Compensation and Benefits Update: Implementing the New Health Plan Laws

This two-part article covers significant developments in late 2011 and 2012 in employee benefits, including employment taxes, executive compensation, health and welfare benefits, and qualified plans. Part I, published in the November 2012 issue, dealt with qualified retirement plan benefits and executive compensation. This month, Part II focuses on guidance released and changes to the rules for group health plans as a result of the Patient Protection and Affordable Care Act (PPACA).1

Supreme Court Upholds PPACA’s Individual Mandate

The U.S. Supreme Court on June 28, 2012, issued its much-anticipated decision in the consolidated PPACA cases.2 The Court held PPACA’s individual mandate in Sec. 5000A is a valid exercise of Congress’s authority to “lay and collect taxes.” The Supreme Court also upheld PPACA’s expanded Medicaid eligibility provisions but held the federal government could not withhold all federal Medicaid funds from states that do not comply with the new requirements.

Form W-2 Reporting on Group Health Plan Coverage

Notice 2012-93 supersedes Notice 2011-284 regarding reporting on Form W-2, Wage and Tax Statement, of the cost of employer-provided group health plan coverage. This new requirement generally applies beginning with 2012 Forms W-2, which generally are required to be filed in January 2013 (and was optional for 2011 Forms W-2). The core requirements remain the same, with certain notable clarifications and modifications:

Small employer relief: Notice 2012-9 clarifies that the exemption for employers that were required to file fewer than 250 Forms W-2 for 2011 is determined without regard to the use of an agent under Sec. 3504.

Related employers: If an employee is concurrently employed by related employers and one of the employers serves as a common paymaster, the common paymaster is required to include the aggregate reportable cost of coverage that is provided to the employee by all the employers for whom it serves as common paymaster. Notice 2012-9 clarifies that, if the related employers do not compensate through a common paymaster, they may either report the entire aggregate reportable cost on one Form W-2 or allocate the cost among the concurrent employers, using any reasonable method.

Dental and vision plans: Under the prior guidance, dental or vision coverage was excludable from reporting if it was not integrated into a group health plan providing other health care coverage. Under Notice 2012-9, this coverage is excludable if it is offered under a separate policy, certificate, or contract of insurance—or the participants must have the right to decline the benefits (and if they elect coverage, are required to pay an additional premium).5

Cost of coverage includible in income: Notice 2012-9 clarifies that the cost of coverage that is includible in the income of a highly compensated individual under Sec. 105(h) and the payments or reimbursements of health insurance premiums that are includible in the income of a 2% shareholder-employee of an S corporation are not included in the aggregate reportable cost.

Calculating reportable cost: Notice 2012-9 clarifies that, if an employer is using a composite rate to determine the aggregate reportable cost for active employees but not for determining the applicable COBRA (Consolidated Omnibus Budget Reconciliation Act) premium, it may use either the composite rate or the applicable COBRA premium to determine the aggregate reportable cost of coverage—as long as the same method is used consistently for all active employees and is used consistently for all qualifying beneficiaries receiving COBRA coverage.

Employee-assistance programs: Notice 2012-9 clarifies that coverage under an employee-assistance program, wellness program, or on-site medical clinic is subject to the reporting requirements only if it is provided under a group health plan under Sec. 5000(b)(1). If so, the coverage is required to be included in the aggregate reportable cost of coverage only if the employer charges a premium for COBRA (or other federal) continuation coverage. Employers that do not charge such premiums and those not subject to COBRA (or other federal) continuation coverage requirements are not required to include the cost of coverage in the aggregate reportable cost of coverage.

Permissible inclusion: Employers are permitted to include the cost of coverage that is not required to be included (e.g., coverage under a health reimbursement arrangement (HRA), a multiemployer plan, an employee-assistance program, wellness program, or on-site medical clinic) in the aggregate reportable cost, as long as the coverage constitutes applicable employer-sponsored coverage (i.e., is coverage under a group health plan that is made available by an employer to an employee and is excludable from the employee’s gross income under Sec. 106) and the calculation of the cost otherwise meets the requirements.

Programs with other benefits: If a program provides benefits that constitute applicable employer-sponsored coverage and other benefits, the employer may use any reasonable method to determine the cost of the portion that constitutes applicable employer-sponsored coverage. Moreover, if that portion is only incidental in comparison with the other portion, the employer is not required to include either portion in the aggregate reportable cost.

