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Information You Need to Use the Estimator

Because of the complexity of the credit, you need to gather some documentation before using the Estimator. You need information on:

  • Yourself,
  • Your insurance plans, and
  • Your employees.

Yourself

    You need to have the following information on yourself:

  • The total amount you pay out of pocket towards your eligible employees' health insurance premiums under a qualifying arrangement,
    • Wellness programs. A wellness program is generally an insurance program of health promotion or disease prevention. If you pay part or all of the cost of an employee's participation in a wellness program, use the amount you paid to figure your employer premiums paid.
    • Tobacco surcharges. A tobacco surcharge is generally an additional amount charged for insurance for a tobacco user. If you pay part or all of an employee's tobacco surcharge, you cannot use the amount you paid to figure your employer premiums paid.
    • Dependent coverage. Dependent coverage is generally coverage offered separately to an individual who is or may become eligible for coverage under the terms of a group health plan because of a relationship to a participant-employee, whether or not a dependent of the participant-employee. Dependent coverage does not include coverage, such as family coverage, which includes coverage of the participant-employee. If you pay part or all of the cost of an employee's dependent coverage, use the amount you paid to figure your employer premiums paid.
    • Portion of Premiums Paid. If you pay only a portion of the premiums and your employees pay the rest, only the portion you pay is taken into account. For this purpose, any premium paid through a salary reduction arrangement under a section 125 cafeteria plan is not treated as an employer paid premium. For more information on cafeteria plans, see section 1 of Publication 15-B, Employer's Tax Guide to Fringe Benefits.
  • Whether you received subsidies or tax credits from a state for providing insurance to your employees and the amount, and
    • State subsidies and credits. If you are entitled to a state tax credit or a state premium subsidy paid directly to you for premiums you paid, do not reduce the amount you paid by the credit or subsidy amount. Also, if a state pays a premium subsidy directly to your insurance provider, treat the subsidy amount as an amount you paid for employee health insurance coverage.
  • Whether or not you are an eligible tax-exempt employer and if so, the amount of your payroll taxes for the year.

If you are an eligible tax-exempt employer, the credit cannot exceed the amount of certain payroll taxes. For tax years beginning in 2014, payroll taxes, for this purpose, mean only the following taxes:

  • Federal income taxes you were required to withhold from employees' wages in calendar year 2014,
  • Medicare taxes you were required to withhold from employees' wages in calendar year 2014, and
  • Medicare taxes you were required to pay for calendar year 2014.

Insurance Plans

Generally, you must pay a uniform percentage (not less than 50%) of the premium cost for each enrolled employee's health insurance coverage. This step will assist you to determine whether you meet this requirement.

You need to have the following information on each plan you offer:

  • The plan name,
  • The state and county where the plans are offered,
    • Average premium limitation. Your credit is reduced if the employer premiums paid are more than the employer premiums that would have been paid if individuals considered employees were enrolled in a plan with a premium equal to the average premium for the small group market in the rating area in which the employee enrolls for coverage.
  • The total premium for each tier of coverage,
    • Wellness program. If a plan provides a wellness program, for purposes of meeting the uniform percentage requirement any additional amount of your contribution attributable to an employee's participation in the wellness program over your contribution with respect to an employee that does not participate in the wellness program is not taken into account in calculating the uniform percentage requirement.
    • Tobacco surcharges. Any additional amount you or your employee pay to cover a tobacco surcharge is not taken into account in figuring the uniform percentage requirement.
    • Dependent coverage. Premiums you pay for dependent coverage are not subject to the uniform percentage requirement. You are not required to pay a uniform percentage (not less than 50%) for dependent coverage.
    • Stand-alone dental plan. A stand-alone dental plan offered through a SHOP exchange will be considered a qualified health plan for purposes of the credit.
  • How much you pay toward the cost of coverage (whether as a percent of the total or a dollar amount) per employee, and
    • This is used to determine whether you meet the uniform percentage requirement.
  • How many of your employees are enrolled in each tier.

Your Employees

You need to have the following information on your employees:

  • Total wages you paid to all your employees,
  • The number of employees that worked at least 2,080 hours for you during the year, and
  • The time your other employees worked for you (those that worked less than 2,080 hours).

Individuals Considered Employees

In general, all employees who perform services for you during the tax year are taken into account in determining your FTEs, average annual wages, and premiums paid. However, certain employees are not taken into account at all and there are special rules in taking into account others.

Excluded Employees

The following individuals are not considered employees when you figure this credit. Hours and wages of these employees and premiums paid for them are not counted when you figure your credit.

