26 CFR Part 54 — Pension Excise Taxes

Contents

2,590 provisions, too many to show on one page. Open a part or section to read it with its history and connections, or search inside the text.

1. 54.4971(c)-1 · (c)-1 Taxes on failure to meet minimum funding standards; definitions.
   1. (a) In general. This section sets forth definitions that apply for purposes of applying the rules of section 4971.
   2. (b) Accumulated funding deficiency—(1) Multiemployer plans. With respect to a multiemployer plan defined in section 414(f), the term accumulated funding deficie
   3. (c) Unpaid minimum required contribution—(1) In general. The term unpaid minimum required contribution means, with respect to any plan year, the portion of the
   4. (d) Correct—(1) Accumulated funding deficiency. With respect to an accumulated funding deficiency for a plan year that is described in paragraph (b) of this sec
   5. (e) Taxable period—(1) In general. The term taxable period means the period beginning with the end of the plan year in which there is an accumulated funding def
   6. (f) Single-employer plan. The term single-employer plan means a plan to which the minimum funding requirements of section 412 apply that is not a multiemployer
   7. (g) Examples. The following examples illustrate the rules of this section. Example 1.(i) Plan A, a single-employer defined benefit plan, has a calendar year pla
   8. (h) Effective/applicability dates and transition rules—(1) Statutory effective date—(i) In general. In general, the amendments made to section 4971 by section 1
   9. (i) The date of mailing of a notice of deficiency under section 6212 with respect to the tax imposed by section 4971(a); or
   10. (ii) Plans with delayed PPA '06 effective dates. In the case of a plan for which the effective date of section 430 for purposes of determining the minimum requi
2. 54.4971-1 · -1 General rules relating to excise tax on failure to meet minimum funding standards.
   1. (a) -(b) [Reserved]
   2. (c) Additional tax. Section 4971(b) imposes an excise tax in any case in which an initial tax is imposed under section 4971(a) on an accumulated funding deficie
   3. (d) [Reserved]
   4. (e) Definition of taxable period—(1) In general. For purposes of any accumulated funding deficiency, the term “taxable period” means the period beginning with t
   5. (i) The date of mailing of a notice of deficiency under section 6212 with respect to the tax imposed by section 4971(a), or
   6. (ii) The date on which the tax imposed by section 4971(a) is assessed.
3. 54.4974-1 · -1 Excise tax on accumulations in qualified retirement plans.
   1. (a) Imposition of excise tax—(1) In general. If the amount distributed to a payee under any qualified retirement plan or any eligible deferred compensation plan
   2. (b) Definition of qualified retirement plan. For purposes of section 4974, each of the following is a qualified retirement plan—
   3. (c) Determination of required minimum distribution for individual accounts—(1) General rule. Except as otherwise provided in this paragraph (c), if a payee's in
   4. (e) Distribution of remaining benefit after deadline for required distribution. If there is any remaining benefit with respect to an employee (or IRA owner) aft
   5. (f) Excise tax for first distribution calendar year. If the amount not paid is an amount required to be paid by April 1 of a calendar year that includes the emp
   6. (g) Waiver of excise tax—(1) General rule. The tax under paragraph (a) of this section may be waived if the payee establishes to the satisfaction of the Commiss
   7. (h) Applicability date. This section applies for taxable years beginning on or after January 1, 2025. For earlier taxable years, the rules of 26 CFR 54.4974-2 (
   8. (i) The failure to distribute the required minimum distribution described in this section was due to reasonable error; and
   9. (ii) Reasonable steps are being taken to remedy the failure.
4. 54.4975-1 · -1 General rules relating to excise tax on prohibited transactions.
   1. (a) Scope. This section provides general rules for the imposition of the excise taxes on prohibited transactions.
   2. (b) Initial tax. Section 4975(a) imposes an initial tax on each prohibited transaction. The initial tax is 5 percent of the amount involved with respect to the
   3. (c) Additional tax. Section 4975(b) imposes an excise tax in any case in which an initial tax is imposed under section 4975(a) on a prohibited transaction and t
   4. (d) Taxable period—(1) In general. For purposes of any prohibited transaction, the term “taxable period” means the period beginning with the date on which the p
   5. (i) The date of mailing of a notice of deficiency under section 6212 with respect to the tax imposed by section 4975(a);
   6. (ii) The date on which correction of the prohibited transaction is completed; or
5. 54.4975-11 · -11 “ESOP” requirements.
   1. (a) In general—(1) Type of plan. To be an “ESOP” (employee stock ownership plan), a plan described in section 4975(e)(7)(A) must meet the requirements of this s
   2. (b) Plan designed to invest primarily in qualifying employer securities. A plan constitutes an ESOP only if the plan specifically states that it is designed to
   3. (c) Suspense account. All assets acquired by an ESOP with the proceeds of an exempt loan under section 4975(d)(3) must be added to and maintained in a suspense
   4. (d) Allocations to accounts of participants—(1) In general. Except as provided in this section, amounts contributed to an ESOP must be allocated as provided und
   5. (e) Multiple plans—(1) General rule. An ESOP may not be considered together with another plan for purposes of applying section 401(a) (4) and (5) or section 410
   6. (f) Distribution—(1) In general. Except as provided in paragraph (f) (2) and (3) of this section, with respect to distributions, a portion of an ESOP consisting
   7. (i) The ESOP and such other plan exist on November 1, 1977, or
   8. (ii) Paragraph (e)(2) of this section is satisfied.
6. 54.4975-12 · -12 Definition of the term “qualifying employer security”.
   1. (a) In general. For purposes of section 4975(e)(8) and this section, the term “qualifying employer security” means an employer security which is:
   2. (b) Special rule. In determining whether a bond, debenture, note, or certificate or other evidence of indebtedness is described in paragraphs (1), (2), and (3)
7. 54.4975-14 · -14 Election to pay an excise tax for certain pre-1975 prohibited transactions.
   1. (a) In general. Section 2003(c)(1)(B) of the Employee Retirement Income Security Act of 1974 (88 Stat. 978) provides an election to pay an excise tax by certain
   2. (b) Effect of election. If a valid election is made under this section with respect to a particular transaction, any loss of exemption under section 501(a) beca
   3. (c) Method of election. A person shall make the election referred to in this section by filing the form issued for such purpose by the Internal Revenue Service,
   4. (d) Computation of section 4975 excise tax. To the extent applicable, and solely for purposes associated with the payment of a section 4975 excise tax under the
8. 54.4975-15 · -15 Other transitional rules.
   1. (a) -(c) [Reserved]
   2. (d) Provision of certain services until June 30, 1977—(1) In general. Section 2003(c)(2)(D) of the Employee Retirement Income Security Act of 1974 (the Act) (88
9. 54.4975-6 · -6 Statutory exemptions for office space or services and certain transactions involving financial institutions.
   1. (a) Exemption for office space or services—(1) In general. Section 4975(d)(2) exempts from the excise taxes imposed by section 4975 payment by a plan to a disqu
   2. (b) Exemption for bank deposits—(1) In general. Section 4975(d)(4) exempts from the excise taxes imposed by section 4975 investment of all or a part of a plan's
   3. (e) Compensation for services—(1) In general. Section 4975(d)(2) refers to the payment of reasonable compensation by a plan to a disqualified person for service
   4. (ii) A person is an affiliate of a bank or similar financial institution if such person and such bank or similar financial institution would be treated as membe
10. 54.4975-7 · -7 Other statutory exemptions.
    1. (a) [Reserved]
    2. (b) Loans to employee stock ownership plans—(1) Definitions. When used in this paragraph (b) and § 54.4975-11, the terms listed below have the following meaning
    3. (i) ESOP. The term “ESOP” refers to an employee stock ownership plan that meets the requirements of section 4975(e)(7) and § 54.4975-11. It is not synonymous wi
    4. (ii) Loan. The term “loan” refers to a loan made to an ESOP by a disqualified person or a loan to an ESOP which is guaranteed by a disqualified person. It inclu
11. 54.4975-9 · -9 Definition of “fiduciary”.
    1. (a) -(b) [Reserved]
    2. (c) Investment advice. (1) A person shall be deemed to be rendering “investment advice” to an employee benefit plan, within the meaning of section 4975(e)(3)(B)
    3. (d) Execution of securities transactions. (1) A person who is a broker or dealer registered under the Securities Exchange Act of 1934, a reporting dealer who ma
    4. (e) Affiliate and control. (1) For purposes of paragraphs (c) and (d) of this section, an “affiliate” of a person shall include:
    5. (i) Any person directly or indirectly, through one or more intermediaries, controlling, controlled by, or under common control with such person;
    6. (ii) Any officer, director, partner, employee or relative (as defined in section 4975(e)(6)) of such person; and
12. 54.4976-1T · -1T Questions and answers relating to taxes with respect to welfare benefit funds (temporary).
    1. (b) A welfare benefit fund will be able to avoid the application of section 4976(b)(1) and (2) if the employer withdraws from such fund, before April 7, 1986, a
    2. (c) In the case of a plan which is maintained pursuant to one or more collective bargaining agreements (1) between employee representatives and one or more empl
13. 54.4977-1T · -1T Questions and answers relating to the election concerning lines of business in existence on January 1, 1984 (temporary).