Dec. 31 information: The aggregate reportable cost may be based on the information available to the employer as of Dec. 31 each year. Elections or notifications made in the subsequent calendar year that have a retroactive effect on coverage need not be taken into account in calculating the aggregate reportable cost for the preceding year. Further, employers are not required to provide a Form W-2c, Corrected Wage and Tax Statement, if a Form W-2 has already been provided.

Coverage period spanning Dec. 31: For coverage periods that include Dec. 31 but cross into the next calendar year, employers can treat the whole coverage period as provided for the year that includes Dec. 31, treat the whole coverage period as provided for the subsequent year, or allocate the cost of coverage between the two years using any reasonable approach (which must generally relate to the number of days in the coverage period that fall within each of the years). Any chosen method must be applied consistently to all employees.

Indemnity plans: The cost of coverage under a hospital indemnity or other fixed indemnity insurance (or the cost of coverage for only a specified disease or illness) must be included in the aggregate reportable cost if the employer makes any contribution to the cost of coverage that is excludable under Sec. 106 or the employee purchases the policy on a pretax basis under a Sec. 125 cafeteria plan. In contrast, if the payment for the benefits is includible in the employee’s gross income, the cost of coverage is not required to be included in the aggregate reportable cost.

Third-party sick-pay providers: Third-party sick-pay providers are not required to report aggregate reportable cost on Form W-2.

The IRS later released a concise set of frequently asked questions, along with a useful chart that sets out the reporting requirements applicable to different types of situations and coverage.6

Medical Loss Ratio Rebates

With a series of online frequently asked questions and answers, the IRS addressed the federal income and employment tax treatment of medical loss ratio (MLR) rebates that are distributed to employees participating in employer group health plans.7 The underlying analysis is specific to the facts in various scenarios, but general rules emerge. (See the exhibit.)

Plan sponsors may be subject to restrictions in handling the MLR rebates. The Department of Labor (DOL) issued a Technical Release explaining the analysis and procedures required by ERISA (Employee Retirement Income Security Act) group health plan sponsors.8

Research Fees on Self-Insured Health Plans

For plan years ending on or after Oct. 1, 2012, and before Oct. 1, 2019, fees will be imposed on issuers of health policies and self-insured group health plans to fund a new nonprofit corporation to advance evidence-based medicine. The IRS issued proposed regulations identifying the plans and policies that are subject to the fee, specifying how the fees will be calculated, and prescribing the filing and payment requirements.9 The proposed regulations explicitly provide that plan sponsors and issuers are entitled to rely on the terms of the proposed regulations until final regulations are issued. The core features of the regime include:

Per-person fee amount: For plan years ending on or after Oct. 1, 2013, and before Oct. 1, 2014, the fee for self-insured health plans is $2 ($1 for plan years ending before Oct. 1, 2013), multiplied by the average number of lives covered during the plan year. For plan years ending on or after Oct. 1, 2014, the fee is increased relative to increases in the projected per capita amount of national health expenditures announced by the Department of Health and Human Services. Identical fees apply to issuers of any accident or health policy, including a policy under a group health plan that is issued with respect to individuals residing in the United States, but the fee is based on the policy year instead of the plan year. These fees are imposed by Sec. 4375 in the case of health policies and Sec. 4376 in the case of self-insured health plans.

Obligor: The issuer is liable for the fees imposed on individual policies, while the plan sponsor is liable for fees imposed on self-insured group health plans. According to the preamble, the DOL is considering whether the fees may be paid with plan assets where a self-insured plan is subject to ERISA.

Self-insured health plan: Under Sec. 4376, the fee is imposed on any plan that provides health coverage if any portion is provided other than through an insurance policy and the plan is maintained by one or more employers for the benefit of their employees or former employees.10 Retiree-only plans fall within this definition, as well as plans maintained by employee organizations for their members or former members and other sponsors and plans funded in voluntary employees’ beneficiary associations.

HRAs: An HRA may or may not be subject to the fee. If the HRA is integrated with a self-insured health plan that provides major medical coverage and is established or maintained by the same plan sponsor as the HRA, the combined arrangement is subject to a single fee. However, an HRA that is integrated with an insured group health plan will itself be subject to the fee even if both the HRA and the plan are maintained by the same plan sponsor.

