Volume 4 - HR Policy Association

A Chief Human Resource Officer Decision Framework Volume 4

June 2013

i

Enactment of the Affordable Care Act has launched a massive restructuring of the American

health care system which is likely to continue until at least the end of the decade.

The member companies of HR Policy Association, all of whom are large employers who

collectively spend more than $75 billion annually on health care in the U.S., are in the process of

assessing their company's current health care strategy and formulating new ones in response.

This Decision Framework has been created under the direction of the Association's Health

Care Policy Steering Committee, chaired by Marc C. Reed, Chief Administrative Officer,

Verizon Communications Inc.

Its purpose is to serve as a tool that Chief Human Resource Officers and other senior

corporate executives can use to:

• Understand both historical and current trends in American health care impacting large

employers;

• Determine long-term objectives with respect to health care for employees, dependents,

and retirees;

• Identify various options available in considering potential changes to company health

care strategies; and

• Support formulation of the company’s long-term health care strategy by its senior

management and board of directors.

This Framework was developed for the Association's CHRO Summit on March 15-16, 2013,

which involved the Chief Human Resource Officers from more than 200 large corporations. It

has been updated utilizing the valuable input the Association has received since the Summit.

HR Policy Association is the lead organization representing chief human resource officers of

major employers. The Association consists of more than 350 of the largest corporations doing

business in the United States and globally, and these employers are represented in the

organization by their most senior human resource executive. Collectively, their companies

employ more than ten million employees in the United States, nearly nine percent of the private

sector workforce, and 20 million employees worldwide. They have a combined market

capitalization of more than $7.5 trillion. These senior corporate officers participate in the

Association because of their commitment to improving the direction of human resource policy.

Their objective is to use the combined power of the membership to act as a positive influence

to better public policy, the HR marketplace, and the human resource profession.

For more information, contact HR Policy Association at 202-789-8670.

ii

Marc C. Reed, Chair

Chief Administrative Officer

Verizon Communications Inc.

William A. Blase, Jr.

Senior Executive Vice President, Human Resources

AT&T Inc.

Lynnette M. Cavalier

Senior Vice President, Human Resources

FirstEnergy Corporation

L. Kevin Cox

Chief Human Resources Officer

American Express Company

Timothy M. Crow

Executive Vice President, Human Resources

The Home Depot, USA Inc.

Michael L. Davis

Senior Vice President, Global Human Resources

General Mills, Inc.

Richard R. Floersch

Executive Vice President, Chief Human Resources Officer

McDonald's Corporation

Mark R. James

Senior Vice President, Human Resources and Communications

Honeywell International Inc.

Daisy Ng

Senior Vice President, Chief Human Resources Officer

Darden Restaurants, Inc.

David A. Rodriguez

Executive Vice President and Chief Human Resources Officer

Marriott International, Inc.

iii

Volume 1

Formulating a Company's Future Long-Term Health Benefits Strategy:

Considerations, Options and Decision Points

Volume 2

The Current State of Employer-Provided Health Care in America

Volume 3

Public and Private Sector Attempts to Reform Health Care

Volume 4

The Affordable Care Act and Large Employers

Volume 5

Emerging Forms of Health Care Delivery Following Enactment of the ACA

iv

Volume 4 provides information intended to inform the discussion of the issues in Volume 1.

It provides key information on the requirements of the Affordable Care Act that large employers

need to comply with including the mandate to provide coverage, the provisions impacting plan

design, and other reporting and compliance requirements. Volume 4 also covers the individual

mandate requirement.

Volumes 2, 3, and 5 also provide additional information intended to inform the discussion of

the issues raised in Volume 1. Volumes 2 and 3 provide data on health care cost and benefit

coverage trends, and information on a variety of private sector initiatives by employers to control

rising health care costs. While Volume 5 provides information on the emerging forms of health

care delivery that are appearing following enactment of the ACA.

v

vii


1. Overview: Role of Employer-Sponsored Coverage ..............................................................1

2. Employer Mandate to Provide Coverage ..............................................................................3

3. Grandfathered Plans ...............................................................................................................9

4. Benefit and Coverage Requirements ....................................................................................11

5. Essential Health Benefits .......................................................................................................13

6. Provisions Impacting Plan Design ........................................................................................15

7. Administrative Requirements ...............................................................................................17

8. Reporting and Compliance Requirements ..........................................................................19

9. Additional Employer Tax Penalties .....................................................................................21

10. Individual Mandate ...............................................................................................................23

HR Policy Association Staff and Consultant Contributors .................................................... 26

Endnotes ........................................................................................................................................27

©2013 HR Policy Association 1

The ACA’s primary goal is to lower the number of uninsured

Americans, but the law does not meaningfully address dysfunctions in the

U.S. health care system

Key elements of the ACA

The law requires almost all Americans to maintain a minimum

level of health coverage or face a modest tax penalty1

Large employers must offer coverage to full-time employees or

pay a penalty

– “Full-time” is defined as an average of 30 or more hours

per week or 130 hours per month2

Insurers must accept applicants regardless of pre-existing

conditions or health status, which means that employees and

retirees no longer need an employment relationship to gain access

to health coverage

State- or federally-operated health insurance exchanges provide

new insurance markets for individuals and small groups to shop for

federally-approved health insurance in 2014

Premium assistance is made available to individuals in certain

households such that health care can be purchased more readily

outside the employment relationship

– Low- and middle-income individuals may be eligible for

federal premium tax credits and cost-sharing reductions to

purchase coverage in ACA exchanges

Medicaid coverage expanded to cover those up to 133 percent of

federal poverty level in adopting states

Financing for the new system comes from new taxes and fees on

employers, insurers, drug and device makers, upper-income

individuals, and potential cuts to future Medicare spending


Failure to Offer Coverage

Beginning in 2014, large employers are subject to an assessment

for not offering minimum essential coverage to at least 95 percent

of full-time employees, if at least one full-time employee receives

premium assistance to purchase coverage on an exchange3

– Premium assistance consists of either a premium tax credit

or a cost-sharing reduction from an ACA exchange

– Maximum employer assessment for failure to offer

coverage is $2,000 per full-time employee per year

(assessed monthly)

