General Terms

An applicable large employer (ALE) is an employer that employed an average of 50 or more full-time employees, including full-time-equivalent employees, in the prior calendar year.

Full-time employee generally means a common-law employee that averages 30 or more hours of service per week, (or 130 hours per month), as determined under one of two specific measurement methods. An hour of service is each hour for which payment is made or due (e.g., performance of duties, vacation, holidays, paid absence, or leave).

Minimum essential coverage means any employer-sponsored group health plan, other than “excepted benefits.” Most flexible spending accounts (FSAs) or stand-alone dental or vision plans are excepted benefits; that is, they are not minimum essential coverage.

Minimum value coverage means the minimum essential coverage plan’s share of total allowed cost of benefits is at least 60 percent of such costs. For 2015, the minimum value coverage is affordable if the employee’s required contribution for self-only coverage does not exceed 9.56 percent of the employee’s income from the employer. For 2016, the percentage is 9.66 due to inflation adjustment.

Official Guidance:

The Internal Revenue Service (IRS) released final forms and instructions to be used for Internal Revenue Code § 6055 and § 6056 reporting:

For 2016 reporting (forms due in early 2017):

• 2016 Form 1095-C, Employer-Provided Health Insurance Offer and Coverage.
• 2016 Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns.
• Instructions for 2016 Forms 1094-C and 1095-C.