  • The owner of a sole proprietorship.
  • A partner in a partnership.
  • A shareholder who owns (after applying the section 318 constructive ownership rules) more than 2% of an S corporation.
  • A shareholder who owns (after applying the section 318 constructive ownership rules) more than 5% of the outstanding stock or stock possessing more than 5% of the total combined voting power of all stock of a corporation that is not an S corporation.
  • A person who owns more than 5% of the capital or profits interest in any other business that is not a corporation.
  • Family members or a member of the household who is not a family member but qualifies as a dependent on the individual income tax return of a person listed above. Family members include:
    • A child (or descendant of a child),
    • A sibling or step-sibling,
    • A parent (or ancestor of a parent),
    • A step-parent,
    • A niece or nephew,
    • An aunt or uncle,
    • A son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law.
    A spouse is also considered a family member for this purpose.

Former Employees

Premiums paid on behalf of a former employee with no hours of service may be treated as paid on behalf of an employee for purposes of figuring the credit provided that if so treated, the former employee is also treated as an employee for purposes of the uniform percentage requirement.

Leased Employees

Do not use premiums paid by the leasing organization to figure your credit. Also, a leased employee who is not a common law employee is considered an employee for credit purposes if he or she does all the following:

  • Provides services to you under an agreement between you and a leasing organization.
  • Has performed services for you (or for you and a related person) substantially full time for at least 1 year.
  • Performs services under your primary direction or control.

But do not use hours, wages, or premiums paid with respect to the initial year of service on which leased employee status is based.

Seasonal Employees

Employees who perform labor or services on a seasonal basis and perform labor or services for you 120 or fewer days during the tax year are not considered employees in determining FTEs and average annual wages. But premiums paid on their behalf are counted in determining the amount of the credit.

Seasonal workers include retail workers employed exclusively during holiday seasons. Seasonal workers also include workers employed exclusively during the summer.

Household and Other Nonbusiness Employees

Household employees and other employees who are not performing services in your trade or business are considered employees if they otherwise qualify as discussed above. A sole proprietor must include both business and nonbusiness employees to determine FTEs, average annual wages, and premiums paid.

Ministers

A minister performing services in the exercise of his or her ministry is treated as self-employed for Social Security and Medicare purposes.

However, for credit purposes, whether a minister is an employee or self-employed is determined under the common law test for determining worker status. Self-employed ministers are not considered employees.

KEY TERMS

Eligible Employees

In general, all employees who perform services for you during the tax year are taken into account in determining your FTEs, average annual wages, and premiums paid.

You can generally calculate your FTEs by adding up the hours of service for all of your employees and then dividing that by 2,080 (which is a full time employee - 40 hours a week at 52 weeks per year).

Former Employees

Premiums paid on behalf of a former employee with no hours of service may be treated as paid on behalf of an employee for purposes of figuring the credit provided that, if so treated, the former employee is also treated as an employee for purposes of the uniform percentage requirement.

Leased Employees

Do not use premiums paid by the leasing organization to figure your credit. Also, a leased employee who is not a common law employee is considered an employee for credit purposes if he or she does all the following:

  • Provides services to you under an agreement between you and a leasing organization,
  • Has performed services for you (or for you and a related person) substantially full time for at least 1 year, and
  • Performs services under your primary direction or control.

But do not use hours, wages, or premiums paid with respect to the initial year of service on which leased employee status is based.

Seasonal Employees

Employees who perform labor or services on a seasonal basis and perform labor or services for you 120 or fewer days during the tax year are not considered employees in determining FTEs and average annual wages. But premiums paid on their behalf are counted in determining the amount of the credit.

Seasonal workers include retail workers employed exclusively during holiday seasons. Seasonal workers also include workers employed exclusively during the summer.

Household and Other Nonbusiness Employees

Household employees and other employees who are not performing services in your trade or business are considered employees if they otherwise qualify as discussed above. A sole proprietor must include both business and nonbusiness employees to determine FTEs, average annual wages, and premiums paid.

Ministers

A minister performing services in the exercise of his or her ministry is treated as self-employed for Social Security and Medicare purposes.

However, for credit purposes, whether a minister is an employee or self-employed is determined under the common law test for determining worker status. Self-employed ministers are not considered employees.

Excluded Employees

The following individuals are not considered employees when you figure this credit. Hours and wages of these employees and premiums paid for them are not counted when you figure your credit.

