Small employers will be able to purchase health insurance for their employees for 2014 and subsequent years through Small Business Health Options Program (SHOP) Marketplaces. Many of these small employers may also be eligible for the Code Sec. 45R tax credit that helps to offset the cost of insurance. In August, the IRS issued new rules on the Code Sec. 45R small employer health insurance credit in the form of proposed regulations. The regulations describe in detail how employers can claim the credit, especially for years after 2013.

Tax credit

The Code Sec. 45R credit was created by the Patient Protection and Affordable Care Act (Affordable Care Act) to encourage small employers to offer health insurance coverage to their employees. A small employer is eligible for the credit if it has fewer than 25 full-time employees (FTEs); the average annual wages of employees are less than $50,000 (adjusted for inflation after 2013), and the employer pays at least 50 percent of the cost of premiums. The Code Sec. 45R credit phases-out for employers if the number of FTEs exceeds 10, or if the average annual wages for FTEs exceed $25,000 (adjusted for inflation after 2013). The phaseout of the credit operates in such a way that an employer with exactly 25 FTEs, or with average annual wages exactly equal to $50,000 (adjusted for inflation after 2013), is not eligible for the credit.

SHOP Marketplaces

When Congress passed the Affordable Care Act in 2010 there was no requirement that employers obtain insurance through a SHOP Marketplace (because they did not exist). The requirement to offer insurance through a SHOP Marketplace starts after 2013. SHOP Marketplaces are scheduled to open on October 1, 2013, with coverage starting January 1, 2014.

Employees and hours of service

Determining who is an “employee” requires a complex calculation. Critics of the credit have said this complexity has discouraged small employers from taking advantage of the credit. For example, the Affordable Care Act and the regulations exclude certain employees from being counted as FTEs because of their status. These include sole proprietors, partners, and their family members (spouses, children, step-children, parents, and other family members). There are also special rules for seasonal workers, part-time workers and leased employees.

Employers must also calculate how many hours service each employee performs. Hours of service include vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty, or leave of absence, but hours in excess of 2,080 for a single employer are excluded. The IRS allows employers to calculate hours of service using any of three methods: actual hours worked; days-worked equivalency; or weeks-worked equivalency.

Let’s look at an example from the IRS:

ABC Co. pays five employees wages for 2,080 hours each, three employees wages for 1,040 hours each, and one employee wages for 2,300 hours. The employer uses the actual hours worked method to calculate hours of service. The employer’s FTEs would be calculated as follows:

10,400 hours for the five employees paid for 2,080 hours (5 x 2,080)
3,120 hours for the three employees paid for 1,040 hours (3 x 1,040)
2,080 hours for the one employee paid for 2,300 hours (lesser of 2,300 and 2,080)

The total hours counted is 15,600 hours. The employer has seven FTEs (15,600 divided by 2,080 = 7.5, rounded to the next lowest whole number).

Maximum credit

For tax years beginning during or after 2014, the maximum Code Sec. 45R credit is 50 percent. The maximum credit for tax-exempt employers for tax years beginning during or after 2014 is 35 percent.  These percentages were lower before 2014 (35 percent for for-profit employers and 25 percent for tax-exempt employers).

The IRS explained in the proposed regulations that an employer may claim the credit for two-consecutive tax years, beginning with the first tax year in or after 2014 in which the eligible small employer attaches a Form 8941, Credit for Small Employer Health Insurance Premiums, to its income tax return, or in the case of a tax-exempt eligible small employer, attaches a Form 8941 to the Form 990-T, Exempt Organization Business Income Tax Return. 

Transition rules

Through the proposed regulations, the IRS has provided employers some relief pending the transition into the 2014 tax year. For example, an eligible small employer does not need to switch plans mid-year to comply with the requirement that an employer offer coverage to its employees through a SHOP Exchange. An employer that has a plan year that begins after the start of its tax year may count premiums paid for the entire 2014 taxable year if the employer begins offering coverage through a SHOP Exchange on the first day of the 2014 health plan year; and the employer offers coverage during the period before the first day of the 2014 health plan year that would have qualified the employer for the credit under the rules applicable to years before 2014.

Reliance regulations

The proposed regs won’t be officially effective until finalized. Taxpayers, however, may rely on the proposed regs for tax years beginning after December 31, 2013, and before December 31, 2014. If future guidance is more restrictive, the IRS explained that future guidance would be applied without retroactive effect and employers will be given time to come into compliance.

If you have any questions about the Code Sec. 45R credit, please contact our office.

NPRM REG 113792-13