Instructions For Form 8941 - Credit For Small Employer Health Insurance Premiums - 2016 Page 8
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30Column (b), Employer Premiums Paid
was enrolled for the entire tax year. You would have paid
$570 ($57 × 10) if the employee was only enrolled for 10
Enter the total employer premiums paid for the tax year for
pay periods. You will need an additional set of
each employee listed in column (a). For details, see
calculations if the premium amounts changed during the
Employer Premiums
Paid, earlier.
tax year.
Column (c), Adjusted Average
Column (d), Enrolled Employee Hours
Premiums
of Service
Your credit is reduced if the employer premiums paid are
Don’t complete column (d) of Worksheet 4 if
more than the employer premiums that would have been
Form 8941, line 12, is zero.
!
paid if individuals considered employees were enrolled in
a plan with a premium equal to the average premium for
CAUTION
Enter the amount from column (b) of Worksheet 1 for
the small group market in the rating area in which the
each employee listed in column (a) of Worksheet 4.
employee enrolls for coverage.
The rating area in which an employee enrolls for
Worksheet 5. Information Needed To
coverage is generally the rating area where your business
Complete Line 8 (If Line 2 is More
is located (based on your primary business address). You
will generally have selected a plan in your rating area that
Than 10)
covers all employees located within or outside your rating
area. However, if you have multiple businesses or
1. Enter the amount from Form 8941,
operations in multiple states, and have set up plans in
line 7
1.
more than one SHOP Marketplace, the average premiums
. . . . . . . . . . . . . . . . . . . . . . . . . .
may be different for employees enrolled in each SHOP
2. Enter the number from Form
Marketplace.
8941, line 2
2.
. . . . . . . . . . . .
3. Subtract 10 from line 2
Enter, for each employee listed in column (a), the
. . . . .
3.
premiums you would have paid if the employee had
4. Divide line 3 by 15. Enter the
enrolled in a plan or plans with a total premium equal to
result as a decimal (rounded to
the average premium for the small group market in the
at least 3 places)
4.
. . . . . . . .
rating area in which the employee enrolls for coverage.
5. Multiply line 1 by line 4
. . . . . . . . . . . . . .
5.
To find the average premium for the small group market
6. Subtract line 5 from line 1. Report this
in a rating area for tax years beginning in 2017, see the
amount on Form 8941, line 8
6.
. . . . . . . . .
average premium tables at the end of these instructions.
Family coverage includes any coverage other than
Worksheet 6. Information Needed To
employee-only coverage.
Complete Line 9 (If Line 3 is More
Example 4. Assume the same facts that were used in
Example 3. The $60 you contribute each payday toward
Than $26,000)
employee health insurance coverage is 60% ($60 ÷ $100)
of the weekly premium for each employee enrolled in
1. Enter the amount from Form 8941,
employee-only coverage and 24% ($60 ÷ $250) of the
line 8
1.
weekly premium for each employee enrolled in family
. . . . . . . . . . . . . . . . . . . . . . . . . .
coverage.
2. Enter the amount from Form
8941, line 7
2.
. . . . . . . . . . . . .
In this situation, the total average premium limitation
amounts that apply are 60% of the applicable average
3. Enter the amount from Form
premium amounts for each employee enrolled in
8941, line 3
3.
. . . . . . . . . . . . .
employee-only coverage and 24% of the applicable
4. Subtract $26,200 from
average premium amounts for each employee enrolled in
line 3
4.
. . . . . . . . . . . . . . . . . .
family coverage.
5. Divide line 4 by $26,200. Enter
You have an employee enrolled in employee-only
the result as a decimal (rounded
coverage who enrolled for coverage in your local rating
to at least 3 places)
5.
. . . . . . . .
area. The applicable employee-only average premium
6. Multiply line 2 by line 5
. . . . . . . . . . . . . .
6.
amount for the rating area is $4,940 or $95 ($4,940 ÷ 52)
7. Subtract line 6 from line 1. Report this
for each weekly payday. The amount you would have paid
amount on Form 8941, line 9
7.
toward this employee's health insurance coverage based
. . . . . . . . .
on the average premiums is $57 (60% of $95) each
Line 10
payday.
To determine the premiums you would have paid for
Enter the total amount of any state premium subsidies
this employee during the tax year if the employee had
paid and any state tax credits available to you for
enrolled in an average premium plan, multiply the number
premiums included on line 4. For details, see
State
of pay periods during which your employee was enrolled
Premium Subsidy and Tax Credit
Limitation, earlier.
in the health insurance coverage by $57. For example,
you would have paid $2,964 ($57 × 52) if the employee
-8-
Instructions for Form 8941 (2017)
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