Failure to Offer Affordable, Minimum Value Coverage

Beginning in 2014, large employers offering coverage to full-time

employees may still be subject to an assessment if coverage fails to

meet affordability and minimum value standards, and if an

employee receives premium assistance to purchase coverage on an

exchange4

– Maximum employer penalty for failing to offer

affordable/minimum essential coverage is $3,000 for each

such full-time employee per year (assessed monthly)

– Determination made on a employee-by-employee basis

– Penalty is capped at maximum penalty for failing to

provide coverage

Employee Eligibility for Premium Assistance

Only employees who are eligible to receive premium assistance

can trigger an employer assessable payment

To be eligible for premium assistance, an individual must:5

– Have income between 100% and 400% of the federal

poverty level (2013: up to $94,200/family of four,

$45,960/individual);

– Not have access employer-sponsored health care that meets

affordability and minimum value requirements

– Enroll in ACA exchange coverage

Decision Framework: Volume 4

4

Regardless of income level, individuals are not eligible for

premium assistance if they are eligible for qualifying “minimum

essential coverage” such as employer-sponsored health coverage or

government-provided health care

Full-Time vs. Part-Time Status

Employers are not subject to penalty for not offering coverage to

part-time employees, or for offering coverage to part-time

employees that is unaffordable or doesn’t provide minimum value6

– Part-time employees are not counted in calculating any

penalty

Generally, a “full-time employee” is one who works on average 30

or more hours per week or 130 hours per month7

– When a new employee is reasonably expected to work full-

time, the new employee must be offered coverage within 90

days8

When it is unclear if a new employee will work full-time, or if the

new employee is a seasonal employee, an employer may use a

look-back stability “safe harbor” to determine the employee’s

status before offering coverage

– The look-back stability safe harbor involves a complex

administrative evaluation of hours worked over a prior 3, 6,

or 12-month period9

• Beginning in 2014, no employer may discharge or discriminate

against any full-time employee with respect to their compensation,

terms, conditions, or other privileges of employment because the

employee received subsidized coverage in an exchange



Dependents

Under the ACA, an employer is subject to a penalty for failing to

offer coverage to “its full-time employees and their dependents”10

– However, no penalty is actually triggered for failing to

offer coverage to such dependents—the penalty is triggered

only when a full-time employee receives premium

assistance

– The penalty is calculated based on the number of full-time

employees, not dependents11

– Recent IRS guidance confirmed that employers must offer

coverage but still did not directly identify a penalty for

failing to do so12

Affordability Requirements

To avoid penalties, an employer offering coverage to its full-time

employees must satisfy an affordability standard

If a full-time employee’s share of the self-only premium for the

employer’s lowest-cost plan exceeds 9.5 percent of the employee’s

household income, the employee may be eligible for a premium

tax credit and the employer may be subject to an assessment13

– Because an employer will not know its employees’

household incomes, the employee may use one of three

affordability safe harbors:14

W-2 safe harbor: If annual cost does not exceed

9.5% of the employee’s W-2 wages

“Rate of Pay” safe harbor: If monthly cost does not

exceed 9.5% of the employee’s average monthly

wage

o Also involves salary reduction restrictions

Federal Poverty Line safe harbor: if annual cost

does not exceed 9.5% of federal poverty level for a

single individual


6

Minimum Value Standard

To avoid penalties, an employer offering coverage to its full-time

employees must also satisfy a minimum value standard

An employer’s plan fails to provide minimum value if the plan

pays less than 60 percent of the benefits provided under the plan15

– Employers can use three methods to determine if they meet

the standard:16

A minimum value calculator to be provided by the

IRS and HHS

A safe harbor checklist to be provided by the IRS

and HHS, or

Actuarial certification as to whether the employer’s

plan provides minimum value

Controlled Group Rules

Members of a controlled group of corporations are considered

separately for determining whether an employer is subject to a

penalty and the amount17

– This means that if an employer is part of a 10-member

controlled group, each subsidiary could only be subject to

penalties associated with its FTEs and not those of another

member of the controlled group

Contributions to HSAs and HRAs

Employer contributions will be counted for measuring the

affordability of an employer’s plan if the contribution may only be

used to pay for plan premiums18

– HSA: Employer contributions will not be credited because

such contributions cannot be used to pay for plan premiums

– HRA: Employer contributions may only be credited for a

premium-only HRA

Employer contributions to HSAs and HRAs will generally be

credited toward minimum value19

– Employer contributions to receive the same credit as it

would for the same amount of first dollar coverage

Employee HSA contributions are not included in

measuring minimum value



Employer Mandate to Provide Coverage: Impact on Employers

• While the ACA may cause certain employers to consider

discontinuing employer-sponsored health coverage, there are

certain financial and liability disincentives associated with exiting

the system:

