Premium Reimbursement is a Costly Violation

(This information relates only to Employer-Sponsored Group Health Plans.  It does not concern either Medicare Plans or Individual and Family Health Plans)

Re: Premium Reimbursement by Employers (outside of an ACA-Approved Group Health Plan) is a Costly Violation

Starting on July 1st, the IRS will begin assessing a penalty of $100 a day (per employee for each affected employee) to employers who continue to pay for employees’ individual health plans.  Please click below link to this article.

We would be happy to help your company find affordable solutions to comply with local and federal requirements regarding health insurance.

Phil Lee

Lee Health Insurance Services

Alert to Individuals who Received Tax Subsidies or APTC to Pay for Covered California Health Plans – Form 1095A

(Note: This alert relates only to Individual and Family health plans. It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)

Re: IRS Form 1095A and Form 8962

Covered California, the California health insurance exchange, will shortly be sending out a form called the IRS Form 1095A to all individuals and families who received tax subsidies in 2014 to help pay for their Individual/Family health plans. This is required by the federal ACA law (Obamacare) and will be sent out by Jan. 31st.
These forms will show, in detail, by month, the amount of APTC (Advance Premium Tax Credit or Tax Subsidy) that the recipient received in helping pay the premium for their subsidized health plans in 2014.
These individuals will be required to use this Form 1095-A to obtain information needed to complete Form 8962 (Premium Tax Credit (PTC)). They must then complete IRS Form 8962 and file it with their 2014 Tax Return by April 15.
Those who enrolled into Off-Exchange health plans need not be concerned, since they did not receive any tax credit, you will not receive a 1095A. Only those who applied for a health plan through Covered CA AND who received an APTC to reduce the premium paid, will be receiving these 1095A forms.
Those enrolled into Medi-Cal (California Medicaid), those on Medicare, and those enrolled on employer group plans are not affected by the above.

Disclaimer: We are not qualified to give tax advice. If you have any questions concerning either Form 1095A or Form 8962, please contact Covered CA, your tax adviser, the IRS or go to the IRS website links below:

Philip W Lee, MBA
Lee Health Insurance Services

Health Care Reform Employer Mandate or “Play or Pay” Delayed until 2015

The White House announced yesterday that enforcement of the Health Care Reform mandate, aka Play or Pay, will be delayed until 2015. This mandate requires large employers with 50 or more full-time equivalent employees to offer minimum essential coverage to full-time employees (and dependents) or incur a penalty tax of between $2,000 and $3,000 per employee should any full-time employee obtain coverage through a “marketplace” with the assistance of a federal subsidy. The delay of this (large employer) Pay or Play mandate does not affect employees’ access to premium tax credits, nor does it affect any other provision such as the Individual mandate. This delay is intended to allow the Treasury Department (IRS) time to consider ways of simplifying the new reporting requirements consistent with the mandate and also time to adapt health coverage and reporting systems while employers are taking steps toward making health coverage affordable and accessible for their employees. Formal guidance describing this transition is expected within the next week. Following is a link to one of many articles reporting on this story:

Small Business Health Care Plan Tax Credits

Did you receive a small  postcard in the mail from the IRS notifying you of the existence of the Small Business Tax Credit for Health Care provided for by the recently passed Patient Protection and Affordable Care  Act or Health Care Reform Act?   The links below give you the official Dept. of Treasury, IRS, definitions and guidelines for qualifying for these tax credits.

IRS Overview:,,id=223666,00.html

Frequently Asked Questions:,,id=220839,00.html

In particular, the following 3 Simple Steps Chart helps you to determine if your company may qualify for these credits.

For more information on Group Health Insurance, please go to or call 800-286-7445.

© Philip W Lee,,


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Lee Health Insurance Services | Healthcare Insurance Agency, Individual Health Insurance, Family Health Plans, Group Medical Insurance, Small Business Health Insurance, Whole & Term Life Insurance, Dental Insurance, Health Care Reform Assistance, Covered California Insurance Exchange Plans, Medicare Supplement Insurance, Medicare Advantage, Medigap Plans, Anthem Blue Cross, Kaiser Permanente, Blue Shield of CA, Health Net, Cigna, Aetna, Contra Costa County CA, Pleasant Hill, Danville, Concord, Berkeley, Martinez, Albany, Oakland, San Ramon, Alameda, Santa Clara, Campbell, Milpitas, Cupertino, Sunnyvale, Saratoga, Fremont, Palo Alto, Newark | 935 Moraga Road, Suite 240, Lafayette CA 94549 (925) 284-2000 or Toll-Free, (800) 286-7445