Excepted benefits: A plan that provides benefits substantially all of which are “excepted” under Sec. 9832(c) is not subject to the fee. Excepted benefits include limited-scope dental or vision benefits if they are offered separately, hospital indemnity or specified illness coverage if the coverage is not coordinated with any sponsor’s group health plan, accident-only coverage, and disability-only coverage.

Health FSAs: Health flexible spending arrangements (health FSAs) that meet the definition of an excepted benefit under Sec. 9832(c) are also not subject to the fee. A health FSA is excepted if (1) other group health plan coverage, not limited to excepted benefits, is made available to the participants for the year and (2) the maximum benefit payable under the health FSA for the year does not exceed two times the participant’s salary reduction election (or, if greater, $500 plus the participant’s salary reduction election).11 Other health FSAs are subject to the fee. However, if the health FSA is integrated with another self-insured health plan that provides major medical coverage and is maintained by the same plan sponsor as the health FSA, a single fee will apply.

Calculation of the fee: The fee for the plan year is determined by multiplying the applicable per-person amount by the average number of lives covered under the plan for the plan year. The plan sponsor can calculate the average number of covered lives in one of three permissible methods: the actual count method; the snapshot method; or the Form 5500, Annual Return/Report of Employee Benefit Plan, method. The same method must be used consistently for the duration of the plan year, although a different method may be used from one year to the next. Under a special counting rule, each participant’s health FSA or HRA not treated as a combined plan is treated as covering a single covered life (i.e., the sponsor is not required to include any spouse, dependent, or other beneficiary).

Reasonable method permitted: For plan years beginning before July 16, 2012, and ending on or after Oct. 1, 2012, plan sponsors were permitted to use any reasonable method to determine the average number of covered lives.

Filing of return and payment of fee: Plan sponsors and issuers will report and pay the fees only once per year, on Form 720, Quarterly Federal Excise Tax Return, which is due by July 31 of the following year in the case of a calendar plan year. The form may be filed electronically. A mechanism for third-party reporting and payment will not be established, according to the proposed regulations’ preamble.

New $2,500 Health FSA Contribution Limit

Notice 2012-4012 addresses the $2,500 limit on employee salary reduction contributions to health FSAs.13 The new limit applies to the first plan year that begins after Dec. 31, 2012. Since a plan year can be changed only for a valid business purpose, the notice cautions that if a plan’s year is changed from a calendar year to a fiscal year for the purpose of delaying the application of the $2,500 limit, the change will be ineffective. Short plan years that begin after 2012 must prorate the $2,500 limit based on the number of months in the short plan year. For plan years beginning after 2013, the $2,500 limit will be adjusted for inflation in multiples of $50.14 Plan amendments to incorporate the limit may be adopted as late as Dec. 31, 2014, and be retroactively effective to the first plan year beginning after 2012, as long as the plan is in operational compliance during that time.

The $2,500 limit applies only to salary reduction contributions, not to employer nonelective contributions (i.e., flex credits). The limit is per employee, per employer (determined on a controlled-group basis). If an employee participates in multiple health FSAs maintained by unrelated employers, the employee may contribute $2,500 to each. Spouses who are both eligible to contribute to a health FSA may each make a $2,500 salary reduction contribution—even if both participate in the same health FSA maintained by the same employer. The limit applies only to salary reduction contributions to a health FSA—not pretax premium contributions to pay for health plan coverage or salary reduction contributions for dependent care or adoption assistance, or salary reduction contributions to a health savings account (HSA). If a health FSA has a grace period (e.g., up to 2½ months after the close of the plan year), unused salary reduction contributions carried over to the grace period within the next plan year will not count against the $2,500 limit for the next plan year.

Relief is provided for contributions that mistakenly exceed the $2,500 limit if they are corrected in a timely manner. The relief is available if (1) the terms of the plan apply uniformly to all participants; (2) the error results from a reasonable mistake by the employer or its agent; and (3) the excess salary reduction contributions are paid to the employee and reported as wages for employment tax and withholding purposes on the employee’s Form W-2 for the employee’s tax year in which ends the plan year in which the correction is made. The relief is not available if the employer’s federal tax return is under examination with regard to cafeteria plan benefits that were provided during the plan year in which the failure occurred.