    1. (a) The employer's name, address, and taxpayer identification number;
    2. (b) A description of all of the employer's lines of business in existence on January 1, 1984; and
    3. (c) For each lines of business which is to have as an employee for purposes of section 132(a) (1) and (2) an individual but for the election under section 4977
14. 54.4978-1T · -1T Questions and answers relating to the tax on certain dispositions by employee stock ownership plans and certain cooperatives (temporary).
    1. (a) An employee stock ownership plan or eligible worker-owned cooperative acquires any qualified securities in a sale to which section 1042 applies;
    2. (b) Section 4978 shall not apply to any disposition of qualified securities which is made by reason of:
    3. (c) If restricted qualified securities held by an employee stock ownership plan or eligible worker-owned cooperative no longer meet the definition of qualified
15. 54.4979-0 · -0 Excise tax on certain excess contributions and excess aggregate contributions; table of contents.
16. 54.4979-1 · -1 Excise tax on certain excess contributions and excess aggregate contributions.
    1. (a) In general—(1) General rule. In the case of any plan (as defined in paragraph (b)(3) of this section), there is imposed a tax for the employer's taxable yea
    2. (b) Definitions. The following is a list of terms and definitions to be used for purposes of section 4979 and this section:
    3. (c) No tax when excess distributed within 2 1/2 months of close of year or additional employer contributions made—(1) General rule. No tax is imposed under this
    4. (d) Effective date—(1) General rule. Except as provided in paragraphs (d)(2) through (4), this section is effective for plan years beginning after December 31,
    5. (i) Any excess contributions under a plan for the plan year ending in the taxable year; and
    6. (ii) The employer's notification to each affected employee of the excess SEP contributions must specifically state, in a manner calculated to be understood by t
17. 54.4980B-0 · -0 Table of contents.
18. 54.4980B-1 · -1 COBRA in general.
    1. (b) COBRA also added parallel continuation coverage requirements to Part 6 of Subtitle B of title I of the Employee Retirement Income Security Act of 1974 (ERIS
    2. (c) A group health plan that is subject to section 4980B (or the parallel provisions under ERISA) is referred to as being subject to COBRA. (See Q&A-4 of § 54.4
19. 54.4980B-10 · -10 Interaction of FMLA and COBRA.
    1. (1) An employee (or the spouse or a dependent child of the employee) is covered on the day before the first day of FMLA leave (or becomes covered during the FML
    2. (2) The employee does not return to employment with the employer at the end of the FMLA leave; and
    3. (3) The employee (or the spouse or a dependent child of the employee) would, in the absence of COBRA continuation coverage, lose coverage under the group health
20. 54.4980B-2 · -2 Plans that must comply.
    1. (b) Due date for filing of return by employers or other persons responsible for benefits under a group health plan. See § 54.6071-1(a)(1).
    2. (c) Due date for filing of return by multiemployer plans. See § 54.6071-1(a)(2).
    3. (d) Effective/applicability date. In the case of an employer or other person mentioned in paragraph (b) of this Q & A-11, the rules in this Q & A-11 are effecti
    4. (e) If the conditions in paragraph (c) of this Q&A-8 are satisfied for a plan year, the health FSA is not obligated to make COBRA continuation coverage availabl
    5. (f) The rules of paragraphs (b), (c), (d), and (e) of this Q&A-8 are illustrated by the following example: Example.(i) An employer maintains a group health plan
    6. (g) A small-employer plan is generally excepted from COBRA. If, however, a plan that has been subject to COBRA (that is, was not a small-employer plan) becomes
21. 54.4980B-3 · -3 Qualified beneficiaries.
    1. (i) Self-employed individuals (within the meaning of section 401(c)(1));
    2. (ii) Independent contractors (and their employees and independent contractors); and
    3. (c) An individual is not a qualified beneficiary if, on the day before the qualifying event referred to in paragraph (a) of this Q&A-1, the individual is covere
    4. (d) A covered employee can be a qualified beneficiary only in connection with a qualifying event that is the termination, or reduction of hours, of the covered
    5. (b) For purposes of §§ 54.4980B-1 through 54.4980B-10, a covered employee is any individual who is (or was) provided coverage under a group health plan (other t
    6. (e) An individual is not a qualified beneficiary if the individual's status as a covered employee is attributable to a period in which the individual was a nonr
    7. (f) A qualified beneficiary who does not elect COBRA continuation coverage in connection with a qualifying event ceases to be a qualified beneficiary at the end
    8. (g) For purposes of §§ 54.4980B-1 through 54.4980B-10, placement for adoption or being placed for adoption means the assumption and retention by the covered emp
    9. (h) The rules of this Q&A-1 are illustrated by the following examples: Example 1.(i) B is a single employee who voluntarily terminates employment and elects COB
22. 54.4980B-4 · -4 Qualifying events.
    1. (b) An event satisfies this paragraph (b) if the event is any of the following—
    2. (c) An event satisfies this paragraph (c) if, under the terms of the group health plan, the event causes the covered employee, or the spouse or a dependent chil
    3. (d) An event satisfies this paragraph (d) if it occurs while the plan is subject to COBRA. Thus, an event will not satisfy this paragraph (d) if it occurs while
    4. (e) A reduction of hours of a covered employee's employment occurs whenever there is a decrease in the hours that a covered employee is required to work or actu
    5. (f) The qualifying event of a qualified beneficiary who is a child born to or placed for adoption with a covered employee during a period of COBRA continuation
    6. (g) The rules of this Q&A-1 are illustrated by the following examples, in each of which the group health plan is subject to COBRA: Example 1.(i) An employee who
23. 54.4980B-5 · -5 COBRA continuation coverage.
    1. (b) In addition to the special enrollment rights described in paragraph (a) of this Q&A-5, if the plan covering the qualified beneficiary provides that new fami
    2. (c) If the addition of a new family member will result in a higher applicable premium (for example, if the qualified beneficiary was previously receiving COBRA
    3. (d) The right to add new family members under this Q&A-5 is in addition to the rights that newborn and adopted children of covered employees may have as qualifi
    4. (e) If a deductible is computed on the basis of a covered employee's compensation instead of being a fixed dollar amount and the employee remains employed durin
    5. (f) The rules of this Q&A-2 are illustrated by the following examples; in each example, deductibles under the plan are determined on a calendar year basis: Exam
24. 54.4980B-6 · -6 Electing COBRA continuation coverage.
    1. (1) The date of the qualifying event; or
    2. (2) In the alternative, the plan can provide continued coverage and treat the qualified beneficiary's use of the facility as a constructive election. In such a
25. 54.4980B-7 · -7 Duration of COBRA continuation coverage.
    1. (1) The date of the qualified beneficiary's death; or
    2. (2) The date that is 36 months after the death of the retired covered employee. Q-5: How does a qualified beneficiary become entitled to a disability extension?
    3. (3) The date upon which the employer or employee organization ceases to provide any group health plan (including successor plans) to any employee;
    4. (4) The date, after the date of the election, upon which the qualified beneficiary first becomes covered under any other group health plan, as described in Q&A-
    5. (5) The date, after the date of the election, upon which the qualified beneficiary first becomes entitled to Medicare benefits, as described in Q&A-3 of this se
    6. (6) In the case of a qualified beneficiary entitled to a disability extension (see Q&A-5 of this section), the later of—
26. 54.4980B-8 · -8 Paying for COBRA continuation coverage.
    1. (b) Notwithstanding paragraph (a) of this Q&A-5, a plan cannot require payment for any period of COBRA continuation coverage for a qualified beneficiary earlier
    2. (c) If, after COBRA continuation coverage has been elected for a qualified beneficiary, a provider of health care (such as a physician, hospital, or pharmacy) c
    3. (d) If timely payment is made to the plan in an amount that is not significantly less than the amount the plan requires to be paid for a period of coverage, the
    4. (e) Payment is considered made on the date on which it is sent to the plan.
27. 54.4980B-9 · -9 Business reorganizations and employer withdrawals from multiemployer plans.
    1. (a) The selling group is the controlled group of corporations or the group of trades or businesses under common control that includes the corporation or other t
    2. (b) The rules of Q&A-9 of this section and this Q&A-10 are illustrated by the following examples; in each example, each group health plan is subject to COBRA: E
    3. (c) (1) In the case of an asset sale, if the selling group ceases to provide any group health plan to any employee in connection with the sale and if the buying
    4. (d) The rules of Q&A-1 through Q&A-7 of this section and this Q&A-8 are illustrated by the following examples; in each example, each group health plan is subjec
    5. (i) The date the selling group ceases to provide any group health plan to any employee; or
    6. (ii) The date of the asset sale.
28. 54.4980D-1 · -1 Requirement of return and time for filing of the excise tax under section 4980D.
    1. (b) Due date for filing of return by employers. See § 54.6071-1(b)(1).
    2. (c) Due date for filing of return by multiemployer plans or multiple employer health plans. See § 54.6071-1(b)(2).
    3. (d) Effective/applicability date. In the case of an employer or other person mentioned in paragraph (b) of this Q & A-1, the rules in this Q & A-1 are effective
29. 54.4980E-1 · -1 Requirement of return and time for filing of the excise tax under section 4980E.
    1. (b) Effective/applicability date. The rules in this Q & A-1 are effective for plan years beginning on or after January 1, 2010.