– If just a few full-time employees receive a premium

subsidy or cost-sharing reduction, the assessment is

triggered for all full-time employees20

– An employer may violate the complex IRS non-

discrimination rules which generally prohibit treating

highly-compensated individuals more favorably for health

care coverage21

– Assessment costs may quickly increase, making long-term

market exit costs unpredictable

Retirees

Because the ACA requires employers to offer coverage to full-time

employees, retirees are not included in this mandate because they

are not employees22

– However, there are other provisions in the ACA that do

impact retiree coverage

– If an employer’s plan for active employees also offers

coverage to retirees, the entire plan must comply with the

ACA’s mandates

– Key distinction is whether the retiree plan is a retiree-only

plan

• Retiree-only plans are defined as plans with fewer than two active

workers23

– Employer plans that cover only retirees are not subject to

most of the ACA’s insurance reforms, coverage mandates,

or new plan fees

– Separating retirees from active plans allows employers to

avoid numerous administrative requirements and

compliance costs

– Retiree plans that also cover disabled inactive employees

may also qualify for this exception


Grandfathered plans are plans that were in existence on March 23,

2010 (date of enactment of the ACA) and have not been

significantly changed since that date24

Grandfathered health plans are exempt from some, but not all, of

the ACA’s insurance reforms and coverage mandates

Rules on maintaining grandfathered plan status are stringent,

prohibiting employers from minor plan design changes such as

increasing cost-sharing (co-insurance) for plan participants or

changing carriers so that the same or a higher quality coverage can

be obtained at a lower cost

Most large employers have decided to forgo grandfathered status

for their plans

– The grandfathering rules significantly limit employers’

ability to effectively manage their plans

– Employers’ need for flexibility to control costs often

trumps advantages of grandfathering

– Many large employer-sponsored plans met ACA market

reform requirements for non-grandfathered plans prior to

ACA


Expansion of dependent coverage

– The ACA requires coverage of children up to age 2625

One of the most costly, but most popular, mandates

– Spouses are not considered “dependents”

– Grandfathered plans must allow coverage for adult children

up to age 26 except if they are eligible for coverage from

another employer

No eligibility waiting periods beyond 90 days26

– However, nothing prohibits employers from maintaining

other reasonable plan eligibility criteria based on, among

other things, employee classifications or hours of service27

No pre-existing condition exclusions regardless of age

– Individuals cannot be excluded from coverage based on a

pre-existing health condition regardless of prior coverage28

Rescission of coverage prohibited29

– Except in cases of intentional misrepresentation of material

fact30

Emergency room services provided by an out-of-network provider

must be covered31

Plans must cover approved clinical trials

– Federally-funded trials conducted in connection with the

prevention or treatment of cancer or other life-threatening

disease, clinical trials conducted under an FDA

investigational new drug application, or certain FDA

exempt drug trials32

Coverage of preventive care services must be provided with no

cost-sharing for plan enrollees (“first-dollar preventive care”)33

– HHS periodically reviews and determines the covered

preventative care services based on recommendations from

U.S. Preventive Services Task Force, CDC, and HRSA


12

No annual or lifetime dollar limits on coverage for “essential

health benefits” (see below)

The prohibition on annual dollar limits restricts employer plan

design options

– Guidance indicates that “stand-alone” HRAs (i.e., funded

by employer contributions but not part of a more

comprehensive group medical plan) would violate the

annual limit restrictions34

– Some “Mini-med” plans, which are low-cost limited benefit

health plans that cover accident and sickness-related

expenses, were granted an exemption from the annual limit

restrictions until as late as 2014 when such plans will no

longer be permitted35


Because no annual or lifetime dollar limits can be imposed on the

coverage of benefits in a health care plan that are deemed to be

"essential health benefits," having a good understanding of what

constitutes essential health benefits is necessary for long term

financial planning of self-insured plans.

Definition of Essential Health Benefits

Essential health benefits (EHB) include health care related items

and services in 10 categories:36

– Ambulatory Services

– Emergency Services

– Hospitalization

– Maternity and Newborn Care

– Mental Health and Substance Abuse

– Prescription Drugs

– Rehabilitative and Habilitative services/Devices

– Laboratory Services

– Preventive and Wellness Services and Chronic Disease

Management

– Pediatric Services, Including Oral and Vision Care

Federal regulations do not define what specific health care related

items and services must be included in the 10 EHB categories –

generally left to states to decide

States designate an EHB “benchmark plan” that identifies what

health care expenses must be covered by plans in the small group

and individual markets in that state37

– Benchmark plans vary from state to state


14

Requirements for Self-Insured Plans

Self-insured and large group plans need not include all of the

health care related items and services in a state EHB “benchmark”

plan38

– However, if a self-insured plan includes benefits that are in

a state’s EHB benchmark plan, there can be no annual or

lifetime dollar limits on those benefits in the employer’s

plan

Self-insured and large group plans may use each

state’s benchmark plan to determine what EHBs are

in their plans, or make a good faith effort to comply

with a reasonable interpretation of what they think

EHBs are to ensure there are no annual or lifetime

dollar limits on EHB in the employer’s plan39

– Although HHS and DOL intend to work with self-insured

plans that make a good faith effort to ensure that there are

no annual or lifetime dollar limits on EHBs in their plans,

such plans may still be subject to different state standards

on annual or lifetime limits

Example: A large self-insured employer with

operations in all 50 states that has an annual limit of

$1,500 per year for acupuncture would be in

violation of the prohibition on annual dollar limits

in California and Washington (which include

acupuncture as an essential health benefit in their

state benchmark plans), but may not be in violation

in other states

– This problem for self-insured employers effectively erodes

traditional notions of ERISA preemption


In 2014, the ACA imposes an annual limitation on cost-sharing for

“deductibles, coinsurance, copayments, or similar charges”