“Minimum Value” of Employer Group Health Plans

Beginning in 2014, large employers (with 50 or more full-time employees) that offer health coverage will be liable for a penalty equal to $250 per month ($3,000 per year) for each full-time employee who elects coverage through an exchange and receives a premium tax credit or cost-sharing reduction for that coverage.15 Large employers that do not offer health coverage will be liable for a penalty if any full-time employee elects coverage through an exchange and receives a premium tax credit or cost-sharing reduction. However, in that case, the penalty will be equal to $166.67 per month ($2,000 per year) for each full-time employee.16

Individuals with household incomes up to four times the federal poverty level—for example, up to $92,200 for a family of four in 2012—are potentially eligible for the credit and cost-sharing reduction.17 An individual is not eligible for a premium tax credit or cost-sharing reduction if the coverage offered by the employer is affordable (the employee’s contribution does not exceed 9.5% of household income) and it provides minimum value (the plan’s share of the cost of allowed benefits is at least 60%).18 Therefore, large employers offering health coverage to their employees may avoid the penalty by ensuring that the coverage offered is affordable and provides minimum value. The IRS last year proposed a safe harbor by which employers would be deemed to provide affordable coverage if the employee portion of the self-only premium for the employer’s lowest-cost coverage is not more than 9.5% of the employee’s Form W-2 Box 1 amount (total wages).19 Notice 2012-3120 proposes to allow employer-sponsored plans to use one of three approaches in determining whether the plan provides minimum value:

1. Minimum value calculator: The government intends to develop a calculator into which employer-sponsored self-insured plans and insured large group plans could enter cost-sharing information to determine whether the plan meets the 60% threshold. The intention is that the calculator would be used by plans with standard cost-sharing features. The notice identifies four core categories of benefits for which cost-sharing information (i.e., deductibles, coinsurance, and maximum out-of-pocket costs) would be entered:

• Physician and midlevel practitioner care;
• Hospital and emergency room services;
• Pharmacy benefits; and
• Laboratory and imaging services.

Employer contributions to HSAs and amounts made available under HRAs would count as coverage provided under the plan (in a manner similar to that under the calculator).

2. Design-based safe-harbor checklists: This method uses an array of safe-harbor checklists for employer-sponsored plans to assess their coverage. If the plan’s terms are consistent with (or more generous than) any of the safe-harbor checklists, the plan would be treated as providing minimum value.

3. Actuarial certification: Plans with nonstandard features (e.g., quantitative limits on any of the four categories of benefits, such as limits on the number of physician visits or days in the hospital) would be able to use the calculator, engaging an actuary to make appropriate adjustments for the nonstandard features. For plans with nonstandard features of a certain type or magnitude, actuarial certification would also allow an actuary to determine the plan’s value without using the calculator.

Premium Tax Credits for Individuals Purchasing Insurance From the Exchanges

Individuals who enroll in a qualified health plan (QHP) through an exchange may obtain advance payment of a premium tax credit to facilitate the purchase. Beginning in 2014, a refundable tax credit is available for any month a taxpayer whose household income is at least equal to (but not more than four times) the federal poverty level (or spouse or dependent of the taxpayer) is enrolled in a QHP through an exchange and is not eligible for “minimum essential coverage” (other than coverage in the individual market).21

“Minimum essential coverage” refers to government-sponsored programs (such as Medicare, Medicaid, or the Children’s Health Insurance Program), eligible employer-sponsored plans, grandfathered health plans, and certain other health benefit coverage.22 An employee is not treated as eligible for minimum essential coverage, however, unless the employer’s plan provides minimum value (i.e., the plan’s share of the total allowed costs of benefits provided under the plan is at least 60%) and is affordable (i.e., the annual premium the employee must pay for self-only coverage does not exceed 9.5%23 of the employee’s household income for the year).

The exchange is required to determine whether an individual is eligible for advance payment of the premium tax credit and the amount of the payment. HSAs do not affect the affordability of employer-sponsored coverage because active employees generally cannot use HSA contributions to pay premiums. It is not yet clear how HRA amounts that can be used to pay premiums will affect the affordability of employer-sponsored plans. Wellness programs that change an employee’s share of premiums may affect the affordability of an employer-sponsored plan, although these rules are still being developed. It is not clear how an employee can be sure of qualifying for the incentive at the time his or her eligibility is being examined for advance payment of the premium credit.

