§4980D — Title 26 Internal Revenue Code | U.S. Code

Summary

A tax applies when a group health plan does not follow the required rules. The tax is $100 for each day the plan is out of compliance for each person affected. The “noncompliance period” starts when the problem first happens and ends when it is fixed. If failures were not fixed before a notice of income tax examination was sent and they happened during the audit, and the violations are more than de minimis, the law replaces a $2,500 limit with $15,000 for the person responsible. That replacement does not apply to church plans. No tax is charged if the person responsible did not know and could not reasonably have known about the problem. No tax is charged if the problem was due to a reasonable cause (not willful neglect) and it is fixed within 30 days (or within the special church-plan correction period). For reasonable-cause failures there are yearly caps: for most plans the cap is the lesser of 10 percent of the employer’s prior-year plan costs or $500,000; for certain multiemployer trusts the cap is the lesser of 10 percent of the trust’s medical payments or $500,000. The Secretary can waive excessive taxes. Small employers (2–50 employees) with fully insured plans are not taxed for failures caused only by the insurer. Usually the employer is liable, but multiemployer plans or certain plans can be liable instead. Group health plan, specified multiple employer health plan, and what “corrected” means are defined for these rules, and pharmacy benefit managers are treated like the plan or employer for some requirements.

Title 26, §4980D

Internal Revenue Code — Source: USLM XML via OLRC

(a)There is hereby imposed a tax on any failure of a group health plan to meet the requirements of chapter 100 (relating to group health plan requirements).

(b)(1)The amount of the tax imposed by subsection (a) on any failure shall be $100 for each day in the noncompliance period with respect to each individual to whom such failure relates.

(2)For purposes of this section, the term “noncompliance period” means, with respect to any failure, the period—

(A)beginning on the date such failure first occurs, and

(B)ending on the date such failure is corrected.

(3)Notwithstanding paragraphs (1) and (2) of subsection (c)—

(A)In the case of 1 or more failures with respect to an individual—

(i)which are not corrected before the date a notice of examination of income tax liability is sent to the employer, and

(ii)which occurred or continued during the period under examination,

(B)To the extent violations for which any person is liable under subsection (e) for any year are more than de minimis, subparagraph (A) shall be applied by substituting “$15,000” for “$2,500” with respect to such person.

(C)This paragraph shall not apply to any failure under a church plan (as defined in section 414(e)).

(c)(1)No tax shall be imposed by subsection (a) on any failure during any period for which it is established to the satisfaction of the Secretary that the person otherwise liable for such tax did not know, and exercising reasonable diligence would not have known, that such failure existed.

(2)No tax shall be imposed by subsection (a) on any failure if—

(A)such failure was due to reasonable cause and not to willful neglect, and

(B)(i)in the case of a plan other than a church plan (as defined in section 414(e)), such failure is corrected during the 30-day period beginning on the first date the person otherwise liable for such tax knew, or exercising reasonable diligence would have known, that such failure existed, and

(ii)in the case of a church plan (as so defined), such failure is corrected before the close of the correction period (determined under the rules of section 414(e)(4)(C)).

(3)In the case of failures which are due to reasonable cause and not to willful neglect—

(A)(i)In the case of failures with respect to plans other than specified multiple employer health plans, the tax imposed by subsection (a) for failures during the taxable year of the employer shall not exceed the amount equal to the lesser of—

(I)10 percent of the aggregate amount paid or incurred by the employer (or predecessor employer) during the preceding taxable year for group health plans, or

(II)$500,000.

(ii)For purposes of this subparagraph, if not all persons who are treated as a single employer for purposes of this section have the same taxable year, the taxable years taken into account shall be determined under principles similar to the principles of section 1561.

(B)(i)In the case of failures with respect to a specified multiple employer health plan, the tax imposed by subsection (a) for failures during the taxable year of the trust forming part of such plan shall not exceed the amount equal to the lesser of—

(I)10 percent of the amount paid or incurred by such trust during such taxable year to provide medical care (as defined in section 9832(d)(3)) directly or through insurance, reimbursement, or otherwise, or

(II)$500,000.

(ii)If an employer is assessed a tax imposed by subsection (a) by reason of a failure with respect to a specified multiple employer health plan, the limit shall be determined under subparagraph (A) (and not under this subparagraph) and as if such plan were not a specified multiple employer health plan.

(4)In the case of a failure which is due to reasonable cause and not to willful neglect, the Secretary may waive part or all of the tax imposed by subsection (a) to the extent that the payment of such tax would be excessive relative to the failure involved.

