U.S. Supreme Court
Ruling Expected at the End of this Month
In March 2015, the Court heard the King v. Burwell
case. The plaintiffs argued that the IRS
unlawfully extended the premium support tax credit to residents of states
having a Federal individual health insurance exchange instead of a state-run
exchange. The plaintiffs argued that the
language of the law limits the credit to only state-run exchanges. Only 16 states run their own exchanges and
six state run exchanges in partnership with the Federal government. The credit pays for a substantial portion of
the premium of health insurance policies purchased by low to middle income
taxpayers from the exchange. If the
Court rules against the government, health insurance would once again become
unaffordable to millions of taxpayers who would also be penalized for not
having health insurance! Furthermore,
employers may escape the penalty for not offering affordable, minimum essential
health insurance in those states having Federal exchanges. Clearly, an adverse ruling to the government
will have far reaching consequences!
Update: On June 25, 2015, in a 6-3 vote, the U.S. Supreme Court upheld the availability of the premium credit for health insurance policies purchased on a Federal exchange.
Employer Reporting
Requirements
Employers having 50 or more full-time equivalent
employees (FTEs) during 2015 must report monthly health insurance information
for 2015 for each full-time employee (those working on average 30 hours a week)
on Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) and Form
1094-C (used to transmit Form 1095-C and also to claim transitional rules
relief). Form 1095-C must be provided to
each full-time employee by February 1, 2016 and the forms must be filed with
the IRS by February 29, 2016. Applicable
employers need to begin gearing up to meet these filing requirements.
Inflation
Adjustments for 2015
The employer mandate penalties and the premium support
credit eligibility figures are adjusted for inflation for 2015.
·
The penalty for not offering health insurance
increases to $2,080 from $2,000.
·
The penalty for offering unaffordable health
insurance increases to $3,120 from $3,000.
·
A premium credit for policies purchased on the
exchange is available for those with household income of 100% to 400% of the federal
poverty line:
o Household
income for a single person: from $11,670
to $46,680 in 2015, up from $11,490 to $45,960 in 2014.
o Household
income for a family of four: from $23,850
to $95,400 in 2015, up from $23,550 to $94,200 in 2014.
2015 Applicable Large
Employer Mandate Transitional Relief
Employers with 50 to 99 FTEs in 2014.
·
There is no penalty for not offering health
insurance to full-time employees if
certain IRS mandated requirements are met:
o The
employer does not reduce the workforce count or reduce hours worked during the
period of February 9, 2014 through December 31, 2014 to get under 100 FTEs, and
o The
employer does not reduce health insurance benefits during the period of
February 9, 2014 through December 31, 2014.
·
These employers will be subject to the mandate
beginning in 2016.
Employers with 100 or more FTEs in 2014.
·
The standard exemption of 30 used to calculate
the penalty for not offering health insurance where an employee obtains a
premium credit is increased to 80 for 2015 only. For example, if the employer did not offer
health insurance and there were 120 full-time employees, the penalty would be $83,360
[$2,084 X (120-80)] instead of $187,560 [$2,084 X (120-30)].
·
There is no penalty for not offering health
insurance if at least 70% of its full-time employees are offered health
insurance. The percentage increases to
95% after 2015.
o Even
if this percentage is met, if the health insurance offered is not deemed
“affordable” to the employee, or if the policy is not at least a “bronze-level”
policy, the employer is subject to a $3,126 penalty for each full-time employee
receiving a premium support credit. This
penalty cannot exceed what the penalty would be if no health insurance were
offered. A policy is deemed affordable
if the employee’s portion of the premium does not exceed 9.56% of wages.
Individual Mandate
Penalty
The individual mandate penalty increases.
·
The flat dollar penalty increases from $95 per
adult (with a $285 household maximum) to $325 per adult (with a $975 household
maximum). For children under age 18, the
penalty is 50% of the per-adult amount.
·
The penalty calculated as percentage of
household income in excess of the tax return filing threshold increases from 1%
to 2%. This penalty applies if it is
greater than the flat dollar penalty.
·
However, the maximum individual mandate penalty
is limited to the national average bronze-level premium. This average increases to $2,484 in 2015 from
$2,448 in 2014 for an individual policy, and to $12,420 from $12,240 for a
family policy covering five or more members.