30. 54.4980F-1 · -1 Notice requirements for certain pension plan amendments significantly reducing the rate of future benefit accrual.
    1. (b) Regulatory effective date—(1) General effective date. Except as otherwise provided in this paragraph (b) of this section, Q&A-1 through Q&A-18 of this secti
    2. (c) Amendment effective before termination date of a plan subject to title IV of ERISA. To the extent that an amendment providing for a significant reduction in
    3. (d) Designees. Section 204(h) notice may be provided to a person designated in writing by an applicable individual or by an employee organization representing p
    4. (e) Facts and circumstances test. Whether a participant or alternate payee is an applicable individual is determined on a typical business day that is reasonabl
    5. (f) Examples. The following examples illustrate the rules in this Q&A-10: Example 1.(i) Facts. A defined benefit plan requires an individual to complete 1 year
    6. (g) Special timing rules relating to certain section 204(h) amendments that reduce section 411(d)(6) protected benefits—(1) Plan amendments permitted to reduce
    7. (i) Either the notice is actually received by the applicable individual or the plan administrator takes appropriate and necessary measures reasonably calculated
    8. (ii) Effective dates for Q&A-9(g)(2) and Q&A-7(b). Except as otherwise provided in Q&A-18(b)(3)(iii) of this section, Q&A-9(g)(2) and Q&A-7(b) of this section a
31. 54.4980G-0 · -0 Table of contents.
32. 54.4980G-1 · -1 Failure of employer to make comparable health savings account contributions.
    1. (b) Effective/applicability date. The rules in this Q & A-5 are effective for employer contributions made for calendar years beginning on or after January 1, 20
    2. (c) Examples. The rules of this Q & A-2 are illustrated by the following examples: Example 1.Employer A maintains an HDHP and contributes to the HSAs of eligibl
33. 54.4980G-2 · -2 Employer contribution defined.
34. 54.4980G-3 · -3 Failure of employer to make comparable health savings account contributions.
    1. (b) Example. The following example illustrates the rules in paragraph (a) of this Q & A-13: Example.In a calendar year, Employer P contributes $600 to the Arche
    2. (c) Examples. The following examples illustrate the rules in paragraph (a) of this Q & A-10. None of the employees in the following examples are covered by a co
35. 54.4980G-4 · -4 Calculating comparable contributions.
    1. (b) Satisfying comparability. An employer that accelerates contributions to the HSAs of its employees will not fail to satisfy the comparability rules because e
    2. (c) Model notice. Employers may use the following sample language as a basis in preparing their own notices. Notice to Employees Regarding Employer Contribution
    3. (d) [Reserved]
    4. (e) Electronic delivery. An employer may furnish the notice required under this section electronically in accordance with § 1.401(a)-21 of this chapter.
    5. (f) Examples. The following examples illustrate the rules in this Q & A-14: Example 1.In a calendar year, Employer Q contributes to the HSAs of current employee
    6. (g) Example. The following example illustrates the rules in paragraph (f) of this Q & A-2: Example.Employer M has established, on a reasonable and consistent ba
    7. (h) Maximum contribution permitted for all employees who are eligible individuals during the last month of the taxable year. An employer may contribute up to th
    8. (i) Examples. The following examples illustrate the rules in paragraph (h) in this Q & A-2. In the following examples, no contributions are made through a secti
    9. (j) Effective/applicability date. The rules in paragraphs (h) and (i) of Q & A-2 are effective for employer contributions made for calendar years beginning on o
36. 54.4980G-5 · -5 HSA comparability rules and cafeteria plans and waiver of excise tax.
    1. (b) Examples. The following examples illustrate the rules in this § 54.4980G-5. The examples read as follows: Example 1.Employer A's written cafeteria plan perm
37. 54.4980G-6 · -6 Special rule for contributions made to the HSAs of nonhighly compensated employees.
    1. (b) Example. The following example illustrates the rules in paragraph (a) of this Q & A-3. In the following example, no contributions are made through a section
38. 54.4980G-7 · -7 Special comparability rules for qualified HSA distributions contributed to HSAs on or after December 20, 2006 and before January 1, 2012.
39. 54.4980H-0 · -0 Table of contents.
40. 54.4980H-1 · -1 Definitions.
    1. (a) Definitions. The definitions in this section apply only for purposes of this section and §§ 54.4980H-2 through 54.4980H-6.
    2. (b) Effective/applicability date. This section is applicable for periods after December 31, 2014.
    3. (ii) Monthly equivalency. Except as otherwise provided in paragraph (a)(21)(iii) of this section, 130 hours of service in a calendar month is treated as the mon
41. 54.4980H-2 · -2 Applicable large employer and applicable large employer member.
    1. (a) In general. Section 4980H applies to an applicable large employer and to all of the applicable large employer members that comprise that applicable large em
    2. (b) Determining applicable large employer status—(1) In general. An employer's status as an applicable large employer for a calendar year is determined by takin
    3. (c) Full-time equivalent employees (FTEs)—(1) In general. In determining whether an employer is an applicable large employer, the number of FTEs it employed dur
    4. (d) Examples. The following examples illustrate the rules of paragraphs (a) through (c) of this section. In these examples, hours of service are computed follow
    5. (e) Additional guidance. With respect to an employer's status as an applicable large employer, the Commissioner may prescribe additional guidance of general app
    6. (f) Effective/applicability date. This section is applicable for periods after December 31, 2014.
42. 54.4980H-3 · -3 Determining full-time employees.
    1. (a) In general. This section sets forth the rules for determining hours of service and status as a full-time employee for purposes of section 4980H. These regul
    2. (b) Hours of service—(1) In general. The following rules on the calculation of hours of service apply for purposes of applying both the look-back measurement me
    3. (e) Use of the look-back measurement method and the monthly measurement method for different categories of employees. Different applicable large employer member
    4. (f) Changes in employment status resulting in a change in full-time employee determination method—(1) Change in employment status from a position to which a loo
    5. (g) Nonpayment or late payment of premiums. An applicable large employer member will not be treated as failing to offer to a full-time employee (and his or her
    6. (h) Additional guidance. With respect to the determination of full-time employee status, including determination of hours of service, the Commissioner may presc
    7. (i) Effective/applicability date. This section is applicable for periods after December 31, 2014.
    8. (ii) Change from monthly measurement method to look-back measurement method. For an employee who is transferring from a position under which the monthly measure
43. 54.4980H-4 · -4 Assessable payments under section 4980H(a).
    1. (a) In general. If an applicable large employer member fails to offer to its full-time employees (and their dependents) the opportunity to enroll in minimum ess
    2. (b) Offer of coverage—(1) In general. An applicable large employer member will not be treated as having made an offer of coverage to a full-time employee for a
    3. (c) Partial calendar month. If an applicable large employer member fails to offer coverage to a full-time employee for any day of a calendar month, that employe
    4. (d) Application to applicable large employer member. The liability for an assessable payment under section 4980H(a) for a calendar month with respect to a full-
    5. (e) Allocated reduction of 30 full-time employees. For purposes of the liability calculation under paragraph (a) of this section, with respect to each calendar
    6. (f) Example. The following example illustrates the provisions of paragraphs (a) and (e) of this section. Example.(i) Facts. Applicable large employer member Z a
    7. (g) Additional guidance. With respect to assessable payments under section 4980H(a), the Commissioner may prescribe additional guidance of general applicability
    8. (h) Effective/applicability date. This section is applicable for periods after December 31, 2014.
44. 54.4980H-5 · -5 Assessable payments under section 4980H(b).
    1. (a) In general. If an applicable large employer member offers to its full-time employees (and their dependents) the opportunity to enroll in minimum essential c
    2. (b) Offer of coverage. For purposes of this section, the same rules with respect to an offer of coverage for purposes of section 4980H(a) apply. See § 54.4980H-
    3. (c) Partial calendar month. If an applicable large employer member fails to offer coverage to a full-time employee for any day of a calendar month, that employe
    4. (d) Applicability to applicable large employer member. The liability for an assessable payment under section 4980H(b) for a calendar month with respect to a ful
    5. (e) Affordability—(1) In general. An employee who is offered coverage by an applicable large employer member may be eligible for an applicable premium tax credi
    6. (f) Additional guidance. With respect to assessable payments under section 4980H(b), including the determination of whether an offer of coverage is affordable f
    7. (g) Effective/applicability date. This section is applicable for periods after December 31, 2014.
45. 54.4980H-6 · -6 Administration and procedure.
    1. (a) In general. [Reserved]
    2. (b) Effective/applicability date. This section is applicable for periods after December 31, 2014.
46. 54.6011-1 · -1 General requirement of return, statement, or list.
    1. (a) Minimum funding standards or excess contributions for self-employed individuals and section 403(b)(7)(A) custodial accounts. Any employer or individual liab
    2. (b) Tax on prohibited transactions. Every disqualified person (as defined in section 4975(e)(2)) liable for the tax imposed under section 4975(a) with respect t
    3. (c) Entity manager tax on prohibited tax shelter transactions—(1) In general. Any entity manager of a tax-exempt entity described in section 4965(c)(4), (c)(5),
    4. (d) Effective/applicability date. Paragraph (c) of this section is applicable on July 6, 2007.
47. 54.6011-1T · -1T General requirement of return, statement, or list (temporary).
