ACA Companion - Insurance Plan Tab

A percentage of the employee's subject wages that determines what the employee needs to contribute for the plan. If this option is selected, two fields are made available:

• Specific % field - The specific % of the employee's subject wages that the employee will pay for the insurance plan.
  
  
• Max amt. - A cap placed on the amount the employee will pay for the insurance plan. This should indicate the maximum monthly premium cost for this plan.

Employee in a section 4980H(b) Limited Non-Assessment Period. Enter code 2D for any month during which an employee is in a section 4980H(b) Limited Non-Assessment Period. If an employee is in an initial measurement period, enter code 2D (employee in a section 4980H(b) Limited Non-Assessment Period) for the month, and not code 2B (employee not a full-time employee). For an employee in a section 4980H(b) Limited Non-Assessment Period for whom the ALE Member is also eligible for the multiemployer interim rule relief for the month, enter code 2E (multiemployer interim rule relief) and not code 2D (employee in a section 4980H(b) Limited Non-Assessment Period).

Multiemployer interim rule relief. Enter code 2E for any month for which the multiemployer arrangement interim guidance applies for that employee, regardless of whether any other code in Code Series 2 (including code 2C) might also apply. This relief is described under Offer of Health Coverage in the Definitions section of these instructions.

Enter code 2F if the ALE Member used the section 4980H Form W-2 safe harbor to determine affordability for purposes of section 4980H(b) for this employee for the year. If an ALE Member uses this safe harbor for an employee, it must be used for all months of the calendar year for which the employee is offered health coverage. To determine this option, take an employee’s W-2 wages for the month and multiply by 0.0966 (in other words, 9.66%). That number defines the monthly maximum that the company could take from the employee’s wages each month to pay for a minimally qualifying health plan. If, for example, an employee’s W-2 showed monthly pay of $1,500, then:

1500 × 0.0966 = $144.90

To meet affordability requirements under the W-2 calculation, an employer would need to offer one plan for which the employee’s monthly contribution was no more than $144.90.

To calculate ACA affordability based on employee compensation, multiply an employee’s monthly salary by 9.66%, which gives you the maximum amount you can charge that employee this year for qualifying coverage. For hourly employees, assuming 130 work hours in a typical month, calculating affordability is based on the lower overall figure when the two following options are calculated:

• Employee hourly rate of pay on the first day of the plan year times 130 days per month, multiplied by 9.66%
• Employee’s lowest hourly pay rate during the calendar month times 130 days per month, multiplied by 9.66%

Qualifying Offer: Minimum essential coverage providing minimum value offered to full-time employee with Employee Required Contribution equal to or less than 9.5% (as adjusted) of mainland single federal poverty line and at least minimum essential coverage offered to spouse and dependent(s).

• Minimum essential coverage and value for employee.
• Includes employee required contribution for self-only coverage, equal to or less than 9.5% of federal poverty line (48 contiguous states)
• Provides minimum essential coverage to spouse and dependent(s).

• Plan covers employee only. NO spouse or dependents are covered.
• Provides ACA minimum essential coverage.
• Provides ACA minimum essential value.

• Plan covers employee and dependent(s). NO spouse is covered.
• Provides ACA minimum essential coverage.
• Provides ACA minimum essential value.

• Plan covers employee and spouse. NO dependents are covered.
• Provides ACA minimum essential coverage.
• Provides ACA minimum essential value.

• Plan covers employee, spouse, and dependent(s).
• Provides ACA minimum essential coverage.
• Provides ACA minimum essential value.

• Plan covers employee and any combination of spouse and dependent(s).
• Provides ACA minimum essential coverage.
• Does NOT provide ACA minimum essential value.

Offer of coverage for at least one month of the calendar year to an individual who was not an employee for any month of the calendar year or to an employee who was not a full-time employee for any month of the calendar year (which may include one or more months in which the individual was not an employee) and who enrolled in self-insured coverage for one or more months of the calendar year.

Code 1G applies for the entire year or not at all. Therefore, if code 1G applies, an ALE Member must enter code 1G on line 14 in the “All 12 Months” column or in each separate monthly box (for all 12 months).

• Not a full time employee for any month of calendar year.
• Enrolled in self-insured employer-sponsored coverage for one or more months of calendar year.

• NO offer of coverage (no offer of health coverage or offered coverage NOT minimum essential)

• Minimum essential coverage and value for employee.
• Minimum essential coverage conditionally offered to spouse.
• Minimum essential coverage NOT offered to dependent(s).