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… when the cost for self-only coverage does not exceed the percentage set by the Internal Revenue Service. This percentage is updated annually. In 2023, the percentage will be 9.12% of household income. Coverage is also considered “affordable” for purposes of satisfying §4980H(b) requirements so long as the employee contribution satisfies at least one of three available safe harbors: federal poverty level (FPL), rate of pay, or Form W-2. ALEs should review affordability annually to determine the potential risk for penalties due to offering unaffordable coverage. Preventive Services Under the ACA, non-grandfathered health plans must provide …

Quick Facts Applicable large employer (ALE) status is determined year-by-year on a calendar year basis. All ALEs are subject to §4980H offer of coverage requirements and §6056 employer reporting requirements on Form 1094-C and Form 1095-Cs. ALEs may count hours of service using one of two measurement methods, the monthly measurement method or the look-back measurement method. ALEs must provide minimum essential coverage to employees that is affordable and offers minimum value to avoid penalties under the Affordable Care Act (ACA). Background As the Internal Revenue Service (IRS) continues to actively enforce the employer shared …

Quick Facts The Internal Revenue Service (IRS) recently released IRS Notice 2022-59 updating the Patient-Centered Outcomes Research Institute (PCORI) fees for plan years ending on or after October 1, 2022, through September 30, 2023. The payment for the respective plan years will be $3.00 per covered life. Plan sponsors may use one of three methods to determine the average number of covered lives for reporting and paying the PCORI fee. Background On November 14, 2022, the IRS issued Notice 2022-59, providing the adjusted PCORI fees for plan years ending in October 2022 through September 2023. Employers …

Quick Facts Starting January 1, 2023, employer plan affordability for family members will be based on the required cost for the entire family to participate in the employer-sponsored plan. Affordability for the employee will still be based on the employee’s cost for single (employee-only) coverage. Applicable large employers (ALEs) can be liable for penalties under section §4980H if the employer plan is unaffordable for full-time employees. As part of a new Section 125 rule, a non-calendar year cafeteria plan may allow an employee to prospectively revoke an election of family coverage under a group health …