    1. (a) Tax on reversions of qualified plan assets to employer. Every employer liable for the tax imposed under section 4980(a) with respect to an employer reversio
    2. (b) [Reserved]
48. 54.6011-2 · -2 General requirement of return, statement, or list.
49. 54.6011-3 · -3 Required use of electronic form for the filing requirements for the return for certain excise taxes related to employee benefit plans.
    1. (a) Excise tax returns required in electronic form. Any employer or individual required to file an excise tax return on Form 5330, Return of Excise Taxes Relate
    2. (b) Exclusions from electronic-filing requirements—(1) Waivers. The Commissioner may grant waivers of the requirements of this section in cases of undue hardshi
    3. (c) Failure to file. If a filer required to file the Form 5330 fails to file the report electronically when required to do so by this section, the filer has fai
    4. (d) Meaning of terms. The following definitions apply for purposes of this section:
    5. (e) Example. The following example illustrates the provisions of paragraph (d)(2) of this section:
    6. (f) Applicability date. The rules of this section apply to any Form 5330 required to be filed for taxable years ending on or after December 31, 2023.
    7. (ii) Definition of filer. For purposes of this section, the term filer means the person required to report the tax on the Form 5330. For general rules on who is
50. 54.6011-4 · -4 Requirement of statement disclosing participation in certain transactions by taxpayers.
    1. (a) In general. If a transaction is identified as a listed transaction or a transaction of interest as defined in § 1.6011-4 of this chapter by the Commissioner
    2. (b) Effective/applicability date. This section applies to listed transactions entered into on or after January 1, 2003. This section applies to transactions of
51. 54.6060-1 · -1 Reporting requirements for tax return preparers.
    1. (a) In general. A person that employs one or more tax return preparers to prepare a return or claim for refund under Chapter 43 of subtitle D of the Internal Re
    2. (b) Effective/applicability date. This section is applicable to returns and claims for refund filed after December 31, 2008.
52. 54.6061-1 · -1 Signing of returns and other documents.
53. 54.6071-1 · -1 Time for filing returns.
    1. (a) Returns under section 4980B. (1) Due date for filing of return by employers or other persons responsible for benefits under a group health plan. If the pers
    2. (b) Returns under section 4980D. (1) Due date for filing of return by employers. If the person liable for the excise tax is an employer, the return required by
    3. (c) Returns under section 4980E. Any employer who is liable for the excise tax under section 4980E must report this tax by filing the return required by § 54.60
    4. (d) Returns under section 4980G. Any employer who is liable for the excise tax under section 4980E must report this tax by filing the return required by § 54.60
    5. (e) Effective/applicability date: The rules in this section are effective for any Form 8928 that is due on or after January 1, 2010.
54. 54.6081-1 · -1 Automatic extension of time for filing returns for certain excise taxes under Chapter 43.
    1. (a) In general. An employer, other person or health plan that is required to file a return on Form 8928, “Return of Certain Excise Taxes Under Chapter 43 of the
    2. (b) Requirements. To satisfy this paragraph (b), an employer, other person or health plan must—
    3. (c) No extension of time for the payment of tax. An automatic extension of time for filing a return granted under paragraph (a) of this section will not extend
    4. (d) Termination of automatic extension. The Commissioner may terminate an automatic extension at any time by mailing to the employer, other person, or health pl
    5. (e) Penalties. See section 6651 for failure to file a pension excise tax return or failure to pay the amount shown as tax on the return.
    6. (f) Effective/applicability date. This section is applicable for applications for an automatic extension of time to file a return due under chapter 43, filed on
55. 54.6091-1 · -1 Place for filing excise tax returns under section 4980B, 4980D, 4980E, or 4980G.
56. 54.6107-1 · -1 Tax return preparer must furnish copy of return or claims for refund to taxpayer and must retain a copy or record.
    1. (a) In general. A person who is a signing tax return preparer of any return or claim for refund of tax under Chapter 43 of subtitle D of the Internal Revenue Co
    2. (b) Effective/applicability date. This section is applicable to returns and claims for refund filed after December 31, 2008.
57. 54.6109-1 · -1 Tax return preparers furnishing identifying numbers for returns or claims for refund filed.
    1. (a) In general. Each tax return or claim for refund of tax under Chapter 43 of subtitle D prepared by one or more signing tax return preparers must include the
    2. (b) Effective/applicability date. Paragraph (a) of this section is applicable to returns and claims for refund filed after December 31, 2008.
58. 54.6151-1 · -1 Time and place for paying of tax shown on returns.
59. 54.6694-1 · -1 Section 6694 penalties applicable to tax return preparer.
    1. (a) In general. For general definitions regarding section 6694 penalties applicable to preparers of tax returns or claims for refund of tax under Chapter 43 of
    2. (b) Effective/applicability date. Paragraph (a) of this section is applicable to returns and claims for refund filed, and advice provided, after December 31, 20
60. 54.6694-2 · -2 Penalties for understatement due to an unreasonable position.
    1. (a) In general. A person who is a tax return preparer of any return or claim for refund of tax under Chapter 43 of subtitle D of the Internal Revenue Code (Code
    2. (b) Effective/applicability date. This section is applicable to returns and claims for refund filed, and advice provided, after December 31, 2008.
61. 54.6694-3 · -3 Penalty for understatement due to willful, reckless, or intentional conduct.
    1. (a) In general. A person who is a tax return preparer of any return or claim for refund of excise tax under chapter 43 of subtitle D of the Internal Revenue Cod
    2. (b) Effective/applicability date. This section is applicable to returns and claims for refund filed, and advice provided, after December 31, 2008.
62. 54.6694-4 · -4 Extension of period of collection when tax return preparer pays 15 percent of a penalty for understatement of taxpayer's liability and certain other procedural matters.
    1. (a) In general. For rules relating to the extension of period of collection when a tax return preparer who prepared a return or claim for refund for tax under c
    2. (b) Effective/applicability date. This section is applicable to returns and claims for refund filed, and advice provided, after December 31, 2008.
63. 54.6695-1 · -1 Other assessable penalties with respect to the preparation of tax returns for other persons.
    1. (a) In general. A person who is a tax return preparer of any return or claim for refund of tax under chapter 43 of subtitle D of the Internal Revenue Code (Code
    2. (b) Effective/applicability date. This section is applicable to returns and claims for refund filed after December 31, 2008.
64. 54.6696-1 · -1 Claims for credit or refund by tax return preparers.
    1. (a) In general. For rules for claims for credit or refund by a tax return preparer who prepared a return or claim for refund for excise tax under chapter 43 of
    2. (b) Effective/applicability date. This section is applicable to returns and claims for refund filed, and advice provided, after December 31, 2008.
65. 54.7701-1 · -1 Tax return preparer.
    1. (a) In general. For the definition of a tax return preparer, see § 301.7701-15 of this chapter.
    2. (b) Effective/applicability date. This section is applicable to returns and claims for refund filed, and advice provided, after December 31, 2008.
66. 54.9801-1 · -1 Basis and scope.
    1. (a) Statutory basis. This section and sections 54.9801-2 through 54.9801-6, 54.9802-1, 54.9802-2, 54.9802-3T, 54.9811-1, 54.9812-1T, 54.9831-1, and 54.9833-1 (p
    2. (b) Scope. A group health plan or health insurance issuer offering group health insurance coverage may provide greater rights to participants and beneficiaries
    3. (c) Similar requirements under the Employee Retirement Income Security Act and the Public Health Service Act. Sections 701, 702, 703, 711, 712, 732, and 733 of
67. 54.9801-1T · -1T Basis and scope (temporary).
    1. (a) Statutory basis. This section and §§ 54.9801-2 through 54.9801-6, 54.9802-1, 54.9802-2, 54.9802-3T, 54.9802-4, 54.9811-1, 54.9812-1, 54.9815-1251, 54.9815-2
    2. (b) Scope. A group health plan or health insurance issuer offering group health insurance coverage may provide greater rights to participants and beneficiaries
    3. (c) Similar requirements under the Employee Retirement Income Security Act and the Public Health Service Act. Sections 701, 702, 703, 711, 712, 716, 717, 732, a
68. 54.9801-2 · -2 Definitions.
    1. (1) A federally qualified health maintenance organization (as defined in section 1301(a) of the PHS Act);
    2. (2) An organization recognized under State law as a health maintenance organization; or
    3. (3) A similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization. Individua
    4. (4) Exhaustion of COBRA continuation coverage means that an individual's COBRA continuation coverage ceases for any reason other than either failure of the indi
69. 54.9801-2T · -2T Definitions (temporary).
    1. (1) A federally qualified health maintenance organization (as defined in section 1301(a) of the PHS Act);
    2. (2) An organization recognized under State law as a health maintenance organization; or
    3. (3) A similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization. Individua
    4. (4) Exhaustion of COBRA continuation coverage means that an individual's COBRA continuation coverage ceases for any reason other than either failure of the indi
70. 54.9801-3 · -3 Limitations on preexisting condition exclusion period.
    1. (a) Preexisting condition exclusion defined. (1) A preexisting condition exclusion means a preexisting condition exclusion within the meaning of § 54.9801-2.
    2. (b) General rules. See section 2704 of the Public Health Service Act, incorporated into section 9815 of the Code, and its implementing regulations for rules pro
71. 54.9801-4 · -4 Rules relating to creditable coverage.
