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26 U.S.C. § 4980H — Shared responsibility for employers regarding health coverage

Federal law — U.S. Code and appendices · legal_authorities

26 U.S.C. § 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 larg

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Stable record: federal_law:legal_authorities:record_usc_b4180754ed5cd574c9a6c5ce
Source file: Laws/federal/codes/united-states-code/title-26/section-4980h-shared-responsibility-for-employers-regarding-health-coverage--a899e4f0e1.md
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Source location: Title 26, Chapter 43, § 4980H; chapter-043-qualified-pension-etc-plans.md

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**(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** — The aggregate amount of tax determined under paragraph (1) with respect to all employees of an applicable large employer for any month shall not exceed the product of the applicable payment amount and the number of individuals employed by the employer as full-time employees during such month. **(c) Definitions and special rules** For purposes of this section— (1) **Applicable payment amount** — The term “applicable payment amount” means, with respect to any month, 1⁄12 of $2,000. (2) **Applicable large employer** (A) *In general* — The term “applicable large employer” means, with respect to a calendar year, an employer who employed an average of at least 50 full-time employees on business days during the preceding calendar year. (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* — The term “seasonal worker” means a worker who performs labor or services on a seasonal basis as defined by the Secretary of Labor, including workers covered by section 500.20(s)(1) of title 29, Code of Federal Regulations and retail workers employed exclusively during holiday seasons. (C) *Rules for determining employer size* — For purposes of this paragraph— (i) *Application of aggregation rule for employers* — All persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as 1 employer. (ii) *Employers not in existence in preceding year* — In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is an applicable large employer shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year. (iii) *Predecessors* — Any reference in this subsection to an employer shall include a reference to any predecessor of such employer. (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* — In the case of persons treated as 1 employer under subparagraph (C)(i), only 1 reduction under subclause (I) or (II) 11 So in original. Probably means subclause (I) or (II) of clause (i). shall be allowed with respect to such persons and such reduction shall be allocated among such persons ratably on the basis of the number of full-time employees employed by each such person. (E) *Full-time equivalents treated as full-time employees* — Solely for purposes of determining whether an employer is an applicable large employer under this paragraph, an employer shall, in addition to the number of full-time employees for any month otherwise determined, include for such month a number of full-time employees determined by dividing the aggregate number of hours of service of employees who are not full-time employees for the month by 120. (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* — The term “full-time employee” means, with respect to any month, an employee who is employed on average at least 30 hours of service per week. (B) *Hours of service* — The Secretary, in consultation with the Secretary of Labor, shall prescribe such regulations, rules, and guidance as may be necessary to determine the hours of service of an employee, including rules for the application of this paragraph to employees who are not compensated on an hourly basis. (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* — If the amount of any increase under subparagraph (A) is not a multiple of $10, such increase shall be rounded to the next lowest multiple of $10. (6) **Other definitions** — Any term used in this section which is also used in the Patient Protection and Affordable Care Act shall have the same meaning as when used in such Act. (7) **Tax nondeductible** — For denial of deduction for the tax imposed by this section, see section 275(a)(6). **(d) Administration and procedure** (1) **In general** — Any assessable payment provided by this section shall be paid upon notice and demand by the Secretary, and shall be assessed and collected in the same manner as an assessable penalty under subchapter B of chapter 68. (2) **Time for payment** — The Secretary may provide for the payment of any assessable payment provided by this section on an annual, monthly, or other periodic basis as the Secretary may prescribe. (3) **Coordination with credits, etc.** — The Secretary shall prescribe rules, regulations, or guidance for the repayment of any assessable payment (including interest) if such payment is based on the allowance or payment of an applicable premium tax credit or cost-sharing reduction with respect to an employee, such allowance or payment is subsequently disallowed, and the assessable payment would not have been required to be made but for such allowance or payment. (4) **Time for response** — The Secretary shall allow an applicable large employer at least 90 days from the date of the first letter which informs the employer of a proposed assessment of the employer shared responsibility payment under this section to respond to the proposed assessment before taking any further action with respect to such proposed assessment.

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 18101 — Repealed. Pub. L. 112–10, div. B, title VIII, § 1858(a), Apr. 15, 2011, 125 Stat. 168

### Statutory Notes Section, Pub. L. 111–148, title X, § 10108(a)–(e), Mar. 23, 2010, 124 Stat. 912, 913, related to free choice vouchers. #### Effective Date of Repeal Repeal by Pub. L. 112–10 effective as if included in the provisions of, and the amendments made by, the provisions of Pub. L. 111–148 to which it relates, see section 1858(d) of Pub. L. 112–10, set out as an Effective Date of 2011 Amendment note under [section 36B of Title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section36B&num=0&edition=prelim), Internal Revenue Code.