– Applies to large group health plans, including self-insured

– Annual cost-sharing limitation for “deductibles,

coinsurance, copayments, or similar charges” cannot

exceed out-of-pocket expenses for HSA compatible high

deductible health plans40

– Amounts for 2014 are expected to be released by the IRS

in the spring of 2013

2013 amount $6,250 for self-only coverage and

$12,500 for non-self-only

In 2014, the ACA also imposes an annual limitation on deductibles

for individual and small group plans and individual offered both in

and out of ACA exchanges41

– Does NOT apply to large group health plans, including

self-insured

BUT in 2017 it may apply to fully-insured large

group plans in states that allow large employers to

purchase coverage through ACA exchanges

– Annual limitation prohibits deductibles for individual and

small group plans from exceeding:

$2,000 for self-only coverage; or

$4,000 for other than self-only coverage42

New internal appeals and external review processes for benefit

claim disputes in addition to existing ERISA claims requirements

will cause employers to alter current appeals processes43

– Among other requirements, employer plans must contract

with 3 independent review organizations which conduct

independent reviews of claim disputes in order to satisfy

DOL safe harbor requirements


16

New non-discrimination rules forbid fully-insured plans from

discriminating in favor of highly-compensated individuals44

– These rules will impact employers by:

Eliminating the tax exclusion for executive “top-

hat” health insurance policies; and

Apply to fully-insured coverage purchased by

employers through private exchanges

– Similar to self-insured plan discrimination rules under

Internal Revenue Code

– Will not be enforced until final regulations are effective,

likely post-2014

To encourage employers to reduce health care costs and curb

employee spending, the ACA revises the tax treatment of certain

health benefits and imposes new taxes, most notably on high-cost

health plans

– Tax penalty on nonqualified HSA withdrawals doubled to

20 percent (effective 2012)45

– Over-the-counter medicine not eligible for FSA, HSA, or

HRA reimbursement unless prescribed (effective 2011)46

– FSA contributions capped at $2,500 starting 201347

Automatic enrollment requirement48

– Large employers must automatically enroll new full-time

employees in one of their health plans if a plan is offered

– Enforced by the Department of Labor, but not effective

until final regulations issued, post 2013

– Enrolled employees may opt-out of the employer’s

coverage, post-2014


Employers to provide Summary of Benefits and Coverage (SBC)

to all enrollees (effective for open enrollment periods beginning on

or after 9/23/2012) in addition to information already required

under ERISA49

– SBC must be issued for each benefit option offered by the

employer which may result in dozens of different SBCs50

– SBC must describe any plan cost-sharing, exceptions or

limitations on coverage, and provide examples of common

benefit scenarios51

– SBC must conform to specific formatting requirements,

such as 4-page limit (double-sided), and be presented in a

culturally and linguistically appropriate manner52

Prior to October 1, 2013, employers must provide all employees

(and new hires) with information about ACA exchanges

including:53

– Detailed information about purchasing health insurance

through, and contact information for, ACA exchanges;

– A statement about the employer’s health plan and whether

the employer is offering affordable health benefits; and

– An explanation about potential eligibility for premium tax

credits for purchasing insurance in ACA exchanges if the

employer’s benefits do not meet certain standards

– The Department of Labor has provided a model employer

notice in both English and Spanish54


W-2 reporting of value of health benefits (effective for tax year

2012)

– Employer-sponsored plans must report the aggregate cost

of each employee’s health benefits55

– May be the first step toward taxing employer-sponsored

health benefits56

Employer plans must disclose claims payment practices and

policies to HHS and state insurance commissioners57

– Details of what must be reported and whether there will be

specific limits on how the information may be used remain

unclear

– Uncertain effective date, regulations pending but likely in

2014

Self-Insured and Issuers of Fully-Insured Plans

Self-insured employers and the issuers of fully-insured plans for

large employers must annually report to the IRS58

– The name, address, and taxpayer identification number of

the primary insured and each other individual covered

under the policy or plan

– The dates each individual was covered during the calendar

year

– The employers name, address, and employer identification

number

– The portion of the premium paid by the employer; and

– Other information the IRS may require for administering

the exchange subsidies

• Applies to coverage provided on or after January 1, 2014

• First report due 2015

• Self-insured employers and the issuers of fully-insured plans for

large employers must also furnish a written statement to each

individual listed on the IRS report showing what information is

being reported to the IRS for that individual


20

Large Employers

Large employers must annually report to the IRS59

– The name and employer identification number of the

applicable large employer

– A certification the applicable large employer offers its full-

time employees (and their dependents) the opportunity to

enroll in an employer-sponsored plan

– The duration of any waiting period

– The months during the calendar year when coverage under

the plan was available

– The monthly premium for the lowest cost option in each

enrollment category under the plan

– The employer’s share of the total allowed costs of benefits

provided under the plan

– The number of full-time employees for each month of the

calendar year

– The name, address, and taxpayer identification number of

the full-time employees and the months (if any) during

which the full-time employee (or any dependents) were

covered

– Other information the IRS may require

• Applies to coverage provided on or after January 1, 2014

• First report due 2015

• Large employers must also furnish a written statement to each

individual listed on the IRS report showing what information being

reported to the IRS for that individual

Labor Department Compliance Audits

• Employers who receive an audit letter the Department of Labor

must also provide:

– General plan documents, including copies of plans and

amendments

– Summary plan descriptions and summaries of material

modifications

– Documents sent to participants regarding plan benefits and

claims

– Contracts with third-party providers

– Any documents describing wellness or disease management

programs offered by the plan.


