Tax Credit For Dependent Health Benefits Paid Worksheet

2015

TAX CREDIT FOR DEPENDENT HEALTH BENEFITS PAID

WORKSHEET INSTRUCTIONS

This credit is available to employers that offer a qualiﬁ ed health beneﬁ t plan (deﬁ ned below) and that employ

fewer than ﬁ ve employees. This credit is equal to the lesser of 20% of the dependent health beneﬁ ts paid by

the employer for low-income employees or $125 per low-income employee with dependent health coverage.

A taxpayer that employs ﬁ ve or more employees after qualifying for the credit may continue to qualify for the

credit for another two years. Otherwise, a taxpayer may claim a credit only for those periods during which the

employer: 1) offers a qualiﬁ ed health beneﬁ t plan that is made available to all low-income employees; 2) pays

at least 80% of the health insurance costs for each low-income employee under the plan; and 3) pays at least

60% of the cost of dependent health insurance beneﬁ ts for children under 19 who are dependents of low-income

employees under the plan. The credit is limited to 50% of the regular income tax due. Any unused credit may

be carried forward for two years.

Employer means an entity that employs one or more individuals performing services for it within this state. For

a complete deﬁ nition of employer, see 26 M.R.S. § 1043.

Dependent means a dependent, as deﬁ ned by IRC § 152, who is under 19 years of age.

Dependent health beneﬁ ts means health beneﬁ ts and health insurance costs allowable as deductions to the

employer under IRC § 105, paid by the taxpayer on behalf of the taxpayer’s low-income employees for the

beneﬁ t of the employees’ dependents.

Qualiﬁ ed health beneﬁ t plan means a plan that includes comprehensive coverage for at least the following

range of beneﬁ ts: inpatient and outpatient hospital services; physicians’ surgical and medical services; laboratory

and x-ray services; and well-baby and well-child care, including age-appropriate immunizations. The plan must

provide coverage that has an actuarial value no less than 80% of the actuarial value of coverage that is provided

to employees of the State of Maine. For purposes of this paragraph, actuarial value means the expected cost

of a beneﬁ t based on assumptions as to relevant variables such as morbidity, mortality, persistency and interest.

When comparing the actuarial value of one beneﬁ t or package of beneﬁ ts to another, both actuarial values

must be based on the same assumptions. The plan must also impose copayment and deductible costs on the

employee that do not exceed 10% of the actuarial value of all beneﬁ ts afforded by the plan and makes the same

or comparable coverage available for the beneﬁ t of the employee’s dependent children who are under 19 years

of age.

Low-income employee means a Maine resident whose average weekly earnings from the employer do not

exceed the state’s average weekly wage as calculated by the Department of Labor.

In the case of pass-through entities (such as partnerships, LLCs, S corporations, and trusts), the partners,

members, shareholders, beneﬁ ciaries or other owners are allowed a credit in proportion to their respective

interest in these entities.

SPECIFIC LINE INSTRUCTIONS

Please enter the employer name and social security number (“SSN”) or employer identiﬁ cation number (“EIN”).

Line 3.

Enter the total amount paid by the employer to provide dependent health beneﬁ ts in 2015 for low-

income employees. See deﬁ nition of dependent health beneﬁ ts above.

Line 6.

Enter any tax credit amounts claimed in 2013 or 2014 but not used.

Lines 8 & 9. The credit is limited to 50% of the Maine tax liability.

Tax Credit For Dependent Health Benefits Paid Worksheet - 2015 Page 2