    1. (a) General rules—(1) Creditable coverage. For purposes of this section, except as provided in paragraph (a)(2) of this section, the term creditable coverage me
    2. (b) Counting creditable coverage rules superseded by prohibition on preexisting condition exclusion. See section 2704 of the Public Health Service Act, incorpor
    3. (i) A group health plan as defined in § 54.9831-1(a).
    4. (ii) Health insurance coverage as defined in § 54.9801-2 (whether or not the entity offering the coverage is subject to Chapter 100 of Subtitle K, and without r
72. 54.9801-5 · -5 Evidence of creditable coverage.
    1. (a) In general. The rules for providing certificates of creditable coverage and demonstrating creditable coverage have been superseded by the prohibition on pre
    2. (b) Applicability. The provisions of this section apply beginning December 31, 2014.
73. 54.9801-6 · -6 Special enrollment periods.
    1. (a) Special enrollment for certain individuals who lose coverage—(1) In general. A group health plan is required to permit current employees and dependents (as
    2. (b) Special enrollment with respect to certain dependent beneficiaries—(1) In general. A group health plan that makes coverage available with respect to depende
    3. (ii) Reasonable procedures for special enrollment. [Reserved]
74. 54.9802-1 · -1 Prohibiting discrimination against participants and beneficiaries based on a health factor.
    1. (a) Health factors. (1) The term health factor means, in relation to an individual, any of the following health status-related factors:
    2. (b) Prohibited discrimination in rules for eligibility—(1) In general. (i) A group health plan, and a health insurance issuer offering health insurance coverage
    3. (e) Nonconfinement and actively-at-work provisions—(1) Nonconfinement provisions—(i) General rule. Under the rules of paragraphs (b) and (c) of this section, a
    4. (f) Nondiscriminatory wellness programs—in general. A wellness program is a program of health promotion or disease prevention. Paragraphs (b)(2)(ii) and (c)(3)
    5. (g) More favorable treatment of individuals with adverse health factors permitted—(1) In rules for eligibility. (i) Nothing in this section prevents a group hea
    6. (h) No effect on other laws. Compliance with this section is not determinative of compliance with any provision of ERISA (including the COBRA continuation provi
    7. (i) Applicability dates. This section applies for plan years beginning on or after July 1, 2007.
    8. (ii) The rules of this paragraph (g)(2) are illustrated by the following example: Example.(i) Facts. Under a group health plan, employees are generally required
75. 54.9802-2 · -2 Special rules for certain church plans.
    1. (a) Exception for certain church plans—(1) Church plans in general. A church plan described in paragraph (b) of this section is not treated as failing to meet t
    2. (b) Church plans to which this section applies—(1) Church plans with certain coverage provisions in effect on July 15, 1997. This section applies to any church
    3. (c) Examples. The rules of this section are illustrated by the following examples: Example 1.(i) Facts. A church organization maintains two church plans for ent
    4. (d) Applicability date. This section is applicable to plan years beginning on or after July 1, 2007.
    5. (ii) A plan does not contain the provisions described in this paragraph (b)(3) if it provides for a longer (or shorter) period than 90 days. Thus, for example,
76. 54.9802-3T · -3T Additional requirements prohibiting discrimination based on genetic information (temporary).
    1. (a) Definitions. Unless otherwise provided, the definitions in this paragraph (a) govern in applying the provisions of this section.
    2. (b) No group-based discrimination based on genetic information—(1) In general. For purposes of this section, a group health plan must not adjust premium or cont
    3. (c) Limitation on requesting or requiring genetic testing—(1) General rule. Except as otherwise provided in this paragraph (c), a group health plan must not req
    4. (e) Examples regarding determinations of medical appropriateness. The application of the rules of paragraphs (c) and (d) of this section to plan determinations
    5. (f) Effective/applicability date. This section applies for plan years beginning on or after December 7, 2009.
    6. (g) Expiration date. This section expires on or before October 1, 2012.
    7. (ii) Limitation. A plan is permitted to request only the minimum amount of information necessary to make a determination regarding payment. The minimum amount o
77. 54.9802-4 · -4 Special Rule Allowing Integration of Health Reimbursement Arrangements (HRAs) and Other Account-Based Group Health Plans with Individual Health Insurance Coverage and Medicare and Prohibiting Discrimination In HRAs and Other Account-Based Group Health Plans.
    1. (a) Scope. This section applies to health reimbursement arrangements (HRAs) and other account-based group health plans, as defined in § 54.9815-2711(d)(6)(i) of
    2. (b) Purpose. This section provides the conditions that an HRA must satisfy in order to be integrated with individual health insurance coverage for purposes of P
    3. (c) General rule. An HRA will be considered to be integrated with individual health insurance coverage for purposes of PHS Act sections 2711 and 2713 and § 54.9
    4. (e) Integration of Individual Coverage HRAs with Medicare—(1) General rule. An individual coverage HRA will be considered to be integrated with Medicare (and de
    5. (f) Examples—(1) Examples regarding classes and the minimum class size requirement. The following examples illustrate the provisions of paragraph (c)(3) of this
    6. (g) Applicability date. This section applies to plan years beginning on or after January 1, 2020.
    7. (i) Example 1: Application of special rule for new hires to all employees—(A) Facts. For 2021, Plan Sponsor A offers all employees a traditional group health pl
    8. (ii) Example 2: Application of special rule for new hires to full-time employees—(A) Facts. For 2021, Plan Sponsor B offers a traditional group health plan to i
    9. (iv) Example 4: Permissible second application of the special rule for new hires to the same class of employees—(A) Facts. For 2021, Plan Sponsor D offers all o
    10. (ix) Example 9: New full-time employees and part-time employees offered HRA—(A) Facts. In 2021, Plan Sponsor G offers its full-time employees a traditional grou
    11. (v) Example 5: Impermissible second application of the special rule for new hires to the same class of employees—(A) Facts. The facts are the same as in paragra
    12. (vi) Example 6: New full-time employees offered different HRAs in different rating areas—(A) Facts. Plan Sponsor E has work sites in rating area 1, rating area
    13. (x) Example 10: Employees in rating area 1 offered HRA; employees in rating area 2 offered traditional group health plan—(A) Facts. The facts are the same as in
    14. (xi) Example 11: Employees in State 1 and rating area 1 of State 2 offered HRA; employees in all other rating areas of State 2 offered traditional group health
    15. (xv) Example 15: Full-time employees offered traditional group health plan; part-time employees offered HRA—(A) Facts. The facts are the same as in paragraph (f
78. 54.9811-1 · -1 Standards relating to benefits for mothers and newborns.
    1. (a) Hospital length of stay—(1) General rule. Except as provided in paragraph (a)(5) of this section, a group health plan that provides benefits for a hospital
    2. (b) Prohibitions—(1) With respect to mothers—(i) In general. A group health plan may not—
    3. (d) Notice requirement. See 29 CFR 2520.102-3(u) for rules relating to a disclosure requirement imposed under section 711(d) of ERISA (29 U.S.C. 1181) on certai
    4. (e) Applicability in certain states—(1) Health insurance coverage. The requirements of section 9811 and this section do not apply with respect to health insuran
    5. (f) Effective/applicability date. This section applies to group health plans for plan years beginning on or after January 1, 2009.
    6. (i) The state law requires the coverage to provide for at least a 48-hour hospital length of stay following a vaginal delivery and at least a 96-hour hospital l
    7. (ii) The state law requires the coverage to provide for maternity and pediatric care in accordance with guidelines that relate to care following childbirth esta
79. 54.9812-1 · -1 Parity in mental health and substance use disorder benefits.
    1. (a) Purpose and meaning of terms—(1) Purpose. This section and § 54.9812-2 set forth rules to ensure parity in aggregate lifetime and annual dollar limits, fina
    2. (b) Parity requirements with respect to aggregate lifetime and annual dollar limits. This paragraph (b) details the application of the parity requirements with
    3. (c) Parity requirements with respect to financial requirements and treatment limitations—(1) Clarification of terms—(i) Classification of benefits. When referen
    4. (e) Applicability—(1) Group health plans. The requirements of this section apply to a group health plan offering medical/surgical benefits and mental health or
    5. (f) Small employer exemption—(1) In general. The requirements of this section do not apply to a group health plan (or health insurance issuer offering coverage
    6. (g) Increased cost exemption—(1) In general. If the application of this section to a group health plan (or health insurance coverage offered in connection with
    7. (h) Sale of nonparity health insurance coverage. A health insurance issuer may not sell a policy, certificate, or contract of insurance that fails to comply wit
    8. (i) This section applies to group health plans on the first day of the first plan year beginning on or after January 1, 2025, except that the requirements of pa
    9. (ii) Until the applicability date in paragraph (i)(1)(i) of this section, plans are required to continue to comply with 26 CFR 54.9812-1, revised as of April 1,
    10. (iv) Audits. The Secretary may audit the books and records of a group health plan or a health insurance issuer relating to an exemption, including any actuarial
    11. (j) Severability. If any provision of this section is held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, or stayed p
80. 54.9812-2 · -2 Nonquantitative treatment limitation comparative analysis requirements.
    1. (a) Meaning of terms. Unless otherwise stated in this section, the terms of this section have the meanings indicated in § 54.9812-1(a)(2).
