§1.36B-1   Premium tax credit definitions.

(a) In general.

(b) Affordable Care Act.

(c) Qualified health plan.

(d) Family and family size.

(e) Household income.

(1) In general.

(2) Modified adjusted gross income.

(f) Dependent.

(g) Lawfully present.

(h) Federal poverty line.

(i) [Reserved]

(j) Advance credit payment.

(k) Exchange.

(l) Self-only coverage.

(m) Family coverage.

(n) Rating area.

(o) Effective/applicability date.

§1.36B-2   Eligibility for premium tax credit.

(a) In general.

(b) Applicable taxpayer.

(1) In general.

(2) Married taxpayers must file joint return.

(i) In general.

(ii) Victims of domestic abuse and abandonment.

(iii) Domestic abuse.

(iv) Abandonment.

(v) Three-year rule.

(3) Dependents.

(4) Individuals not lawfully present or incarcerated.

(5) Individuals lawfully present.

(6) Special rule for taxpayers with household income below 100 percent of the Federal poverty line for the taxable year.

(i) In general.

(ii) Exceptions.

(7) Computation of premium assistance amounts for taxpayers with household income below 100 percent of the Federal poverty line.

(c) Minimum essential coverage.

(1) In general.

(2) Government-sponsored minimum essential coverage.

(i) In general.

(ii) Obligation to complete administrative requirements to obtain coverage.

(iii) Special rule for coverage for veterans and other individuals under chapter 17 or 18 of title 38, U.S.C.

(iv) Retroactive effect of eligibility determination.

(v) Determination of Medicaid or Children's Health Insurance Program (CHIP) ineligibility.

(vi) Examples.

(3) Employer-sponsored minimum essential coverage.

(i) In general.

(A) Plans other than health reimbursement arrangements (HRAs) or other account-based group health plans described in paragraph (c)(3)(i)(B) of this section.

(B) HRAs and other account-based group health plans integrated with individual health insurance coverage.

(ii) Plan year.

(iii) Eligibility for months during a plan year.

(A) Failure to enroll in plan.

(B) Waiting periods.

(C) Example.

(iv) Post employment coverage.

(v) Affordable coverage.

(A) In general.

(1) Affordability for employee.

(2) Affordability for related individual.

(3) Employee safe harbor.

(4) Wellness program incentives.

(5) Employer contributions to health reimbursement arrangements.

(6) Employer contributions to cafeteria plans.

(7) Opt-out arrangements.

(B) Affordability for part-year period.

(C) Required contribution percentage.

(D) Examples.

(vi) Minimum value.

(vii) Enrollment in eligible employer-sponsored plan.

(A) In general.

(B) Automatic enrollment.

(C) Examples.

(4) Special eligibility rules.

(i) Related individual not claimed as a personal exemption deduction.

(ii) Exchange unable to discontinue advance credit payments.

(A) In general.

(B) Medicaid or CHIP.

(5) Affordable HRA or other account-based group health plan.

(i) In general.

(ii) Required HRA contribution.

(iii) Monthly amounts.

(A) Monthly lowest cost silver plan premium.

(B) Monthly HRA amount.

(iv) Employee safe harbor.

(v) Amounts used for affordability determination.

(vi) Affordability for part-year period.

(vii) Related individual not allowed as a personal exemption deduction.

(viii) Post-employment coverage.

(ix) Examples.

(d) Applicability date.

(e) Effective/applicability dates.

§1.36B-3   Computing the premium assistance credit amount.

(a) In general.

(b) Definitions.

(c) Coverage month.

(1) In general.

(2) Certain individuals enrolled during a month.

(3) Premiums paid for a taxpayer.

(4) Appeals of coverage eligibility.

(5) Examples.

(d) Premium assistance amount.

(1) Premium assistance amount.

(2) Examples.

(i) In general.

(ii) Examples.

(e) Adjusted monthly premium.

(f) Applicable benchmark plan.

(1) In general.

(2) Family coverage.

(3) Silver-level plan not covering pediatric dental benefits.

(4) Family members residing in different locations.

(5) Single or multiple policies needed to cover the family.

(i) Policy covering a taxpayer's family.

(ii) Policy not covering a taxpayer's family.

(6) Plan not available for enrollment.

(7) Benchmark plan terminates or closes to enrollment during the year.

(8) Only one silver-level plan offered to the coverage family.

(9) Examples.

(g) Applicable percentage.

