who inadvertently miss some employees.

Finally, the proposed reliance regs provide several transition rules. A major rule allows employers with plans on a fiscal year to wait to apply the standards until the first day of the first plan year that begins in 2014. Another rule exempts employers from penalties in 2014 if they must add dependent coverage to their health plans. Other transition rules apply to health plans offered through cafeteria plans and multiemployer plans. In addition, there are many notification responsibilities that will be placed upon the shoulders of all employers regarding access by their employees to health insurance.

If you have questions about the health care requirements for employers, the shared responsibility payment under Code Sec. 4980H, or anything related to the tax provisions of the new health care law, please contact our offices.

If and only to the extent that this publication contains contributions from tax professionals who are subject to the rules of professional conduct set forth in Circular 230, as promulgated by the United States Department of the Treasury, the publisher, on behalf of those contributors, hereby states that any U.S. federal tax advice that is contained in such contributions was not intended or written to be used by any taxpayer for the purpose of avoiding penalties that may be imposed on the taxpayer by the Internal Revenue Service, and it cannot be used by any taxpayer for such purpose.

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