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Instructions

  1. Tax year
  2. Employer Information
  3. Payment Scenarios
  4. Optional: Employee Status

When you are finished with each step, click "Next" to proceed. Alternatively, you may go to any of the steps by clicking on the Steps on the left side of the estimator.

Step One - Tax Year

The estimator starts by asking for the tax year. Remember: The payment amount is indexed to inflation. If you select a future year where that is unavailable, the estimator cannot provide a detailed estimate of the payment amount.

Step Two - Employer Information

This step estimates whether you have 50 or more full-time employees (and equivalents). If so, you are an applicable large employer and subject to the provision. It will also ask about your status as an employer.

Enter the number of your seasonal and non-seasonal full-time employees as well as the total hours of your seasonal and non-seasonal employees who are not full-time.

Step Three - Payment Scenarios

This step shows you an estimated amount you may have to pay if you either:

  • Don't offer insurance to any of your employees you listed in Step 2, or
  • Offer insurance to your employees listed in Step 2 that doesn't have minimum value or is not affordable.

The payment depends on whether any of your employees receive the premium tax credit, which you may not know. Because of this, the estimator will show the highest estimate of what you may owe assuming you will owe the payment for all of your employees.

You may change the number of full-time employees used in calculating the estimated payment to view different scenarios and see what the payment may be based on different numbers of full-time employees.

Step Four - Employee Status

This step is optional. It is a guide to the two methods of measuring your employees' hours of service and allows you to enter information on one employee and see how the methods work to make a determination. It is intended as a tool to help you understand the provision – not to make the full-time status determination for your employees.

The two measurement methods are:

  • The monthly measurement method and
  • The lookback measurement method.

Choose which method you use and enter the information about it and an employee. The estimator will guide you through how the full-time status determination is made. More information about each method is in The Provision section of this overview.

KEY TERMS

Administrative period

An optional period you select that is no longer than 90 days that begins immediately after the end of a measurement period and ends immediately before the start of the associated stability period.

The administrative period also includes the period between a new employee's start date and the beginning of the initial measurement period, if the initial measurement period does not begin on the employee's start date.

Affordable coverage

Generally, coverage is affordable for an employee if the employee's required contribution of the annual premium for self-only coverage does not exceed an applicable percentage of the employee's household income for the year. Depending on the employee's household income, the applicable percentage is between 2 and 9.5 percent.

Applicable large employer

With respect to a calendar year, an employer that employed an average of at least 50 full-time employees (including full-time equivalent employees) on business days during the preceding calendar year.

Employee resuming services

An employee that has previously been employed by you, but experienced a break in service (for example, due to termination and rehire or unpaid leave). Depending on the rehire and continuing employee rules, these employees can be treated as a new employee or as an ongoing employee.

Full-Time employee

Generally, with respect to a calendar month, an employee who is employed an average of at least 30 hours of service per week.

Hours of service

The hours for which an employee is paid, or entitiled to payment, for the performance of duties for the employer; and each hour for which an employee is paid, or entitled to payment by the employer for a period of time during which no duties are performed due to vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty or leave of absence.

Certain hours are excluded from hours of service; for more information, see the ESRP Regulations.

Hours of service monthly equivalency

As part of counting hours of service for your employees: 130 hours of service in a calendar month is treated as the monthly equivalent of at least 30 hours of service per week, and this 130 hours of service equivalency applies for both the look-back measurement method and the monthly measurement method for determining full-time employee status.

Initial measurement period

Under the lookback measurement method: A period of at least three but not more than 12 consecutive months that is used to determine the full-time status of your new employees. A new employee that averages at least 30 hours of service per week during the initial measurement period is treated as a full-time employee through the end of the associated stability period that follows.

Limited non-assessment periods

The limited non-assessment period for certain employees refers to the limited period during which an employer will not be subject to an assessable payment under section 4980H(a) and in certain cases 4980H(b), with respect to an employee as set in the ESRP Regulations:

Minimum Value

An eligible employer-sponsored plan provides minimum value only if the plan’s share of the total allowed costs of benefits provided to the employee under the plan (as determined under guidance issued by the Secretary of Health and Human Services) is at least 60 percent.

New employee

Under the look-back measurement method, a new employee is an employee who has been employed for less than one complete standard measurement period.

Under the monthly measurement method, a new employee means an employee who has not previously been employed.

Ongoing employee

Under the lookback measurement method, an ongoing employee is an employee who has been employed for at least one complete standard measurement period.

Under the monthly measurement method, an employee who has been continuously employed by you without any breaks in service.

Section 4980H(a) applicable payment amount

With respect to any calendar month 1/12 of $2,000, adjusted for inflation.

This amount is multiplied by a certain number of your full-time employees for a calendar month to calculate the actual payment.

Section 4980H(b) applicable payment amount

With respect to any calendar month, 1/12 of $3,000 – adjusted for inflation.

This amount is multiplied by a certain number of your full-time employees for a calendar month to calculate the actual payment

Stability period

Under the lookback measurement method: A period you select that immediately follows and is associated with a standard measurement period or an initial measurement period (and if elected, the administrative period associated with that standard measurement period or initial measurement period).

Standard measurement period

Under the lookback measurement method: A period of at least three but not more than 12 consecutive months that is used to determine the full-time status of your employees. Employees that average at least 30 hours of service per week during the standard measurement period are treated as full-time employees through the end of the associated stability period that follows.

Variable hour employee

Generally, an employee that, based on the facts and circumstances at the employee’s start date, you are unable to determine whether the employee is reasonably expected to be employed on average at least 30 hours of service per week during the initial measurement period because the employee’s hours are variable or otherwise uncertain.

Waiting Period

A waiting period is the period that must pass before coverage for an individual who is otherwise eligible to enroll under the terms of a group health plan can become effective. If an individual enrolls as a late enrollee or special enrollee, any period before such late or special enrollment is not a waiting period.