(1) In general.

(2) Applicable percentage table.

(3) Examples.

(h) Plan covering more than one family.

(1) In general.

(2) Example.

(i) [Reserved]

(j) Additional benefits.

(1) In general.

(2) Method of allocation.

(3) Examples.

(k) Pediatric dental coverage.

(1) In general.

(2) Method of allocation.

(3) Example.

(l) Families including individuals not lawfully present.

(1) In general.

(2) Revised household income computation.

(i) Statutory method.

(ii) Comparable method.

(m) Applicability date.

(n) Effective/applicability date.

§1.36B-4   Reconciling the premium tax credit with advance credit payments.

(a) Reconciliation.

(1) Coordination of premium tax credit with advance credit payments.

(i) In general.

(ii) Allocation rules and responsibility for advance credit payments.

(A) In general.

(B) Individuals enrolled by a taxpayer and claimed as a personal exemption deduction by another taxpayer.

(1) In general.

(2) Allocation percentage.

(3) Allocating premiums.

(4) Allocating advance credit payments.

(5) Premiums for the applicable benchmark plan.

(C) Responsibility for advance credit payments for an individual for whom no personal exemption deduction is claimed.

(iii) Advance credit payment for a month in which an issuer does not provide coverage.

(2) Credit computation.

(3) Limitation on additional tax.

(i) In general.

(ii) Additional tax limitation table.

(iii) Limitation on additional tax for taxpayers who claim a section 162(l) deduction for a qualified health plan.

(A) In general.

(B) Determining the limitation amount.

(C) Requirements.

(D) Specified premiums not paid through advance credit payments.

(E) Examples.

(4) Examples.

(b) Changes in filing status.

(1) In general.

(2) Taxpayers who marry during the taxable year.

(i) In general.

(ii) Alternative computation of additional tax liability.

(A) In general.

(B) Alternative premium assistance amounts for pre-marriage months.

(C) Premium assistance amounts for marriage months.

(3) Taxpayers not married to each other at the end of the taxable year.

(4) Taxpayers filing returns as married filing separately or head of household.

(i) Allocation of advance credit payments.

(ii) Allocation of premiums.

(5) Examples.

(c) Applicability date.

§1.36B-5   Information reporting by Exchanges.

(a) In general.

(b) Individual filing a return.

(c) Information required to be reported.

(1) Information reported annually.

(2) Information reported monthly.

(3) Special rules for information reported.

(i) Multiple families enrolled in a single qualified health plan.

(ii) Alternative to reporting applicable benchmark plan.

(iii) Partial month of coverage.

(A) In general.

(B) Certain mid-month enrollments.

(4) Exemptions.

(d) Time for reporting.

(1) Annual reporting.

(2) Monthly reporting.

(i) In general.

(ii) Initial monthly reporting in 2014.

(3) Corrections to information reported.

(e) Electronic reporting.

(f) Annual statement to be furnished to individuals.

(1) In general.

(2) Form of statements.

(3) Time and manner for furnishing statements.

(g) Electronic furnishing of statements.

(1) In general.

(2) Consent.

(i) In general.

(ii) Withdrawal of consent.

(iii) Change in hardware or software requirements.

(iv) Examples.

(3) Required disclosures.

(i) In general.

(ii) Paper statement.

(iii) Scope and duration of consent.

(iv) Post-consent request for a paper statement.

(v) Withdrawal of consent.

(vi) Notice of termination.

(vii) Updating information.

(viii) Hardware and software requirements.

(4) Format.

(5) Notice.

(i) In general.

(ii) Undeliverable electronic address.

(iii) Corrected statement.

(6) Access period.

(7) Paper statements after withdrawal of consent.

§1.36B-6   Minimum value.

(a) In general.

(b) MV standard population.

(c) MV percentage.

(1) In general.

(2) Wellness program incentives.

(i) In general.

(ii) Example.

(3) Employer contributions to health savings accounts.

(4) Employer contributions to health reimbursement arrangements.

(5) Expected spending adjustments for health savings accounts and health reimbursement arrangements.

(d) Methods for determining MV.

(e) Scope of essential health benefits and adjustment for benefits not included in MV Calculator.

(f) Actuarial certification.

(1) In general.

(2) Membership in American Academy of Actuaries.

(3) Actuarial analysis.

(4) Use of MV Calculator.

(g) Effective/applicability date.

(1) In general.

(2) Exception.