Penalty for violating the ACA’s insurance reform and coverage

mandates

– The general penalty on employer plans for violations of the

ACA’s reforms and mandates is an excise tax penalty of

$100 per-day per-individual impacted, which includes

dependents60

– Enforced by Departments of Treasury, Health and Human

Services, and Labor; also subject to state enforcement

Excise Tax on High-Cost Plans

Excise tax on high-cost employer plans (effective 2018)61

– 40% excise tax on plan cost in excess of threshold

– For active workers, the threshold limit is $10,200 for

singles, $27,500 for families

– Multi-employer/union threshold is $27,500 whether the

employee has individual or family coverage

– For retirees and certain high-risk employees, limit $11,850

for singles, $30,950 for families

– Thresholds indexed after 2018

Accounting Treatment

Although the excise tax on high-cost employer plans is not payable

until 2018, under the Financial Accounting Standards Board

statement 106 (FAS 106) several accountants and auditing firms

have required employers to book the liability associated with the

tax for retiree health plans as early as 2010

Elimination of Medicare Part D subsidy

Effective 2013

Tax deduction eliminated for employers who receive the Retiree

Drug Subsidy under Medicare Part D for continuing to provide a

qualified retiree drug benefit62


22

Transitional Reinsurance Fee

The ACA imposes a new “transitional reinsurance fee” on

employer-sponsored fully- and self-insured plans (effective 2014-

2016)63

– Used to subsidize insurance carriers providing coverage to

“high-risk individuals” in ACA exchanges

– Group plans must pay the fee but are not eligible for the

benefit

– HHS will collect the fee annually from self-insured/self-

administered employers, although a third-party

administrator may be utilized to transfer the reinsurance fee

on behalf of a self-insured group health plan if one is used

by the plan

– HHS will also collect the fee annually from health

insurance issuers of fully-insured plans

Federal Reinsurance Fee

– $63 per covered life in 2014 (est.)



– States may impose their own reinsurance fees after 2016,

but rules still pending

Comparative Effectiveness (PCORI) Fee

Employer plans required to pay the annual Patient-Centered

Outcomes Research Institute (PCORI) comparative effectiveness

study fee64

– $1 X the average number of covered lives for plan years

ending 10/1/2012 through 9/30/2013

– $2 X the average number of covered lives for plan years

ending after 9/30/2013

– Includes dependents and retirees

– Indexed to increase in national health expenditures after

2014

– The PCORI fee is paid to HHS and calculated like the

reinsurance fee


Beginning January 1, 2014, ACA requires most individuals to have

minimum essential health coverage for themselves and their

dependents or pay a penalty, though some individuals are exempt

from the penalty65

– Minimum essential coverage is generally defined as

coverage under

• A government-sponsored plan

• An employer-sponsored plan

• Plans in the individual market

• Grandfathered plans

– Individuals and their dependents exempt from the penalty

generally include

• Individuals whose family income is less than the

IRS tax filing threshold ($9,350 for an individual

and $18,700 for a family in 2010)

• An individual who has to pay more than eight

percent of their income for health insurance after

employer contributions or exchange subsidies

• Hardship cases as determined by HHS

• Individuals with religious objections

The penalty for not maintaining coverage in 2014 is the greater of

either $95 per adult and $47.50 per child (up to $285 per family),

or 1.0 percent of family income66

– In 2015, the penalty increases to the greater of either $325

per adult and $162.50 per child (up to $975 per family), or

2.0 percent of family income

– In 2016, the penalty increases to the greater of either $695

per adult and $347.50 per child (up to $2,085 per family),

or 2.5 percent of family income

There is no penalty for a single gap in coverage of less than three

months, and the penalty cannot exceed the national average

premium for bronze level health plans offered through exchanges

(for the relevant family size)


24

Enforcement

– Individuals who are required to pay a penalty but fail to do

so will receive a notice from the IRS

– If they still do not pay the penalty, the IRS can attempt to

collect the funds by reducing the amount of their future tax

refunds, if any

– However, individuals who fail to pay the penalty will not

be subject to any criminal prosecution or penalty, and the

IRS cannot place a lien or levy on any property




26

The following members of the HR Policy Association staff and consultants

participated in the preparation and update of the Decision Framework:

Jeffrey C. McGuiness

Walter Dawson

Kendra L. Kosko

Colleen A. McHugh

Marie L. Murphy

Michael D. Peterson

Vanessa A. Scott

Michael Thompson

Alec R. Wescott

Steve A. Wetzell

D. Mark Wilson

Daniel V. Yager


1 "Requirement to maintain minimum essential coverage." Title 26 U.S. Code § 5000A: 2892. GPO Access. Web. 20 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-

subtitleD-chap48-sec5000A.pdf>.

2 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78.1 (2

January 2013): 241. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-

02/pdf/2012-31269.pdf>. 3 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2

January 2013): 233. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-02/pdf/2012-31269.pdf>.

4 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2 January 2013): 218-253. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-

02/pdf/2012-31269.pdf>.

5 "Health Insurance Premium Tax Credit; Final Regulations." Federal Register 77. 100 (23 May 2012): 30377-

30400. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-05-23/pdf/2012-

12421.pdf>.