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18101

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 18001 — Immediate access to insurance for uninsured individuals with a preexisting condition

**(a) In general** Not later than 90 days after March 23, 2010, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014. **(b) Administration** (1) **In general** — The Secretary may carry out the program under this section directly or through contracts to eligible entities. (2) **Eligible entities** — To be eligible for a contract under paragraph (1), an entity shall— (A) be a State or nonprofit private entity; (B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and (C) agree to utilize contract funding to establish and administer a qualified high risk pool for eligible individuals. (3) **Maintenance of effort** — To be eligible to enter into a contract with the Secretary under this subsection, a State shall agree not to reduce the annual amount the State expended for the operation of one or more State high risk pools during the year preceding the year in which such contract is entered into. **(c) Qualified high risk pool** (1) **In general** — Amounts made available under this section shall be used to establish a qualified high risk pool that meets the requirements of paragraph (2). (2) **Requirements** — A qualified high risk pool meets the requirements of this paragraph if such pool— (A) provides to all eligible individuals health insurance coverage that does not impose any preexisting condition exclusion with respect to such coverage; (B) provides health insurance coverage— (i) in which the issuer’s share of the total allowed costs of benefits provided under such co

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18001

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Federal law — U.S. Code and appendices · legal_authorities

29 U.S.C. § 218b — Notice to employees

**(a) In general** In accordance with regulations promulgated by the Secretary, an employer to which this chapter applies, shall provide to each employee at the time of hiring (or with respect to current employees, not later than March 1, 2013), written notice— (1) informing the employee of the existence of an Exchange, including a description of the services provided by such Exchange, and the manner in which the employee may contact the Exchange to request assistance; (2) if the employer plan’s share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs, that the employee may be eligible for a premium tax credit under [section 36B of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section36B&num=0&edition=prelim) and a cost sharing reduction under [section 18071 of title 42](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18071&num=0&edition=prelim) if the employee purchases a qualified health plan through the Exchange; and (3) if the employee purchases a qualified health plan through the Exchange, the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for Federal income tax purposes. **(b) Effective date** Subsection (a) shall take effect with respect to employers in a State beginning on March 1, 2013.

Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 218b

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 18081 — Procedures for determining eligibility for Exchange participation, premium tax credits and reduced cost-sharing, and individual responsibility exemptions

**(a) Establishment of program** The Secretary shall establish a program meeting the requirements of this section for determining— (1) whether an individual who is to be covered in the individual market by a qualified health plan offered through an Exchange, or who is claiming a premium tax credit or reduced cost-sharing, meets the requirements of sections 18032(f)(3), 18071(e), and 18082(d) of this title and [section 36B(e) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section36B/e&num=0&edition=prelim) that the individual be a citizen or national of the United States or an alien lawfully present in the United States; (2) in the case of an individual claiming a premium tax credit or reduced cost-sharing under [section 36B of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section36B&num=0&edition=prelim) or [section 18071 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18071&num=0&edition=prelim)— (A) whether the individual meets the income and coverage requirements of such sections; and (B) the amount of the tax credit or reduced cost-sharing; (3) whether an individual’s coverage under an employer-sponsored health benefits plan is treated as unaffordable under sections 36B(c)(2)(C) and 5000A(e)(2) of title 26; 11 See References in Text note below. and (4) whether to grant a certification under [section 18031(d)(4)(H) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18031/d/4/H&num=0&edition=prelim) attesting that, for purposes of the individual responsibility requirement under [section 5000A of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section5000A&num=0&edition=prelim), a

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18081

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Federal law — U.S. Code and appendices · legal_authorities

26 U.S.C. § 4980H — Shared responsibility for employers re-

Page 3116 TITLE 26—INTERNAL REVENUE CODE § 4980H (b) Rules and requirements Rules and requirements similar to the rules and requirements of section 4980E shall apply for purposes of this section. (c) Regulations The Secretary shall issue regulations to carry out the purposes of this section, including regu- lations providing special rules for employers who make contributions to Archer MSAs and health savings accounts during the calendar year. (d) Exception For purposes of applying section 4980E to a contribution to a health savings account of an employee who is not a highly compensated em- ployee (as defined in section 414(q)), highly com- pensated employees shall not be treated as com- parable participating employees. (Added Pub. L. 108–173, title XII, § 1201(d)(4)(A), Dec. 8, 2003, 117 Stat. 2478; amended Pub. L. 109–432, div. A, title III, § 306(a), Dec. 20, 2006, 120 Stat. 2951.) Editorial Notes AMENDMENTS 2006—Subsec. (d). Pub. L. 109–432 added subsec. (d). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2006 AMENDMENT Pub. L. 109–432, div. A, title III, § 306(b), Dec. 20, 2006, 120 Stat. 2951, provided that: ‘‘The amendment made by this section [amending this section] shall apply to tax- able years beginning after December 31, 2006.’’ EFFECTIVE DATE Section applicable to taxable years beginning after Dec. 31, 2003, see section 1201(k) of Pub. L. 108–173, set out as an Effective Date of 2003 Amendment note under section 62 of this title. § 4980H. Shared responsibility for employers re- garding 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 de- pendents) the opportunity to enroll in min- imum essential coverage under

Source: Supplied 2024 U.S. Code historical extraction · 26 U.S.C. § 4980H

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