(d)(1)In the case of a group health plan of a small employer which provides health insurance coverage solely through a contract with a health insurance issuer, no tax shall be imposed by this section on the employer on any failure (other than a failure attributable to section 9811) which is solely because of the health insurance coverage offered by such issuer.

(2)(A)For purposes of paragraph (1), the term “small employer” means, with respect to a calendar year and a plan year, an employer who employed an average of at least 2 but not more than 50 employees on business days during the preceding calendar year and who employs at least 2 employees on the first day of the plan year. For purposes of the preceding sentence, all persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 shall be treated as one employer.

(B)In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is a small employer shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year.

(C)Any reference in this paragraph to an employer shall include a reference to any predecessor of such employer.

(3)For purposes of paragraph (1), the terms “health insurance coverage” and “health insurance issuer” have the respective meanings given such terms by section 9832.

(e)The following shall be liable for the tax imposed by subsection (a) on a failure:

(1)Except as otherwise provided in this subsection, the employer.

(2)In the case of a multiemployer plan, the plan.

(3)In the case of a failure under section 9803 (relating to guaranteed renewability) with respect to a plan described in subsection (f)(2)(B), the plan.

(f)For purposes of this section—

(1)The term “group health plan” has the meaning given such term by section 9832(a).

(2)The term “specified multiple employer health plan” means a group health plan which is—

(A)any multiemployer plan, or

(B)any multiple employer welfare arrangement (as defined in section 3(40) of the Employee Retirement Income Security Act of 1974, as in effect on the date of the enactment of this section).

(3)A failure of a group health plan shall be treated as corrected if—

(A)such failure is retroactively undone to the extent possible, and

(B)the person to whom the failure relates is placed in a financial position which is as good as such person would have been in had such failure not occurred.

(g)In the case of any requirement under section 9826 that applies with respect to an entity providing pharmacy benefit management services on behalf of a group health plan, any reference in this section to such group health plan (and the reference in subsection (e)(1) to the employer) shall be treated as including a reference to such entity.

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 3(40) of the Employee Retirement Income Security Act of 1974, referred to in subsec. (f)(2)(B), is classified to section 1002(40) of Title 29, Labor. The date of the enactment of this section, referred to in subsec. (f)(2)(B), is the date of enactment of Pub. L. 104–191, which was approved Aug. 21, 1996.

Amendments

2026—Subsec. (g). Pub. L. 119–75 added subsec. (g). 2005—Subsec. (a). Pub. L. 109–135 substituted “plan requirements” for “plans requirements”. 1997—Subsec. (a). Pub. L. 105–34, § 1531(b)(2)(A), substituted “plans” for “plan portability, access, and renewability”. Subsec. (c)(3)(B)(i)(I). Pub. L. 105–34, § 1531(b)(2)(B), substituted “9832(d)(3)” for “9805(d)(3)”. Subsec. (d)(1). Pub. L. 105–34, § 1531(b)(2)(C), inserted “(other than a failure attributable to section 9811)” after “on any failure”. Subsec. (d)(3). Pub. L. 105–34, § 1531(b)(2)(D), substituted “section 9832” for “section 9805”. Subsec. (f)(1). Pub. L. 105–34, § 1531(b)(2)(E), substituted “section 9832(a)” for “section 9805(a)”.

Statutory Notes and Related Subsidiaries

Effective Date

of 1997 Amendment Pub. L. 105–34, title XV, § 1531(c), Aug. 5, 1997, 111 Stat. 1085, provided that: “The

Amendments

made by this section [enacting section 9811 and 9812 of this title, amending this section and section 9801 and 9831 of this title, and renumbering sections 9804 to 9806 of this title as sections 9831 to 9833 of this title] shall apply with respect to group health plans for plan years beginning on or after January 1, 1998.”

Effective Date

Pub. L. 104–191, title IV, § 402(c), Aug. 21, 1996, 110 Stat. 2087, provided that: “The

Amendments

made by this section [enacting this section] shall apply to failures under chapter 100 of the Internal Revenue Code of 1986 (as added by section 401 of this Act).”

§4980D Failure to Meet Certain Group Health Plan Requirements

Summary

Title 26, §4980D

Notes & Related Subsidiaries

Editorial Notes

References in Text

Amendments

Statutory Notes and Related Subsidiaries

Effective Date

Amendments

Effective Date

Amendments

Citations & Metadata