"Health Insurance Premium Tax Credit; Final Regulations." Federal Register 78. 22 (1 February 2013): 7264-

7765. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-01/pdf/2013-02136.pdf >. 6 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2


7 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2




02/pdf/2012-31269.pdf>.

9 "Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2 January 2013): 227. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-

02/pdf/2012-31269.pdf>.

"Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2


02/pdf/2012-31269.pdf>.




02/pdf/2012-31269.pdf>.






02/pdf/2012-31269.pdf>.



02/pdf/2012-31269.pdf>.

http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleD-chap48-sec5000A.pdf

http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleD-chap48-sec5000A.pdf

http://www.gpo.gov/fdsys/pkg/FR-2013-01-02/pdf/2012-31269.pdf
































28



"Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2 January 2013): 235. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-

02/pdf/2012-31269.pdf>.

15 "Refundable Credit for Coverage Under a Qualified Health Plan." Title 26 U.S. Code § 36B (c) (2) (C) (ii):

141. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-

2011-title26-subtitleA-chap1-subchapA-partIV-subpartC-sec36B.pdf>. 16 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,

and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web. 25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>.

17 Shared Responsibility for Employers Regarding Health Coverage; Proposed Rule." Federal Register 78. 1 (2 January 2013): 218-253. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-

02/pdf/2012-31269.pdf>.

18 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,

and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web.

25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>.

Department of the Treasury. Internal Revenue Service. "Minimum Value of an Employer-Sponsored Health Plan, Notice 2012-31." Internal Revenue Bulletin: 2012-20. 14 May 2012. <http://www.irs.gov/pub/irs-drop/n-

12-31.pdf>.

Department of Health and Human Services. Office of Consumer Information and Insurance Oversight.

"Actuarial Value and Cost-Sharing Reductions Bulletin." 24 February 2012.

<http://cciio.cms.gov/resources/files/Files2/02242012/Av-csr-bulletin.pdf>. 19 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,


Department of the Treasury. Internal Revenue Service. "Minimum Value of an Employer-Sponsored Health

Plan, Notice 2012-31." Internal Revenue Bulletin: 2012-20. 14 May 2012. <http://www.irs.gov/pub/irs-drop/n-

12-31.pdf>.



02/pdf/2012-31269.pdf>. 21 "Amounts Received Under Accident and Health Plans." Title 26 U.S. Code § 105 (h) (2) (a): 106. GPO

Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleA-chap1-subchapB-partIII-sec105.pdf>.

Department of Treasury. Internal Revenue Service. "Affordable Care Act Nondiscrimination Provisions Applicable to Insured Group Health Plans, Notice 2011-1." Internal Revenue Bulletin: 2011-2. 10 January

2011. <http://www.irs.gov/pub/irs-drop/n-11-01.pdf>.


January 2013): 218-253. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-01-

02/pdf/2012-31269.pdf>. 23 Towers Watson. Health Care Reform: Overview and Implications; A presentation to New York Business

Group on Health (NYBGH). 15 July 2010. <http://www.nebgh.org/pdf/presentations/071510smithstone.pdf>.

Aetna. Aetna.com. "Retiree-Only Plans Q&A - Aetna Health Reform Connection." 2010. Web. 25 Feb 2013.

<https://www.aetna.com/health-reform-connection/questions-answers/retiree-only-plans.html>. 24 "Preservation of Right to Maintain Existing Coverage." Title 26 U.S. Code §18011: 8123. GPO Access. Web.

21 Feb 2013. <http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf>. 25 "Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26

Under the Patient Protection and Affordable Care Act; Interim Final Rule and Proposed Rule." Federal Register 75. 123 (13 May 2010): 27124. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-05-

13/pdf/2010-11391.pdf>.

"Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review; Final Rule."

Federal Register 78 (27 February 2013).





http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleA-chap1-subchapA-partIV-subpartC-sec36B.pdf

http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleA-chap1-subchapA-partIV-subpartC-sec36B.pdf





http://www.irs.gov/pub/irs-drop/n-12-31.pdf


http://cciio.cms.gov/resources/files/Files2/02242012/Av-csr-bulletin.pdf






http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleA-chap1-subchapB-partIII-sec105.pdf

http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleA-chap1-subchapB-partIII-sec105.pdf




http://www.nebgh.org/pdf/presentations/071510smithstone.pdf

https://www.aetna.com/health-reform-connection/questions-answers/retiree-only-plans.html

http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf



End Notes


26 "Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions,

Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule." Federal

Register.75.123 (28 June 2010): 37188-37241. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-06-28/pdf/2010-15278.pdf>.

27 Department of Treasury. Internal Revenue Service. "Guidance on 90-day Waiting Period Limitation Under Public Health Service Act Section 2708; Notice 2012-59." Internal Revenue Bulletin 2012-41. 9 October 2012.

<http://www.irs.gov/pub/irs-drop/n-12-59.pdf>.

Department of Health and Human Services. Centers for Medicare and Medicaid Services. "Guidance on 90-Day

Waiting Period Limitation under Public Health Service Act § 2708." 31 August 2012.

<http://cciio.cms.gov/resources/files/Files2/2708-guidance-8-31-2012.pdf>.

Department of Labor. Employee Benefits Security Administration. "Guidance on 90-Day Waiting Period

Limitation under Public Health Service Act § 2708; Technical Release 2012-02." 31 August 2012. <http://www.dol.gov/ebsa/newsroom/tr12-02.html>.



Register 75. 123 (28 June 2010): 37192. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-06-28/pdf/2010-15278.pdf >.


Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule." Federal Register.75.123 (28 June 2010): 37192. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-

2010-06-28/pdf/2010-15278.pdf>.

30 "Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance

Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions,

Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule." Federal Register 75. 123 (28 June 2010): 37188-37241. GPO Access. Web. 14 Feb 2013.

<http://www.gpo.gov/fdsys/pkg/FR-2010-06-28/pdf/2010-15278.pdf >.

31 "Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance

Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions,

Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule." Federal Register 75. 123 (28 June 2010): 37212. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-

2010-06-28/pdf/2010-15278.pdf >.

32 "Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a

Grandfathered Health Plan Under the Patient Protection and Affordable Care Act." Federal Register 75. 116 (17

June 2010): 34559-34568. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-06-17/pdf/2010-14488.pdf>.

33 "Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act." Federal Register 75. 137 (19 July 2010):

41726-41760. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-07-19/pdf/2010-

17242.pdf>.

"Coverage of Certain Preventive Services Under the Affordable Care Act; Proposed Rules." Federal Register

78. 25 (6 February 2013): 8456-8476. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-06/pdf/2013-02420.pdf>.

34 Department of Labor. Employee Benefits Security Administration. "FAQs about Affordable Care Act Implementation Part XI." 24 January 2013. <http://www.dol.gov/ebsa/pdf/faq-aca11.pdf>.



Register.75.123 (28 June 2010): 37188-37241. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2010-06-28/pdf/2010-15278.pdf>.

36 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12834-12872. GPO Access. Web.







http://cciio.cms.gov/resources/files/Files2/2708-guidance-8-31-2012.pdf

http://www.dol.gov/ebsa/newsroom/tr12-02.html














http://www.dol.gov/ebsa/pdf/faq-aca11.pdf





30





25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>. 40 "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value,





and Accreditation; Final Rule." Federal Register 78. 37 (25 February 2013): 12847. GPO Access. Web. 25 Feb

2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf>. 43 "Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and

External Review Processes." Federal Register 76. 122 (24 June 2011): 37208-37234. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2011-06-24/pdf/2011-15890.pdf>.

"Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and External

Review Processes, Correction." Federal Register 76.143 (26 July 2011): 44491-44493. GPO Access. Web. 14

Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2011-07-26/pdf/2011-18820.pdf>. 44 Department of Treasury. Internal Revenue Service. "Affordable Care Act Nondiscrimination Provisions

Applicable to Insured Group Health Plans, Notice 2011-1." Internal Revenue Bulletin: 2011-2. 10 January 2011. <http://www.irs.gov/pub/irs-drop/n-11-01.pdf>.

45 Department of the Treasury. Internal Revenue Service. "Section 105 — Amounts Received Under Accident and Health Plans, Section 106 — Contributions by Employers to Accident and Health Plans, Section 125 —

Cafeteria Plans, Section 220 — Archer MSAs, Section 223 — Health Savings Accounts; Notice 2010-59."

Internal Revenue Bulletin: 2010-39. 27 September 2010. <http://www.irs.gov/pub/irs-drop/n-10-59.pdf>.

46 Department of the Treasury. Internal Revenue Service. "Section 105 — Amounts Received Under Accident

and Health Plans, Section 106 — Contributions by Employers to Accident and Health Plans, Section 125 — Cafeteria Plans, Section 220 — Archer MSAs, Section 223 — Health Savings Accounts; Notice 2010-59."

Internal Revenue Bulletin: 2010-39. 27 September 2010. <http://www.irs.gov/pub/irs-drop/n-10-59.pdf>.

47 Department of the Treasury. Internal Revenue Service. "Health Flexible Spending Arrangements not Subject

to $2,500 Limit on Salary Reduction Contributions for Plan Years Beginning before 2013 and Comments

Requested on Potential Modification of Use-or-Lose Rule, Notice 2012-40." Internal Revenue Bulletin: 2012-26. 25 June 2012. <http://www.irs.gov/pub/irs-drop/n-12-40.pdf>.

48 Department of Health and Human Services. Center for Consumer Information and Insurance Oversight. "Frequently Asked Questions from Employers Regarding Automatic Enrollment, Employer Shared

Responsibility, and Waiting Periods." 9 February 2012.

<http://cciio.cms.gov/resources/files/Files2/02102012/employer_faq_bulletin_2_9_12_final.pdf>. 49 "Summary of Benefits and Coverage and the Uniform Glossary; Final Rule." Federal Register 77. 30 (14

February 2012): 8668-8706. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-02-14/pdf/2012-3228.pdf>.

50 "Summary of Benefits and Coverage and the Uniform Glossary; Final Rule." Federal Register 77. 30 (14 February 2012): 8673. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-02-

14/pdf/2012-3228.pdf>.

51 "Summary of Benefits and Coverage and the Uniform Glossary; Final Rule." Federal Register 77. 30 (14

February 2012): 8673. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-02-

14/pdf/2012-3228.pdf>. 52 "Summary of Benefits and Coverage and the Uniform Glossary; Final Rule." Federal Register 77. 30 (14

February 2012): 8673-8676. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-02-14/pdf/2012-3228.pdf>.

53 "Notice to employees." Title 29 U.S. Code § 218b (a): 97. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title29/pdf/USCODE-2011-title29-chap8-sec218b.pdf >.












http://cciio.cms.gov/resources/files/Files2/02102012/employer_faq_bulletin_2_9_12_final.pdf









http://www.gpo.gov/fdsys/pkg/USCODE-2011-title29/pdf/USCODE-2011-title29-chap8-sec218b.pdf

End Notes


54 Department of Labor. Employee Benefits Security Administration. "Guidance on the Notice to Employees of

Coverage Options under Fair Labor Standards Act §18B and Updated Model Election Notice under the Consolidated Omnibus Budget Reconciliation Act of 1985." Technical Release No. 2013-02, 8 May 2013.

