['Employee Benefits']
['Patient Protection and Affordable Care Act']
12/05/2023
Copyright 2024 J. J. Keller & Associate, Inc. For re-use options please contact copyright@jjkeller.com or call 800-558-5011.
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(a) Federal taxes. The report required in §158.110 of this subpart must separately report:
(1) Federal taxes excluded from premium under subpart B which include all Federal taxes and assessments allocated to health insurance coverage reported under section 2718 of the PHS Act.
(2) Federal taxes not excluded from premium under subpart B of this part which include Federal income taxes on investment income and capital gains, as well as Federal employment taxes, as other non-claims costs.
(b) State taxes and assessments. The report required in §158.110 of this subpart must separately report:
(1) State taxes and assessments excluded from premium under subpart B which include:
(i) Any industry-wide (or subset) assessments (other than surcharges on specific claims) paid to the State directly, or premium subsidies that are designed to cover the costs of providing indigent care or other access to health care throughout the State.
(ii) Guaranty fund assessments.
(iii) Assessments of State industrial boards or other boards for operating expenses or for benefits to sick employed persons in connection with disability benefit laws or similar taxes levied by States.
(iv) Advertising required by law, regulation or ruling, except advertising associated with investments.
(v) State income, excise, and business taxes other than premium taxes.
(vi) State premium taxes plus State taxes based on policy reserves, if in lieu of premium taxes.
(vii) Payments made by a Federal income tax exempt issuer for community benefit expenditures as defined in paragraph (c) of this section, limited to the highest of either:
(A) Three percent of earned premium; or
(B) The highest premium tax rate in the State for which the report is being submitted, multiplied by the issuer's earned premium in the applicable State market.
(viii) In lieu of reporting amounts described in paragraph (b)(1)(vi) of this section, an issuer that is not exempt from Federal income tax may choose to report payment for community benefit expenditures as described in paragraph (c) of this section, limited to the highest premium tax rate in the State for which the report is being submitted multiplied by the issuer's earned premium in the applicable State market.
(2) State taxes and assessments not excluded from premium under subpart B which include:
(i) State sales taxes if the issuer does not exercise options of including such taxes with the cost of goods and services purchased.
(ii) Any portion of commissions or allowances on reinsurance assumed that represent specific reimbursement of premium taxes.
(iii) Any portion of commissions or allowances on reinsurance ceded that represents specific reimbursement of premium taxes.
(iv) State employment and similar taxes and assessments.
(c) Community benefit expenditures. Community benefit expenditures means expenditures for activities or programs that seek to achieve the objectives of improving access to health services, enhancing public health and relief of government burden. This includes any of the following activities that:
(1) Are available broadly to the public and serve low-income consumers;
(2) Reduce geographic, financial, or cultural barriers to accessing health services, and if ceased to exist would result in access problems (for example, longer wait times or increased travel distances);
(3) Address Federal, State or local public health priorities such as advancing health care knowledge through education or research that benefits the public;
(4) Leverage or enhance public health department activities such as childhood immunization efforts; and
(5) Otherwise would become the responsibility of government or another tax-exempt organization.
[75 FR 74925 Dec. 1, 2010; 75 FR 82279 Dec. 30, 2010; 76 FR 76593 Dec. 7, 2011; 78 FR 15540, March 11, 2013; 80 FR 10876, Feb. 27, 2015]
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