    2. (b) In general. In the case of a group health plan that provides both medical/surgical benefits and mental health or substance use disorder benefits and that im
    3. (c) Comparative analysis content requirements. With respect to each nonquantitative treatment limitation applicable to mental health or substance use disorder b
    4. (d) Requirements related to submission of comparative analyses to the Secretary upon request—(1) Initial request by the Secretary for comparative analysis. A gr
    5. (e) Requests for a copy of a comparative analysis. In addition to making a comparative analysis available upon request to the Secretary, a plan must make availa
    6. (f) Rule of construction. Nothing in this section or § 54.9812-1 shall be construed to prevent the Secretary from acting within the scope of existing authoritie
    7. (g) Applicability. The provisions of this section apply to group health plans described in § 54.9812-1(e), to the extent the plan is not exempt under § 54.9812-
    8. (h) Severability. If any provision of this section is held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, or stayed p
    9. (ii) Content of notice. The notice to participants and beneficiaries required in paragraph (d)(4)(i) of this section shall be written in a manner calculated to
81. 54.9815-1251 · -1251 Preservation of right to maintain existing coverage.
    1. (a) Definition of grandfathered health plan coverage—(1) In general—(i) Grandfathered health plan coverage means coverage provided by a group health plan, or a
    2. (b) Allowance for new employees to join current plan— (1) In general. Subject to paragraph (b)(2) of this section, a group health plan (including health insuran
    3. (e) Applicability of PHS Act sections 2704, 2711, and 2714 to grandfathered group health plans and group health insurance coverage—(1) The provisions of PHS Act
    4. (f) Effect on collectively bargained plans—In general. In the case of health insurance coverage maintained pursuant to one or more collective bargaining agreeme
    5. (g) Maintenance of grandfather status—(1) Changes causing cessation of grandfather status. Subject to paragraphs (g)(2) and (3) of this section, the rules of th
    6. (i) Elimination of benefits. The elimination of all or substantially all benefits to diagnose or treat a particular condition causes a group health plan or heal
    7. (ii) Increase in percentage cost-sharing requirement. Any increase, measured from March 23, 2010, in a percentage cost-sharing requirement (such as an individua
82. 54.9815-2704 · -2704 Prohibition of preexisting condition exclusions.
    1. (a) No preexisting condition exclusions. A group health plan, or a health insurance issuer offering group health insurance coverage, may not impose any preexist
    2. (b) Examples. The rules of paragraph (a) of this section are illustrated by the following examples (for additional examples illustrating the definition of a pre
    3. (c) Applicability date. The provisions of this section are applicable to group health plans and health insurance issuers for plan years beginning on or after Ja
83. 54.9815-2705 · -2705 Prohibiting discrimination against participants and beneficiaries based on a health factor.
    1. (a) In general. A group health plan and a health insurance issuer offering group health insurance coverage must comply with the requirements of § 54.9802-1.
    2. (b) Applicability date. This section is applicable to group health plans and health insurance issuers offering group health insurance coverage for plan years be
84. 54.9815-2708 · -2708 Prohibition on waiting periods that exceed 90 days.
    1. (a) General rule. A group health plan, and a health insurance issuer offering group health insurance coverage, must not apply any waiting period that exceeds 90
    2. (b) Waiting period defined. For purposes of this part, a waiting period is the period that must pass before coverage for an individual who is otherwise eligible
    3. (c) Relation to a plan's eligibility criteria—(1) In general. Except as provided in paragraphs (c)(2) and (c)(3) of this section, being otherwise eligible to en
    4. (d) Application to rehires. A plan or issuer may treat an employee whose employment has terminated and who then is rehired as newly eligible upon rehire and, th
    5. (e) Counting days. Under this section, all calendar days are counted beginning on the enrollment date (as defined in § 54.9801-2), including weekends and holida
    6. (f) Examples. The rules of this section are illustrated by the following examples: Example 1.(i) Facts. A group health plan provides that full-time employees ar
    7. (g) Special rule for health insurance issuers. To the extent coverage under a group health plan is insured by a health insurance issuer, the issuer is permitted
    8. (h) No effect on other laws. Compliance with this section is not determinative of compliance with any other provision of State or Federal law (including ERISA,
    9. (i) Applicability date. The provisions of this section apply for plan years beginning on or after January 1, 2015. See section 1251 of the Affordable Care Act,
85. 54.9815-2711 · -2711 No lifetime or annual limits.
    1. (a) Prohibition—(1) Lifetime limits. Except as provided in paragraph (b) of this section, a group health plan, or a health insurance issuer offering group healt
    2. (b) Construction—(1) Permissible limits on specific covered benefits. The rules of this section do not prevent a group health plan, or a health insurance issuer
    3. (c) Definition of essential health benefits. The term “essential health benefits” means essential health benefits under section 1302(b) of the Patient Protectio
    4. (d) Health reimbursement arrangements (HRAs) and other account-based group health plans—(1) In general. If an HRA or other account-based group health plan is in
    5. (e) Applicability date. The provisions of this section are applicable to group health plans and health insurance issuers for plan years beginning on or after Ja
    6. (ii) Exception for health flexible spending arrangements. A health flexible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code)
86. 54.9815-2712 · -2712 Rules regarding rescissions.
    1. (a) Prohibition on rescissions—(1) A group health plan, or a health insurance issuer offering group health insurance coverage, must not rescind coverage under t
    2. (b) Compliance with other requirements. Other requirements of Federal or State law may apply in connection with a rescission of coverage.
    3. (c) Applicability date. The provisions of this section are applicable to group health plans and health insurance issuers for plan years beginning on or after Ja
87. 54.9815-2713 · -2713 Coverage of preventive health services.
    1. (a) Services—(1) In general. Beginning at the time described in paragraph (b) of this section and subject to § 54.9815-2713A, a group health plan, or a health i
    2. (b) Timing—(1) In general. A plan or issuer must provide coverage pursuant to paragraph (a)(1) of this section for plan years that begin on or after September 2
    3. (c) Recommendations not current. For purposes of paragraph (a)(1)(i) of this section, and for purposes of any other provision of law, recommendations of the Uni
    4. (d) Effective/applicability date. April 16, 2012.
    5. (i) Evidence-based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force w
    6. (ii) Notwithstanding paragraph (b)(2)(i) of this section, to the extent a recommendation or guideline described in paragraph (a)(1)(i) of this section that was
88. 54.9815-2713A · -2713A Accommodations in connection with coverage of preventive health services.
    1. (a) Eligible organizations for optional accommodation. An eligible organization is an organization that meets the criteria of paragraphs (a)(1) through (4) of t
    2. (b) Optional accommodation—self-insured group health plans—(1) A group health plan established or maintained by an eligible organization that provides benefits
    3. (c) Optional accommodation—insured group health plans—(1) General rule. A group health plan established or maintained by an eligible organization that provides
    4. (d) Notice of availability of separate payments for contraceptive services—self-insured and insured group health plans. For each plan year to which the optional
    5. (e) Reliance—insured group health plans—(1) If an issuer relies reasonably and in good faith on a representation by the eligible organization as to its eligibil
    6. (f) Definition. For the purposes of this section, reference to “contraceptive” services, benefits, or coverage includes contraceptive or sterilization items, pr
    7. (g) Severability. Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, shall be construe
    8. (i) The issuer must expressly exclude contraceptive coverage from the group health insurance coverage provided in connection with the group health plan and prov
    9. (ii) With respect to payments for contraceptive services, the issuer may not impose any cost-sharing requirements (such as a copayment, coinsurance, or a deduct
89. 54.9815-2713T · -2713T Coverage of preventive health services (temporary).
    1. (a) Services—(1) In general. Beginning at the time described in paragraph (b) of this section and subject to § 54.9815-2713A, a group health plan, or a health i
    2. (b) Timing—(1) In general. A plan or issuer must provide coverage pursuant to paragraph (a)(1) of this section for plan years that begin on or after September 2
    3. (c) Recommendations not current. For purposes of paragraph (a)(1)(i) of this section, and for purposes of any other provision of law, recommendations of the Uni
    4. (d) Applicability date. The provisions of paragraphs (a)(1)(i) through (iv), (a)(2), (a)(3)(i) and (ii), (a)(4) through (5), (b)(1) and (2), and (c) of this sec
    5. (e) Sunset date. The provisions of paragraphs (a)(1)(v), (a)(3)(iii), and (b)(3) of this section will not apply with respect to a qualifying coronavirus prevent
    6. (i) Evidence-based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force w
    7. (ii) Notwithstanding paragraph (b)(2)(i) of this section, to the extent a recommendation or guideline described in paragraph (a)(1)(i) of this section that was
90. 54.9815-2714 · -2714 Eligibility of children until at least age 26.
    1. (a) In general—(1) A group health plan, or a health insurance issuer offering group health insurance coverage, that makes available dependent coverage of childr
    2. (b) Restrictions on plan definition of dependent—(1) In general. With respect to a child who has not attained age 26, a plan or issuer may not define dependent
    3. (c) Coverage of grandchildren not required. Nothing in this section requires a plan or issuer to make coverage available for the child of a child receiving depe
    4. (d) Uniformity irrespective of age. The terms of the plan or health insurance coverage providing dependent coverage of children cannot vary based on age (except
    5. (e) Examples. The rules of paragraph (d) of this section are illustrated by the following examples: Example 1.(i) Facts. A group health plan offers a choice of
    6. (f) Applicability date. The provisions of this section are applicable to group health plans and health insurance issuers for plan years beginning on or after Ja
91. 54.9815-2715 · -2715 Summary of benefits and coverage and uniform glossary.
