The Patient Protection and Affordable Care Act requires employers to report the aggregate cost of employer-sponsored health coverage on the Forms W-2 of its employees. In March 2011, the Internal Revenue Service issued interim guidance on the Form W-2 informational reporting requirement in the form of 31 Q&As. Recently, the Internal Revenue Service revised this interim guidance by issuing Notice 2012-9, which clarifies several of the original Q&As and adds some Q&As.

Provisions clarified in the Notice include:

  • Exemption for Small Employers. Employers filing fewer than 250 Forms W-2 for the preceding calendar year are not required to report the aggregate cost of coverage.
  • Stand-Alone Dental and Vision Plan Reporting. The Notice clarifies that the standard for determining whether the cost of coverage under a dental plan or vision plan is included in the aggregate cost is the same standard for determining whether such coverage is an excepted benefit under HIPAA. Thus, certain stand-alone dental and vision plans may be exempt from the reporting requirement.
  • Excess Reimbursement for Highly Compensated Individuals. The reporting requirement does not apply to the cost of coverage includible in income under Section 105(h) of the Internal Revenue Code, or payments or reimbursements of health insurance premiums for a 2 percent shareholder-employee of an S corporation that is required to include the premium payments in gross income.
  • Coverage under Employee Assistance Program or Similar Program. An employer that does not charge a premium for an EAP, wellness program, or on-site medical clinic to COBRA-qualifying beneficiaries is not required to include the cost of such coverage in the aggregate reportable cost. For arrangements that are not subject to any federal continuation coverage requirements (such as church plans), the employer is not required to include the cost of such coverage on the Form W-2.
  • Optional Reporting of Exempted Benefits. Employers may, for convenience, include in the aggregate reportable cost the cost of coverage that is not required to be included (e.g., cost of coverage under a Health Reimbursement Account (HRA)), provided that certain conditions are satisfied.
  • Reporting Non-Applicable Employer-Sponsored Coverage. Employers may use any reasonable method to determine the relative allocation of cost for benefit programs that make available both applicable employer-sponsored coverage (e.g., group health plans) and other coverage (e.g., longā€term disability programs).
  • Employee Election Changes after Year-End. The aggregate reportable cost for a calendar year reported on a Form W-2 may be based on the information available to the employer as of December 31 of the calendar year, without regard to any election or notification made or provided in a subsequent calendar year that has a retroactive effect on a previous year’s coverage.
  • Payroll Periods Crossing Two Taxable Years. The Notice provides employers with various options for reporting the aggregate reportable cost for a payroll period that spans two taxable years.
  • Hospital Indemnity/Specified Disease Insurance. Employers are required to include the cost of coverage in the aggregate reportable cost on Form W-2 if the employer makes any contribution to the cost of coverage that is excluded from the employee’s income, or if the employee purchases a policy on a pre-tax basis under a cafeteria plan. However, if the employer provides the opportunity for employees to purchase an independent, non-coordinated fixed indemnity policy and the employee pays the full amount of the premium with after-tax dollars, the cost of coverage provided under that policy is not required to be reported on Form W-2.
  • Third-Party Sick Pay. The aggregate reportable cost is not required to be reported on a Form W-2 furnished by a third-party sick pay provider. However, a Form W-2 furnished by the employer to an employee must include the aggregate reportable cost, regardless of whether that Form W-2 includes sick pay, or whether a third-party sick pay provider is furnishing a separate Form W-2 to report sick pay.

If you have questions regarding the contents of this legal alert or the Form W-2 reporting requirements under the Patient Protection and Affordable Care Act, contact Brian M. Pinheiro at 215.864.8511 or

As the federal health care reform effort gained steam, Ballard Spahr attorneys launched the Health Care Reform Initiative to monitor and analyze legislative developments. With federal health care reform now a reality, our attorneys are assisting health care entities and employers in understanding the relevant changes and planning for the future.

Copyright © 2012 by Ballard Spahr LLP.
(No claim to original U.S. government material.)

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, including electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the author and publisher.

This alert is a periodic publication of Ballard Spahr LLP and is intended to notify recipients of new developments in the law. It should not be construed as legal advice or legal opinion on any specific facts or circumstances. The contents are intended for general informational purposes only, and you are urged to consult your own attorney concerning your situation and specific legal questions you have.