<http://www.dol.gov/ebsa/pdf/tr13-02.pdf >.

55 Department of Treasury. Internal Revenue Service. "Interim Guidance on Informational Reporting to

Employees of the Cost of Their Group Health Insurance Coverage, Notice 2012-9." Internal Revenue Bulletin:

2012-4. 3 January 2012. <http://www.irs.gov/pub/irs-drop/n-12-09.pdf>. 56 Saunders, Laura. "Is Taxing Health Plans Next?" Wall Street Journal. 1 February. 2013. Web. 14th Feb 2013.

<http://online.wsj.com/article/SB10001424127887323926104578276322541021826.html>. 57 "Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans;

Exchange Standards for Employers; Final Rule and Interim Final Rule." Federal Register 77. 59 (27 March 2012): 18470. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-03-27/pdf/2012-

6125.pdf>.

58 Department of Treasury. Internal Revenue Service. "Request for Comments on Reporting of Health Insurance

Coverage, Notice 2012-32." Internal Revenue Bulletin: 2012-20. 14 May 2012. <http://www.irs.gov/pub/irs-

drop/n-12-32.pdf>. 59 Department of Treasury. Internal Revenue Service."Request for Comments on Reporting by Applicable Large

Employers on Health Insurance Coverage Under Employer-Sponsored Plans, Notice 2012-33." Internal Revenue Bulletin: 2012-20. 14 May 2012. <http://www.irs.gov/pub/irs-drop/n-12-33.pdf>.

60 "Enforcement." Title 42 U.S. Code § 300gg-22 (b) (2): 1316. GPO Access. Web. 20 Feb 2013.

<http://www.gpo.gov/fdsys/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap6A-subchapXXV-

partA-subpart2-sec300gg-22.pdf>. 61 Department of the Treasury. Internal Revenue Service. "Health Flexible Spending Arrangements not Subject

to $2,500 Limit on Salary Reduction Contributions for Plan Years Beginning before 2013 and Comments Requested on Potential Modification of Use-or-Lose Rule, Notice 2012-40." Internal Revenue Bulletin: 2012-

26. 25 June 2012. <http://www.irs.gov/pub/irs-drop/n-12-40.pdf>.

"Excise Tax on High Cost Employer-sponsored Health Coverage." Title 26 U.S. Code § 4980I - (a) (2): 2881.

Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-

subtitleD-chap43-sec4980I.pdf>.

62 Department of Treasury. Internal Revenue Service. Irs.gov. "Frequently Asked Questions: Retiree Drug

Subsidy." 2013. Web. 14 Feb 2013. <http://www.irs.gov/uac/Newsroom/Frequently-Asked-Questions:-Retiree-Drug-Subsidy>.

63 "Health Insurance." Title 26 U.S. Code§ 4375: 2748. GPO Access. Web. 20 Feb 2013. <http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleD-chap34-

subchapB-sec4375.pdf>.

"Self-insured health plans." Title 26 U.S. Code§ 4376: 2748. GPO Access. Web. 20 Feb 2013.

<http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleD-chap34-

subchapB-sec4375.pdf>.

"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014;

Proposed Rule." Federal Register 77. 236 (7 December 2012): 73118-73218. GPO Access. Web. 14 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-12-07/pdf/2012-29184.pdf>.

Department of the Treasury. Internal Revenue Service. Irs.gov. "ACA Section 1341 Transitional Reinsurance Program FAQs." 2012. Web. 14 Feb 2013. <http://www.irs.gov/uac/Newsroom/ACA-Section-1341-

Transitional-Reinsurance-Program-FAQs>.

64 "Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes Research Trust

Fund, Final Regulations." Federal Register 77. 235 (6 December 2012): 72721. GPO Access. Web. 14 Feb

2013. <http://www.gpo.gov/fdsys/pkg/FR-2012-12-06/pdf/2012-29325.pdf>. 65 "Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage."Federal Register 78. 22

(1February 2013): 7314-7331. GPO Access. Web. 25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-01/pdf/2013-02141.pdf>.

66 "Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage."Federal Register 78. 22 (1February 2013): 7316. GPO Access. Web. 25 Feb 2013. <http://www.gpo.gov/fdsys/pkg/FR-2013-02-

01/pdf/2013-02141.pdf>.


http://online.wsj.com/article/SB10001424127887323926104578276322541021826.html






http://www.gpo.gov/fdsys/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap6A-subchapXXV-partA-subpart2-sec300gg-22.pdf

http://www.gpo.gov/fdsys/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap6A-subchapXXV-partA-subpart2-sec300gg-22.pdf


http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleD-chap43-sec4980I.pdf

http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleD-chap43-sec4980I.pdf

http://www.irs.gov/uac/Newsroom/Frequently-Asked-Questions:-Retiree-Drug-Subsidy

http://www.irs.gov/uac/Newsroom/Frequently-Asked-Questions:-Retiree-Drug-Subsidy

http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleD-chap34-subchapB-sec4375.pdf





http://www.irs.gov/uac/Newsroom/ACA-Section-1341-Transitional-Reinsurance-Program-FAQs

http://www.irs.gov/uac/Newsroom/ACA-Section-1341-Transitional-Reinsurance-Program-FAQs