  • The owner of a sole proprietorship.
  • A partner in a partnership.
  • A shareholder who owns (after applying the section 318 constructive ownership rules) more than 2% of an S corporation.
  • A shareholder who owns (after applying the section 318 constructive ownership rules) more than 5% of the outstanding stock or stock possessing more than 5% of the total combined voting power of all stock of a corporation that is not an S corporation.
  • A person who owns more than 5% of the capital or profits interest in any other business that is not a corporation.
  • Family members or a member of the household who is not a family member but qualifies as a dependent on the individual income tax return of a person listed above. Family members include:
    • A child (or descendant of a child),
    • A sibling or step-sibling,
    • A parent (or ancestor of a parent),
    • A step-parent,
    • A niece or nephew,
    • An aunt or uncle,
    • A son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law.
    A spouse is also considered a family member for this purpose.

Eligible Tax Exempt Employers

A tax-exempt small employer is an eligible small employer described in section 501(c) that is exempt from taxation under section 501(a). A tax-exempt employer not described in section 501(c) is generally not eligible to claim this credit. However, a tax-exempt farmers' cooperative subject to tax under section 1381 may be able to claim it as a general business credit.

Hours of Service

Count both the time your employees worked for you and for the time that you paid (and were supposed to pay) them for time off, such as vacation, holidays, illness, incapacity (including disability), layoff, jury duty, military duty, or leave of absence.

Also, if any of your employees took more than 160 hours of continuous paid time off (as described above) you only need to count the first 160 hours. If your employees have more than 2,080 hours, only count the first 2,080.

Net Premium Payments

In the case of an employer receiving a State tax credit or State subsidy for providing health insurance to its employees, net premium payments are the excess of the employer’s actual premium payments over the State tax credit or State subsidy received by the employer.

In the case of a State payment directly to an insurance company (or another entity licensed under State law to engage in the business of insurance), the employer’s net premium payments are the employer’s actual premium payments.

If a State-administered program (such as Medicaid or another program that makes payments directly to a health care provider or insurance company on behalf of individuals and their families who meet certain eligibility guidelines) makes payments that are not contingent on the maintenance of an employer-provided group health plan, those payments are not taken into account in determining the employer’s net premium payments.

Payroll Tax Limitation for Tax-Exempt Small Employers

If you are an eligible tax-exempt employer, your credit cannot exceed the amount of certain payroll taxes. Payroll taxes, for this purpose, mean only the following:

  • Federal income taxes and Medicare taxes you were required to withhold from employees’ wages during the calendar year.
  • Medicare taxes you were required to pay for the calendar year.

State

The state is where your employee is enrolled in coverage. It is used in determining whether the State Average Premium Limitation applies.

State Average Premium Limitation

The amount of your premium payments that are taken into account in calculating the credit is limited to those you would have made under the same arrangement if the average premium for the small group market in the rating area in which your employees enroll for coverage were substituted for the actual premium.

State Subsidies and Tax Credits

Your credit may be reduced if you are entitled to a state tax credit or a state premium subsidy for the cost of health insurance coverage you provide under a qualifying arrangement to individuals considered employees. The state tax credit may be refundable or nonrefundable and the state premium subsidy may be paid to you or directly to your insurance provider.

Although a state tax credit or premium subsidy paid directly to you does not reduce the amount of your employer premiums paid, and although a state premium subsidy paid directly to an insurance provider is treated as an employer premium you paid, the amount of your credit cannot be more than your net premium payments. Net premium payments are employer premiums paid minus the amount of any state tax credits you received or will receive and any state premium subsides paid either to you or directly to your insurance provider for premiums for health insurance coverage you provide under a qualifying arrangement to individuals considered employees.

Total Wages

Wages, for this purpose, mean wages subject to Social Security and Medicare tax withholding determined without considering any wage base limit. If an individual is not considered an employee or is an excluded employee, his or her wages do not count. This includes:

  • Wages paid to any seasonal employees who worked 120 or fewer days during the tax year; and
  • Wages paid with respect to the initial year of service on which leased employee status is based.

Wages or compensation paid to ministers who are common-law employees for duties performed in the exercise of their ministry are not subject to FICA taxes and are not wages as defined in § 3121(a). So the wages of a minister who is a common law employee are not taken into account.

Short Taxable Year If an employer has a short taxable year, wages must be pro-rated (or annualized) in calculating the credit. For example, if a small employer has been in business (and paying premiums) for 6 months during its first taxable year, it must pro-rate the wages earned to reflect the 6 months the employer has been in operation.