Simplify ACA Reporting with Our Affordable and Accurate Solution

The Affordable Care Act (ACA) introduced many provisions affecting employers, one of which is the requirement to report the cost of employer-sponsored health coverage on employees’ Form W-2. This requirement applies to employers who issue at least 250 W-2s in a calendar year. Reporting this information is intended to provide greater transparency about healthcare costs, but it does not affect employees’ tax liability. Here’s what employers need to know about this reporting obligation.

What Must Be Reported?

Employers must include the total cost of employer-sponsored health coverage in Box 12 of Form W-2 using code DD. This amount represents the combined total of:

• The employer's contributions toward the health coverage premium.
• The employee's share of the health coverage premium paid through payroll deductions.

Key Points to Remember:

• Scope of Coverage:
  The reported amount includes medical plans but generally does not include:
  • Vision or dental coverage (if provided under a separate plan).
  • Health savings accounts (HSAs) or health reimbursement arrangements (HRAs).
  • Employee contributions to health flexible spending accounts (FSAs).
• Exclusions: The reporting requirement does not apply to certain plans, such as long-term care, standalone dental or vision plans, or plans for specific diseases or illnesses.

Who Is Required to Comply?

The requirement applies to employers that issued 250 or more W-2s in the previous calendar year. This includes:

• Private sector employers.
• Government entities.
• Churches and other religious organizations, if they meet the threshold.
• Smaller employers issuing fewer than 250 W-2s are exempt from this requirement under current IRS guidelines.

Purpose of the Requirement

The ACA implemented this reporting rule to:

• Educate Employees: Employees can better understand the cost of their employer-sponsored health benefits.
• Increase Transparency: The rule highlights the value of employer-sponsored health coverage.

Important Note: This is not a taxable benefit. The information is purely informational and does not impact the employee’s gross income or tax obligations.

How to Report the Cost of Coverage

• Determine the Total Cost: Calculate the total annual cost of employer-sponsored health coverage provided to each employee. This includes both the employer-paid and employee-paid portions.
• Fully Insured Plans. For fully insured health plans, employers should report the total premium amount that includes both:
• Employer Contributions: The portion of the premium paid by the employer.
• Employee Contributions: The portion paid by the employee through payroll deductions.

This total represents the cost of coverage as invoiced by the insurance carrier.

• Self-Insured Plans. For self-insured plans, calculating the cost of coverage is more complex and involves determining the applicable premium. Employers may use one of the following methods:
  • COBRA Rate (Excluding Administration Fees): Calculate the COBRA premium as if the employee were a qualified beneficiary, excluding the additional 2% administrative fee allowed under COBRA rules. The COBRA rate can be based on:
    • Actuarial Method: Estimating future costs using actuarial assumptions.
    • Past Cost Method: Using historical claims data to set the premium.
  • Modified COBRA Rate If the employer subsidizes COBRA premiums, the applicable premium can be calculated using a modified method. This method may apply if:
    • The COBRA premium charged is less than the full applicable premium.
    • The actual premium charged for a current year matches the applicable premium determined for a previous year.
• Enter the Amount in Box 12: Use code DD in Box 12 of Form W-2 to report the total cost.
• Verify Accuracy: Ensure the amount reported accurately reflects the applicable premiums for the calendar year.

Common Questions

Does this impact employee taxes? No, the reported amount is informational only and does not increase the employee's taxable income.

What if the coverage changes during the year? The reported amount should reflect the actual cost of coverage for the calendar year, including any mid-year changes to the plan.

What if an employee waives health coverage? No amount is reported in Box 12 for employees who decline employer-sponsored health coverage.

Why It Matters

While this ACA requirement adds another layer to employer reporting obligations, it ultimately provides employees with a clearer picture of the value of their health benefits. Employers should take steps to ensure compliance, as failure to report this information accurately can result in penalties.

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