Individuals are treated as not eligible for minimum essential coverage under an employer-sponsored plan during a waiting period to become eligible for coverage (e.g., 90 days after hire). For that period, the individual could be eligible for premium tax credits to purchase a QHP through the exchange. Similarly, individuals are to be treated as eligible for minimum essential coverage under an employer-sponsored plan by reason of continuation coverage only for months the individual is actually enrolled in the continuation coverage. Despite being automatically enrolled, an employee will be treated as not enrolled in an employer-sponsored plan for those months if he or she timely terminates the coverage. Individuals who are not tax dependents but who enroll in employer-sponsored coverage based on their relationship to the employee (e.g., adult children or domestic partners) are considered eligible for minimum essential coverage only when actually enrolled in the plan. Future guidance is needed to determine affordability for family members.

Determining Full-Time Employees

Employers need to determine the number of individuals employed full time to determine whether the penalty provisions under Sec. 4980H apply. An employer is an “applicable large employer” for a calendar year if, during the preceding calendar year, it employed on average at least 50 full-time employees.24 An employee is a full-time employee for any month if he or she was employed, on average, at least 30 hours per week.25 Special rules apply in making these calculations.26

Notice 2012-5827 provides employers with an optional safe harbor for determining whether employees are full time. Slightly different safe harbors are available for ongoing employees and newly hired employees. Both are based on the concept of a “measurement period” (a lookback period for determining whether the employee is full time), a “stability period” (a period going forward during which the determination applies), and an “administrative period” (a short period between the end of the measurement period and the beginning of the stability period, during which the employee’s full-time status is determined and the employee is offered coverage).

Ongoing Employees

For ongoing employees, under the notice’s safe-harbor rule, the employer is permitted to determine full-time status by looking at a “standard measurement period” it has designated. A standard measurement period cannot be less than three or more than 12 consecutive calendar months. If, based on the standard measurement period, the employee is determined to be full time, a stability period applies that lasts no less than six consecutive calendar months and at least as long as the standard measurement period.

During the stability period, the employee is considered full time for purposes of the employer’s obligation to offer minimum coverage. If the employee is determined not to be full time, the employee is considered not full time during the following stability period—however, in that case, the stability period cannot last longer than the standard measurement period (i.e., the six-month minimum does not apply). The employer must apply these periods on a uniform and consistent basis to all employees within a designated category. Permissible categories of employees include collectively bargained, non–collectively bargained, hourly, salaried, employees in different states, and employees employed by different entities.

To allow time to make the determination and notify and enroll employees who are determined to be full time, the employer may use an administrative period after the standard measurement period and before the stability period. The administrative period cannot exceed 90 days and will not create gaps in coverage. Employees covered under the plan as full-time employees immediately prior to the administrative period (based on a prior standard measurement period) would continue to be covered during the administrative period.

New Employees Expected to Work Full Time

For newly hired employees who are reasonably expected to work full time, the employer penalty for failure to offer coverage under Sec. 4980H(a) will apply after the first three months of employment (i.e., the employer gets a maximum of three calendar months before the penalty will apply for such an employee).

New Variable-Hour or Seasonal Employees

A safe harbor similar to the one for ongoing employees is available for newly hired employees who work on a variable-hour or seasonal basis. A variable-hour employee is one with respect to whom, based on all the facts and circumstances at the start date, it cannot be determined whether the employee is reasonably expected to work at least 30 hours a week on average. A seasonal employee is not defined, and Notice 2012-58 allows employers to use a good-faith interpretation through at least 2014.

For these newly hired seasonal and variable-hour employees, the safe harbor allows an employer to establish an initial measurement period of between three and 12 consecutive months as the lookback period for determining whether the employee worked an average of at least 30 hours per week. As with the safe harbor for ongoing employees, the administrative period may not exceed 90 days. Together, the initial measurement period and the administrative period may not extend beyond the last day of the calendar month that begins on or after the one-year anniversary of the employee’s start date (i.e., totaling, at most, 13 months and a fraction of a month). The stability period must be the same length as for ongoing employees, with slight permitted modifications.

