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The IRS has given employees relief on the application of the individual mandate to those eligible for health insurance coverage under a fiscal-year plan.

Navigating health reform

IRS Gives Health Plan Participants Relief From Individual Mandate

  • 7/10/2013

The IRS has provided relief for individuals under the Patient Protection and Affordable Care Act (PPACA). Notice 2013-42 describes the application of the individual mandate to employees eligible for health insurance coverage under a fiscal-year plan.

The individual mandate takes effect on January 1, 2014, and is one of the key provisions of the health care law. The IRS continues to issue guidance so that employers, employees, and others understand their benefits and responsibilities under PPACA.

Maintenance of minimum essential coverage

Under the individual mandate, individuals who are not exempt must maintain minimum essential coverage (MEC) for each month beginning on or after January 1, 2014, or pay an individual shared responsibility payment. Individuals are responsible for their dependents. MEC includes coverage under an eligible employer-sponsored plan and other group health insurance coverage.

Under proposed regulations issued in February 2013, an individual has MEC for a month in which the person is enrolled and is entitled to benefits identified as MEC. MEC includes coverage under an eligible employer-sponsored plan. These plans include a group health plan (whether insured or self-insured) or coverage that is:

  • A governmental plan
  • Any other plan or coverage offered within a state
  • A grandfathered plan offered in a group market

Fiscal year plans

A crucial issue is which plans qualify as MEC. Many employer-sponsored plans do not operate on a calendar year. Generally, an employee cannot enroll in a health plan after the plan year begins. The IRS explained that for a fiscal year employer plan that begins in 2013 and ends in 2014, individuals would have to enroll in coverage in 2013 (even though the individual mandate does not yet apply) to have coverage in 2014 (when the mandate does apply).

Proposed regulations regarding the employer shared responsibility payment (the employer mandate) provide transition relief to employers offering a fiscal year plan. If an employer offers adequate coverage for the first fiscal year beginning in 2014, the employer will not be liable for coverage in 2014 in months prior to the beginning of the plan year. The relief is available if the employee was eligible to enroll in the plan as of December 27, 2012.

The IRS provided similar transition relief from the individual mandate to an employee (or related individual) who is eligible to enroll in a fiscal year employer plan that begins in 2013 and ends in 2014. The employee will not be liable for a payment under the individual mandate during the transition period beginning January 2014 and continuing through the end of the 2013-2014 plan year.

The proposed regulations already provide transition relief for cafeteria plan elections for employer-provided health plans with a fiscal year beginning in 2013. Employers may permit employees to make new elections for 2014.

Examples

A taxpayer is unmarried with a five-year-old daughter. They are eligible to enroll in an employer-sponsored plan with a fiscal year beginning August 1, 2013, and ending July 31, 2014, but do not enroll in the plan. The notice concludes that the taxpayer and her daughter are eligible for transition relief for January 2014 through July 2014.

In a second example, a married couple work for separate employers. The individuals are both eligible to enroll in the plans offered by their respective employers, one a fiscal-year plan (August 1, 2013 through July 31, 2014) and one a calendar year plan. Neither individual enrolls in an employer plan. The notice concludes that both individuals are eligible for transition relief for the period in 2014 covered by the fiscal year plan (January 2014 through July 2014), even though the individuals could have enrolled in a calendar year plan.

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