ERISA Benefits Law Desk ReferenceERISA Benefits Tech, LLC

Part 14 · Chapter 1

ACA Employer Mandate, Reporting, and Market Reforms

Law stated as of October 3, 2026 · ACA Employer Mandate and Health Reform

Scope and status

This is the highest-change area in the Desk Reference — the affordability percentage and §4980H penalty amounts index every year, and the Letter 226-J/limitations rules changed under 2024 legislation. The indexed figures below are stated for 2026 (with 2027 figures where issued); re-verify every dollar amount, percentage, deadline, and threshold against current IRS guidance for the calendar year at issue before relying on them.

Citations are to primary authority (Code §§4980H, 6055, 6056, 36B, 5000A, 4980D, 6721/6722; the §4980H final regulations, T.D. 9655, Treas. Reg. §§54.4980H-1 to -6; the 2019 HRA/ICHRA rules; and the PHSA market reforms incorporated into ERISA §715 / Code §9815). Scope/routing: this Part owns the employer mandate, §6055/§6056 reporting, affordability/MV, ICHRAs, market reforms, and §4980D. Related questions are treated elsewhere: the §6055/§6056 mechanics in the companion ACA Information Reporting: §6055 and §6056; controlled-group/ASG in Part 1 (Controlled Groups and Affiliated Service Groups); and the welfare-overlap topics — HIPAA privacy/security, COBRA, MHPAEA, the No Surprises Act / gag clause / RxDC, and §125 — in Part 13 (COBRA, HIPAA, and Welfare Benefits) (which owns that source material).

Sections

Part A is shown in full. The other sections are listed by title; their text is available to subscribers.

Part A — ALE Status and Full-Time Employees (analyze first)

A1.Applicable large employer (ALE) determination

Part 14, ch. 1, § A1

The employer mandate reaches an applicable large employer — an employer that employed an average of 50 or more full-time employees (including full-time-equivalents) on business days during the preceding calendar year. Statute: Code §4980H(c)(2); Final reg: Treas. Reg. §54.4980H-2. ALE status is determined on a controlled-group/ASG-aggregated basis (§414(b)/(c)/(m)/(o)), so a sub-50-employee entity can be an ALE member through aggregation — but §4980H liability is then assessed separately for each ALE member. For the aggregation, see Part 1 (Controlled Groups and Affiliated Service Groups).

A2.Full-time employees and the two measurement methods

Part 14, ch. 1, § A2

A full-time employee averages 30 hours of service per week (130 per month). An ALE identifies full-time employees under either the monthly measurement method or the look-back measurement method (a standard/initial measurement period, an optional administrative period, and a stability period), with rules for changes in status, rehires/breaks in service, and special unpaid leave. Final reg: Treas. Reg. §54.4980H-3; IRS guidance: Notice 2014-49. Certain limited non-assessment periods (e.g., the initial measurement period, the first three months for a new full-time employee) suspend §4980H exposure.

Part B — §4980H Employer Shared Responsibility

  1. B1The §4980H(a) "A penalty"Subscribers
  2. B2The §4980H(b) "B penalty"Subscribers
  3. B3Affordability and minimum valueSubscribers
  4. B4The PTC trigger and the family-glitch boundarySubscribers

Part C — Information Reporting (§6055/§6056) and Letter 226-J

  1. C1The reporting architectureSubscribers
  2. C2The 2024 reporting-relief laws and the penalty regimeSubscribers
  3. C3Letter 226-J defenseSubscribers

Part D — ICHRAs, HRAs, QSEHRAs, and Carve-Outs

  1. D1HRAs and ICHRAsSubscribers
  2. D2Excepted benefits and retiree-only plansSubscribers
  3. D3Proposed excepted fertility benefits (new category — proposed only)Subscribers

Part E — ACA Market Reforms for Group Health Plans

  1. E1Reforms that reach self-insured (and all) group health plansSubscribers
  2. E2Preventive services — Braidwood upheldSubscribers
  3. E3Grandfathered plansSubscribers
  4. E4PCORI feeSubscribers

Part F — §4980D Excise Tax and Correction

  1. F1The market-reform excise taxSubscribers

Part G — §1557 Nondiscrimination

  1. G1Scope — and why an employer plan usually is not directly coveredSubscribers
  2. G2Indirect exposure — carriers, TPAs, and the Title VII overlaySubscribers
  3. G3Current status of the 2024 rule — the gender-identity provisions are vacatedSubscribers
  4. G4The obligations that remainSubscribers

The first Part of each chapter is open to everyone. The remaining sections, with their authority and practice points, are available to subscribers and to clients of ERISA Benefits Law Group, PLLC whose engagement includes access.

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