ACA compliance: What qualifies as an offer of health care coverage?

Published Updated 5 Min Read

Whether an employer makes the requisite offer of group health plan coverage is critical to the application of the Affordable Care Act’s employer shared responsibility rules as reflected in final implementing regulations issued earlier this year (and see here for a useful IRS summary of those rules). The rules are codified in a newly added provision of the Internal Revenue Code, i.e., Code § 4980H. Generally, Code § 4980H imposes penalties or “assessable payments” where “at least one full-time employee” qualifies for subsidized coverage from a public exchange, and either:

  • “An 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 . . . for any month,” or
  • “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 . . .” but that coverage is either unaffordable or fails to provide minimum value.
Alden J. Bianchi
Practice Group Leader

Bianchi is the practice group leader of the Mintz Levin's employee benefits & executive compensation practice, where he advises corporate, not-for-profit, governmental, and individual clients on … Read full bio

Edward A. Lenz
Senior Adviser

Lenz is a senior adviser for the employment, labor and benefits practice in Mintz Levin's Washington DC office. He is one of the nation’s leading authorities on the legal and public policy aspects of … Read full bio


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