26 USC 4980H - Shared responsibility for employers regarding health coverage

U.S Code last checked for updates: Nov 26, 2024

§ 4980H.

Shared responsibility for employers regarding health coverage

(a)

Large employers not offering health coverage

If—

(1)

any applicable large employer fails to offer to its full-time employees (and their dependents) the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) for any month, and

(2)

at least one full-time employee of the applicable large employer has been certified to the employer under section 1411 of the Patient Protection and Affordable Care Act as having enrolled for such month in a qualified health plan with respect to which an applicable premium tax credit or cost-sharing reduction is allowed or paid with respect to the employee,

then there is hereby imposed on the employer an assessable payment equal to the product of the applicable payment amount and the number of individuals employed by the employer as full-time employees during such month.

(b)

Large employers offering coverage with employees who qualify for premium tax credits or cost-sharing reductions

(1)

In general

If—

(A)

an applicable large employer offers to its full-time employees (and their dependents) the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) for any month, and

(B)

1 or more full-time employees of the applicable large employer has been certified to the employer under section 1411 of the Patient Protection and Affordable Care Act as having enrolled for such month in a qualified health plan with respect to which an applicable premium tax credit or cost-sharing reduction is allowed or paid with respect to the employee,

then there is hereby imposed on the employer an assessable payment equal to the product of the number of full-time employees of the applicable large employer described in subparagraph (B) for such month and an amount equal to ¹⁄₁₂ of $3,000.

(2)

Overall limitation

(c)

Definitions and special rules

For purposes of this section—

(1)

Applicable payment amount

(2)

Applicable large employer

(A)

In general

(B)

Exemption for certain employers

(i)

In general

An employer shall not be considered to employ more than 50 full-time employees if—

(I)

the employer’s workforce exceeds 50 full-time employees for 120 days or fewer during the calendar year, and

(II)

the employees in excess of 50 employed during such 120-day period were seasonal workers.

(ii)

Definition of seasonal workers

(C)

Rules for determining employer size

For purposes of this paragraph—

(i)

Application of aggregation rule for employers

(ii)

Employers not in existence in preceding year

(iii)

Predecessors

(D)

Application of employer size to assessable penalties

(i)

In general

The number of individuals employed by an applicable large employer as full-time employees during any month shall be reduced by 30 solely for purposes of calculating—

(I)

the assessable payment under subsection (a), or

(II)

the overall limitation under subsection (b)(2).

(ii)

Aggregation

(E)

Full-time equivalents treated as full-time employees

(F)

Exemption for health coverage under TRICARE or the Department of Veterans Affairs

Solely for purposes of determining whether an employer is an applicable large employer under this paragraph for any month, an individual shall not be taken into account as an employee for such month if such individual has medical coverage for such month under—

(i)

chapter 55 of title 10, United States Code, including coverage under the TRICARE program, or

(ii)

under a health care program under chapter 17 or 18 of title 38, United States Code, as determined by the Secretary of Veterans Affairs, in coordination with the Secretary of Health and Human Services and the Secretary.

(3)

Applicable premium tax credit and cost-sharing reduction

The term “applicable premium tax credit and cost-sharing reduction” means—

(A)

any premium tax credit allowed under section 36B,

(B)

any cost-sharing reduction under section 1402 of the Patient Protection and Affordable Care Act, and

(C)

any advance payment of such credit or reduction under section 1412 of such Act.

(4)

Full-time employee

(A)

In general

(B)

Hours of service

(5)

Inflation adjustment

(A)

In general

In the case of any calendar year after 2014, each of the dollar amounts in subsection (b) and paragraph (1) shall be increased by an amount equal to the product of—

(i)

such dollar amount, and

(ii)

the premium adjustment percentage (as defined in section 1302(c)(4) of the Patient Protection and Affordable Care Act) for the calendar year.

(B)

Rounding

(6)

Other definitions

(7)

Tax nondeductible

(d)

Administration and procedure

(1)

In general

(2)

Time for payment

(3)

Coordination with credits, etc.

(Added and amended Pub. L. 111–148, title I, § 1513(a), title X, §§ 10106(e)–(f)(2), 10108(i)(1)(A), Mar. 23, 2010, 124 Stat. 253, 910, 914; Pub. L. 111–152, title I, § 1003, Mar. 30, 2010, 124 Stat. 1033; Pub. L. 112–10, div. B, title VIII, § 1858(b)(4), Apr. 15, 2011, 125 Stat. 169; Pub. L. 114–41, title IV, § 4007(a)(1), July 31, 2015, 129 Stat. 465; Pub. L. 115–141, div. U, title IV, § 401(a)(2)(B), Mar. 23, 2018, 132 Stat. 1184.)

cite as: 26 USC 4980H