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ACA Form 1095-C Line 16 Applicable Section 4980H Safe Harbor Codes

Below is a list of the Applicable Section 4980H Safe Harbor Codes that are valid for line 16 on Form 1095-C:

Code 2A: Employee not employed during the month.  Enter code 2A if the employee was not employed on any day of the calendar month.  Do not use code 2A for a month if the individual was an employee of the employer on any day of te calendar month.  Do not use code 2A for the month during which an employee termintates employement with the employer.

Code 2B: Employee not a full-time employee. Enter code 2B if the employee is not a full-time employee for the month and did not enroll in minimum essential coverage, if offered for the month. Enter code 2B also if the employee is a full-time employee for
the month and whose offer of coverage (or coverage if the employee was enrolled) ended before the last day of the month solely because the employee terminated employment during the
month (so that the offer of coverage or coverage would have continued if the employee had not terminated employment during the month). Also use this code for January 2015 if the
employee was offered health coverage no later than the first day of the first payroll period that begins in January 2015 and the coverage offered was affordable for purposes of the employer
shared responsibility provisions under section 4980H and provided minimum value.

Code 2C: Employee enrolled in coverage offered. Enter code 2C for
any month in which the employee enrolled in health coverage offered by the employer for each day of the month, regardless of whether any other code in Code Series 2 might also apply (for
example, the code for a section 4980H affordability safe harbor).

Code 2D: Employee in a section 4980H(b) Limited Non-Assessment Period. Enter code 2D for any month during which an employee is in a Limited Non-Assessment Period for
section 4980H(b).
If an employee is in an initial measurement period, enter code
2D (employee in a section 4980H(b) Limited Non-Assessment Period) for the month, and not code 2B (employee not a full-time employee). For an employee in a section 4980H(b) Limited Non-Assessment Period for whom the employer is also eligible for the multiemployer interim rule relief for the month code 2E, enter code 2E (multiemployer interim rule relief) and not code 2D (employee in a Limited Non-Assessment Period).

Code 2E: Multiemployer interim rule relief. Enter code 2E for any month for which the multiemployer interim guidance applies forMultiemployer interim rule relief. Enter code 2E for any
month for which the multiemployer interim guidance applies for that employee. This relief is described under Offer of Health Coverage in the Definitions section of these instructions.that employee. This relief is described under Offer of Health
Coverage in the Definitions section of these instructions.

Code 2F: Section 4980H affordability Form W-2 safe harbor. Enter code 2F if the employer used the section 4980H Form W-2 safe harbor to determine affordability for purposes of section
4980H(b) for this employee for the year. If an employer uses this safe harbor for an employee, it must be used for all months of the calendar year for which the employee is offered health coverage.

Code 2G: Section 4980H affordability federal poverty line safe harbor. Enter code 2G if the employer used the section 4980H federal poverty line safe harbor to determine affordability for purposes of section 4980H(b) for this employee for any month(s).

Code 2H: Section 4980H affordability rate of pay safe harbor. Enter code 2H if the employer used the section 4980H rate of pay safe harbor to determine affordability for purposes of section
4980H(b) for this employee for any month(s).

Note: Codes 2F through 2H: Although employers may use the section 4980H affordability safe harbors to determine affordability for purposes of the multiemployer interim guidance, an employer eligible for the relief provided in the multiemployer interim guidance for a month for an employee should enter code 2E (multiemployer interim rule relief), and not a code for the section 4980H affordability safe harbors (codes 2F, 2G, or 2H).

Code 2I: Non-calendar year transition relief applies to this employee. Enter code 2I if non-calendar year transition relief for section 4980H(b) applies to this employee for the month. See the instructions later under Section 4980H Transition Relief for 2015 and 2015 Section 4980H(b) Transition Relief for
Employers with Non-Calendar Year Plans (Form 1095-C, line 16, code 2I), for a description of this relief.

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