    1. (a) Summary of benefits and coverage—(1) In general. A group health plan (and its administrator as defined in section 3(16)(A) of ERISA)), and a health insuranc
    2. (b) Notice of modification. If a group health plan, or health insurance issuer offering group health insurance coverage, makes any material modification (as def
    3. (c) Uniform glossary—(1) In general. A group health plan, and a health insurance issuer offering group health insurance coverage, must make available to partici
    4. (d) Preemption. State laws that conflict with this section (including a state law that requires a health insurance issuer to provide an SBC that supplies less i
    5. (e) Failure to provide. A group health plan that willfully fails to provide information required under this section to a participant or beneficiary is subject t
    6. (f) Applicability to Medicare Advantage benefits. The requirements of this section do not apply to a group health plan benefit package that provides Medicare Ad
    7. (g) Applicability date. (1) This section is applicable to group health plans and group health insurance issuers in accordance with this paragraph (g). (See 29 C
    8. (i) For disclosures with respect to participants and beneficiaries who enroll or re-enroll through an open enrollment period (including re-enrollees and late en
    9. (ii) For disclosures with respect to participants and beneficiaries who enroll in coverage other than through an open enrollment period (including individuals w
92. 54.9815-2715A1 · -2715A1 Transparency in coverage—definitions.
    1. (a) Scope and definitions—(1) Scope. This section sets forth definitions for the price transparency requirements for group health plans and health insurance iss
    2. (b) [Reserved]
93. 54.9815-2715A2 · -2715A2 Transparency in coverage—required disclosures to participants and beneficiaries.
    1. (a) Scope and definitions—(1) Scope. This section establishes price transparency requirements for group health plans and health insurance issuers offering group
    2. (b) Required disclosures to participants and beneficiaries. At the request of a participant or beneficiary who is enrolled in a group health plan, the plan must
    3. (c) Applicability. (1) The provisions of this section apply for plan years beginning on or after January 1, 2023 with respect to the 500 items and services to b
    4. (d) Severability. Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, or stayed pending
    5. (ii) Other contractual arrangements. A group health plan or health insurance issuer may satisfy the requirements under this paragraph (b) by entering into a wri
94. 54.9815-2715A3 · -2715A3 Transparency in coverage—requirements for public disclosure.
    1. (a) Scope and definitions—(1) Scope. This section establishes price transparency requirements for group health plans and health insurance issuers offering group
    2. (b) Requirements for public disclosure of in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for covere
    3. (ii) Other contractual arrangements. A group health plan or health insurance issuer may satisfy the requirements under this paragraph (b) by entering into a wri
95. 54.9815-2719 · -2719 Internal claims and appeals and external review processes.
    1. (a) Scope and definitions-(1) Scope. This section sets forth requirements with respect to internal claims and appeals and external review processes for group he
    2. (b) Internal claims and appeals process—(1) In general. A group health plan and a health insurance issuer offering group health insurance coverage must implemen
    3. (c) State standards for external review—(1) In general. (i) If a State external review process that applies to and is binding on a health insurance issuer offer
    4. (e) Form and manner of notice—(1) In general. For purposes of this section, a group health plan and a health insurance issuer offering group health insurance co
    5. (f) Secretarial authority. The Secretary may determine that the external review process of a group health plan or health insurance issuer, in operation as of Ma
    6. (g) Applicability date. The provisions of this section are applicable to group health plans and health insurance issuers for plan years beginning on or after Ja
    7. (ii) The plan or issuer must provide, upon request, a notice in any applicable non-English language; and
96. 54.9815-2719A · -2719A Patient protections.
    1. (a) Choice of health care professional—(1) Designation of primary care provider—(i) In general. If a group health plan, or a health insurance issuer offering gr
    2. (b) Coverage of emergency services—(1) Scope. If a group health plan, or a health insurance issuer offering group health insurance coverage, provides any benefi
    3. (ii) Other cost sharing. Any cost-sharing requirement other than a copayment or coinsurance requirement (such as a deductible or out-of-pocket maximum) may be i
97. 54.9815-2719AT · -2719AT Patient protections (temporary).
    1. (a) -(b) [Reserved]
    2. (c) Applicability date. The provisions of this section are applicable to group health plans and health insurance issuers for plan years beginning before January
98. 54.9815-2719T · -2719T Internal claims and appeals and external review processes (temporary).
    1. (a) Scope and definitions—(1) Scope—(i) In general. This section sets forth requirements with respect to internal claims and appeals and external review process
    2. (b) Internal claims and appeals process—(1) In general. A group health plan and a health insurance issuer offering group health insurance coverage must implemen
    3. (c) State standards for external review—(1) In general. (i) If a State external review process that applies to and is binding on a health insurance issuer offer
    4. (e) Form and manner of notice—(1) In general. For purposes of this section, a group health plan and a health insurance issuer offering group health insurance co
    5. (f) Secretarial authority. The Secretary may determine that the external review process of a group health plan or health insurance issuer, in operation as of Ma
    6. (g) Applicability date. The provisions of this section generally are applicable to group health plans and health insurance issuers for plan years beginning on o
    7. (ii) The plan or issuer must provide, upon request, a notice in any applicable non-English language; and
99. 54.9816-1T · -1T Basis and scope (temporary).
    1. (a) Basis. This section and §§ 54.9816-2T through 54.9816-8T, 54.9817-1T, 54.9817-2T, and 54.9822-1T implement subchapter B of chapter 100 of the Internal Reven
    2. (b) Scope. This part establishes standards for group health plans with respect to surprise medical bills, transparency in health care coverage, and additional p
100. 54.9816-2T · -2T Applicability (temporary).
     1. (a) In general. (1) The requirements in §§ 54.9816-4T through 54.9816-7T, 54.9817-1T, and 54.9822-1T apply to group health plans (including grandfathered health
     2. (b) Exceptions. The requirements in §§ 54.9816-4T through 54.9816-8T, 54.9817-1T, 54.9817-2T, and 54.9822-1T do not apply to the following:
101. 54.9816-3 · -3 Definitions.
     1. (a) The definitions in § 54.9801-2 apply to §§ 54.9816-4 through 54.9816-9, 54.9817-1, 54.9817-2, and 54.9822-1, unless otherwise specified. In addition, for pu
     2. (b) For further guidance, see 29 CFR 2590.716-3.
102. 54.9816-3T · -3T Definitions (temporary).
     1. (1) A hospital (as defined in section 1861(e) of the Social Security Act);
     2. (2) A hospital outpatient department;
     3. (3) A critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act); and
     4. (4) An ambulatory surgical center described in section 1833(i)(1)(A) of the Social Security Act. Independent freestanding emergency department means a health ca
103. 54.9816-4T · -4T Preventing surprise medical bills for emergency services (temporary).
     1. (a) In general. If a group health plan provides or covers any benefits with respect to services in an emergency department of a hospital or with respect to emer
     2. (b) Coverage requirements. A plan described in paragraph (a) of this section must provide coverage for emergency services in the following manner—
     3. (c) Definitions. In this section—
     4. (d) Applicability date. The provisions of this section are applicable with respect to plan years beginning on or after January 1, 2022.
104. 54.9816-5T · -5T Preventing surprise medical bills for non-emergency services performed by nonparticipating providers at certain participating facilities (temporary).
     1. (a) In general. If a group health plan provides or covers any benefits with respect to items and services described in paragraph (b) of this section, the plan m
     2. (b) Items and services described. The items and services described in this paragraph (b) are items and services (other than emergency services) furnished to a p
     3. (c) Coverage requirements. In the case of items and services described in paragraph (b) of this section, the plan—
     4. (d) Applicability date. The provisions of this section are applicable with respect to plan years beginning on or after January 1, 2022.
105. 54.9816-6 · -6 Methodology for calculating qualifying payment amount.
     1. (a) Definitions. For further guidance, see 29 CFR 2590.716-6(a) introductory text through (a)(17).
     2. (b) Methodology for calculation of median contracted rate. For further guidance, see 29 CFR 2590.716-6(b).
     3. (c) Methodology for calculation of the qualifying payment amount. For further guidance, see 29 CFR 2590.716-6(c).
     4. (d) Information to be shared about the qualifying payment amount. In cases in which the recognized amount, for an item or service furnished by a nonparticipatin
     5. (e) For further guidance, see 29 CFR 2590.716-6(e).
     6. (f) For further guidance, see 29 CFR 2590.716-6(f).
     7. (g) Applicability date. The provisions of this section are applicable for plan years beginning on or after January 1, 2022, except that paragraph (a)(18) of thi
     8. (h) Severability. (1) Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, will be const
106. 54.9816-6A · -6A Use of claim adjustment reason codes and remittance advice remark codes.
     1. (a) In general. When providing any remittance advice (including in paper or electronic form) to an entity (other than a participant, beneficiary, or enrollee) t
     2. (b) Severability—(1) Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, will be constr
107. 54.9816-6T · -6T Methodology for calculating qualifying payment amount (temporary).