For employees determined to be full time, the stability period must be no less than six consecutive calendar months and at least as long as the initial measurement period. For employees determined not to be full time, the stability period must not be more than the initial measurement period plus one month—and must not exceed the remainder of the ongoing employees’ standard measurement period (and associated administrative period) in which the initial measurement period ends. Once a new employee has been employed for an initial measurement period and has been employed for an entire standard measurement period, the employee must be tested for full-time status beginning with that standard measurement period, under the same conditions as other ongoing employees.

Reliance

Employers can rely on the safe harbors through at least the end of 2014. This reliance covers measurement periods that begin in 2013 or 2014 and the associated stability periods, which may extend into 2014, 2015, or 2016.

Maximum 90-Day Waiting Period

Effective for plan years beginning in 2014, group health plans (and issuers of group health coverage) are prohibited from imposing a waiting period of more than 90 days. Notice 2012-5928 explains that a waiting period is the period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll under the terms of the plan can become effective. An employer is not required to offer coverage to any particular employee or class of employees, but once an individual becomes eligible for coverage under the terms of the plan, he or she cannot be forced to wait more than 90 days for that coverage to become effective. Other eligibility conditions are generally permissible unless they are designed to avoid compliance with the 90-day limit. An eligibility condition based on hours worked is permitted as long as no more than 1,200 cumulative hours of service are required. A plan that allows an individual to take additional time to elect coverage (so that the coverage becomes effective outside the 90-day limit) will satisfy the requirement as long as the individual could have elected coverage to begin within the 90-day period.

Plans that condition eligibility on working full time or working a specified number of hours per pay period are permitted to use the safe-harbor methodology in Notice 2012-58 for determining whether a newly hired variable-hour employee is expected to work the requisite number of hours. A lookback measurement period of up to 12 months can be used to determine whether an employee meets the plan’s eligibility condition. The period for determining whether an employee meets the hours condition will pass muster as long as coverage becomes effective, for an employee who is determined to meet the hours requirement, no later than 13 months after the employee’s start date (plus, if the employee’s start date is not the first day of the month, the time remaining until the first day of the next calendar month).

The guidance on the 90-day limit will remain in effect at least through the end of 2014.

This publication contains general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional adviser. Deloitte, its affiliates and related entities, shall not be responsible for any loss sustained by any person who relies on this publication.

Authors’ note: The authors gratefully acknowledge the valuable assistance provided by Balasubramanian Yogishwar and Sandra Rolitsky in compiling this article.

Footnotes

¹ Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act, P.L. 111-152.

² National Federation of Independent Business v. Sebelius, Sup. Ct. Dkt. No. 11-393 (U.S. 6/28/12).

³ Notice 2012-9, 2012-4 I.R.B. 315.

⁴ Notice 2011-28, 2011-16 I.R.B. 656.

⁵ See also Regs. Sec. 54.9831-1(c)(3).

⁶ Available here. 

⁷ Available here. 

⁸ Department of Labor Technical Release 2011-04.

⁹ REG-136008-11.

¹⁰ Sec. 4376(c).

¹¹ Regs. Sec. 54.9831-1(c)(3)(v).

¹² Notice 2012-40, 2012-25 I.R.B. 1046.

¹³ Sec. 125(i), as amended by the Patient Protection and Affordable Care Act, §9005.

¹⁴ Sec. 125(i)(2).

¹⁵ Sec. 4980H(b). Exchanges are government agencies or nonprofit entities established by the states (or the federal government in states that do not establish an exchange) that will make qualified health plans available to individuals and employers (PPACA §1311(d)).

¹⁶ Secs. 4980H(a) and (c).

¹⁷ Sec. 36B(b)(3)(A).

¹⁸ Sec. 36B(c)(2)(C).

¹⁹ Notice 2011-73, 2011-40 I.R.B. 474.

²⁰ Notice 2012-31, 2012-20 I.R.B. 906.

²¹ Sec. 36B.

²² Sec. 5000A(f)(1).

²³ The 9.5% may be adjusted for years after 2014 to reflect the rate of premium growth relative to income growth (Sec. 36B(c)(2)(C)(iv)).

²⁴ Sec. 4980H(c)(2).

²⁵ Sec. 4980H(c)(4).

²⁶ See Notice 2011-36, 2011-21 I.R.B. 792.

²⁷ Notice 2012-58, 2012-41 I.R.B. 436.

²⁸ Notice 2012-59, 2012-41 I.R.B. 443.