Final Regulation on the Premium Tax Credit
Solidified details on eligibility for premium tax credits
May 25, 2012
On May 23, 2012, the Department of Health and Human Services (HHS) published a Final Regulation on the Premium Tax Credit available to individuals who enroll in a Qualified Health Plan through state insurance exchanges. Individuals with a household income between 100%-400% of the Federal Poverty Level (FPL) who enroll in a Qualified Health Plan (QHP) are eligible for the premium tax credit unless they are eligible for coverage under an employer sponsored plan that is affordable and provides minimum value. This Final Regulation offers specific guidance to individuals pertaining to eligibility for a premium tax credit and enrollment in a QHP.
The guidance clarifies eligibility requirements based on individual or joint income taxpayer status at the time of enrollment. It includes details around lawfulness of citizenship, such as a lawful alien or an incarcerated person, whereas such a person is an applicable taxpayer contributing to household income. Eligibility and timing of coverage are also clarified for enrollment in government-sponsored programs vs. employer-sponsored minimum essential coverage.
Comments on several issues noted in this Final Regulation are due August 21, 2012.
These issues include, but are not limited to:
- Determining affordability and minimum value of employer-sponsored coverage as they pertain to individuals who may qualify for tax credits when enrolling for family coverage
- Determining affordability of employer-sponsored coverage as it pertains to wellness incentives and the certainty of eligibility for qualifying individuals
- Administering credits for married individuals who are unable to file a joint tax return due to situations such as domestic abuse, as married individuals must file a joint return to qualify for the tax credits
You can view details of this Final Regulation* as it is posted in the Federal Register. Cigna will continue to review this and other regulations, and will update communications accordingly. We encourage you to bookmark our health care reform website, InformedOnReform.com.