     1. (a) Definitions. For purposes of this section, the following definitions apply:
     2. (b) Methodology for calculation of median contracted rate—(1) In general. The median contracted rate for an item or service is calculated by arranging in order
     3. (c) Methodology for calculation of the qualifying payment amount—(1) In general. (i) For an item or service (other than items or services described in paragraph
     4. (e) Certain access fees to databases. In the case of a plan that, pursuant to this section, uses an eligible database to determine the qualifying payment amount
     5. (f) Audits. See 45 CFR 149.140(f) for audit procedures that apply with respect to ensuring that a plan is in compliance with the requirement of applying a quali
     6. (g) Applicability date. The provisions of this section are applicable with respect to plan years beginning on or after January 1, 2022.
     7. (ii) For an item or service (other than items or services described in paragraphs (c)(1)(iii) through (vii) of this section) furnished during 2023 or a subseque
108. 54.9816-7T · -7T Complaints process for surprise medical bills regarding group health plans (temporary).
109. 54.9816-8 · -8 Independent dispute resolution process.
     1. (a) Scope and Definitions—(1) Scope. For further guidance, see 29 CFR 2590.716-8(a)(1).
     2. (b) Determination of payment amount through open negotiation and initiation of the Federal IDR process—(1) Determination of payment amount through open negotiat
     3. (c) Federal IDR process following initiation—(1) Selection of certified IDR entity—(i) Preliminary selection of the certified IDR entity. Within 3 business days
     4. (e) Certification of IDR entity—(1) In general. For further guidance, see 29 CFR 2590.716-8(e)(1).
     5. (f) Reporting of information relating to the Federal IDR process. For further guidance, see 29 CFR 2590.716-8(f) introductory text through (f)(1)(iv).
     6. (g) Extension of time periods for extenuating circumstances. (1) In general. The time periods specified in this section (other than the time for payment, if app
     7. (h) Applicability date. (1) Paragraph (a) of this section is applicable for plan years (or in the individual market, policy years) beginning on or after January
     8. (i) Severability. (1) Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, will be const
     9. (ii) The Secretary determines that the parties or certified IDR entity cannot meet applicable timeframes due to systematic delays in processing disputes under t
110. 54.9816-8T · -8T Independent dispute resolution process (temporary).
     1. (a) Scope and definitions—(1) Scope. This section sets forth requirements with respect to the independent dispute resolution (IDR) process (referred to in this
     2. (b) Determination of payment amount through open negotiation and initiation of the Federal IDR process—(1) Determination of payment amount through open negotiat
     3. (e) Certification of IDR entity—(1) In general. In order to be selected under paragraph (c)(1) of this section—
     4. (f) Reporting of information relating to the Federal IDR process—(1) Reporting of information. Within 30 business days of the close of each month, for qualified
     5. (g) Extension of time periods for extenuating circumstances—(1) General. The time periods specified in this section (other than the time for payment, if applica
     6. (h) Applicability date. The provisions of this section are applicable with respect to plan years beginning on or after January 1, 2022, except that the provisio
     7. (i) An extension is necessary to address delays due to matters beyond the control of the parties or for good cause; and
     8. (ii) The parties attest that prompt action will be taken to ensure that the determination under this section is made as soon as administratively practicable und
111. 54.9816-9 · -9 Federal independent dispute resolution registry of group health plans, health insurance issuers, and Federal Employees Health Benefits Program Carriers.
     1. (a) Establishment of Federal independent dispute resolution registry. The Secretary of the Treasury (Secretary), jointly with the Secretary of the Health and Hu
     2. (b) Federal IDR registration—(1) Registration requirement. Each self-insured group health plan, each FEHB Program carrier, and each health insurance issuer offe
     3. (c) Severability. (1) Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, will be const
112. 54.9817-1T · -1T Preventing surprise medical bills for air ambulance services (temporary).
     1. (a) In general. If a group health plan provides or covers any benefits for air ambulance services, the plan must cover such services from a nonparticipating pro
     2. (b) Coverage requirements. A plan described in paragraph (a) of this section must provide coverage of air ambulance services in the following manner—
     3. (c) Applicability date. The provisions of this section are applicable with respect to plan years beginning on or after January 1, 2022.
113. 54.9817-2 · -2 Independent dispute resolution process for air ambulance services.
     1. (a) For further guidance see § 54.9817-2T(a).
     2. (b) For further guidance see § 54.9817-2T(b) introductory text.
     3. (c) Applicability date. The provisions of this section are applicable with respect to plan years beginning on or after January 1, 2022, except that paragraphs (
114. 54.9817-2T · -2T Independent dispute resolution process for air ambulance services (temporary).
     1. (a) Definitions. Unless otherwise stated, the definitions in § 54.9816-3T apply.
     2. (b) Determination of out-of-network rates to be paid by group health plans; independent dispute resolution process. (1) For further guidance see § 54.9817-2(b)(
     3. (c) Applicability date. The provisions of this section are applicable with respect to plan years beginning on or after January 1, 2022, except that paragraphs (
115. 54.9822-1T · -1T Choice of health care professional (temporary).
     1. (a) Choice of health care professional—(1) Designation of primary care provider—(i) In general. If a group health plan, requires or provides for designation by
     2. (b) Applicability date. The provisions of this section are applicable with respect to plan years beginning on or after January 1, 2022.
     3. (ii) Construction. Nothing in paragraph (a)(1)(i) of this section is to be construed to prohibit the application of reasonable and appropriate geographic limita
116. 54.9825-1T · -1T Basis and scope (temporary).
     1. (a) Basis. This section and §§ 54.9825-2T through 54.9825-6T implement subchapter B of chapter 100 of the Internal Revenue Code of 1986.
     2. (b) Scope. This part establishes standards for group health plans with respect to surprise medical bills, transparency in health care coverage, and additional p
117. 54.9825-2T · -2T Applicability (temporary).
     1. (a) In general. The requirements in §§ 54.9825-4T through 54.9825-6T apply to group health plans (including grandfathered health plans as defined in § 54.9815-1
     2. (b) Exceptions. The requirements in §§ 54.9825-4T through 54.9825-6T do not apply to the following:
118. 54.9825-3T · -3T Definitions (temporary).
119. 54.9825-4T · -4T Reporting requirements related to prescription drug and health care spending (temporary).
     1. (a) General requirement. A group health plan or a health insurance issuer offering group health insurance coverage must submit an annual report to the Secretary
     2. (b) Timing and form of report. The report for the 2020 reference year must be submitted to the Secretary by December 27, 2021. Beginning with the 2021 reference
     3. (c) Transfer of business. Issuers that acquire a line or block of business from another issuer during a reference year are responsible for submitting the inform
     4. (d) Reporting entities and special rules to prevent unnecessary duplication—(1) Special rule for insured group health plans. To the extent coverage under a grou
     5. (e) Applicability date. The provisions of this section are applicable beginning December 27, 2021.
120. 54.9825-5T · -5T Aggregate reporting (temporary).
     1. (a) General requirement. A group health plan or a health insurance issuer offering group health insurance coverage must submit, or arrange to be submitted, the
     2. (b) Aggregation by reporting entity—(1) In general. If a reporting entity submits data on behalf of more than one group health plan in a State and market segmen
     3. (c) Aggregation by State. (1) Experience with respect to each fully-insured policy must be included on the report for the State where the contract was issued, e
     4. (d) Applicability date. The provisions of this section are applicable beginning December 27, 2021.
     5. (ii) The Secretary, jointly with the Secretary of Health and Human Services and the Secretary of Labor, may specify in guidance alternative or additional aggreg
121. 54.9825-6T · -6T Required information (temporary).
     1. (a) Information for each plan or coverage. The report required under § 54.9825-4T must include the following information for each plan or coverage, at the plan
     2. (b) Information for each state and market segment. The report required under § 54.9825-4T must include the following information with respect to plans or covera
     3. (c) Applicability date. The provisions of this section are applicable beginning December 27, 2021.
122. 54.9831-1 · -1 Special rules relating to group health plans.
     1. (a) Group health plan—(1) Defined. A group health plan means a plan (including a self-insured plan) of, or contributed to by, an employer (including a self-empl
     2. (b) General exception for certain small group health plans. (1) Subject to paragraph (b)(2) of this section, the requirements of §§ 54.9801-1 through 54.9801-6,
     3. (c) Excepted benefits—(1) In general. The requirements of §§ 54.9801-1 through 54.9801-6, 54.9802-1, 54.9802-2, 54.9811-1, 54.9812-1, 54.9815-1251 through 54.98
     4. (d) Treatment of partnerships. For purposes of this part:
     5. (e) Determining the average number of employees. [Reserved]
     6. (ii) The rules of this paragraph (c)(5) are illustrated by the following example: Example.(i) Facts. An employer sponsors a group health plan that provides cove
     7. (iv) Long-term care. Long-term care benefits are benefits that are either—
     8. (v) Health flexible spending arrangements. Benefits provided under a health flexible spending arrangement (as defined in section 106(c)(2)) are excepted for a c
     9. (vi) Employee assistance programs. Benefits provided under employee assistance programs are excepted if they satisfy all of the requirements of this paragraph (
123. 54.9833-1 · -1 Applicability dates.