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Form 1094-B for Pittsburgh Pennsylvania: What You Should Know

Insurance Exchange If you are applying for insurance under an alternative method of payment (or “qualified insurance”) program administered by the IRS at a place other than an office or agent of the IRS, or if you wish to purchase an insurance plan using an Exchange established under the Affordable Care Act, then you must apply to obtain certification at an Exchange. IRS Certification Program Qualified Health Plan Certifications The certification requirements of the ACA are detailed by paragraph 8 of IRS Publication 595-G. The certification process involves the IRS reviewing applicants' qualifications to purchase a qualified health plan. Certifications are given to qualified applicants when a plan meets the qualifications for certification required of the Affordable Care Act, section 481 of the Act (Sec. 481), or section 4980H. This is required when, for a plan year beginning or ending on or after January 1, 2018, the employee has made more than 50 premium payments to a qualified health plan offered in the exchange during the prior calendar year. Qualified Health Plan Qualification Rules Sec. 875(b)(4) The plan meets the qualifications for certification if it meets one or more of the following requirements. (4) It provides coverage that is at least as comprehensive and affordable as the coverage provided in the health care law that establishes minimum essential coverage as described in subsection (13)(A). Sec. 875(b)(4)(B) Health plans that do not meet the requirements of this paragraph shall not be certified under this section for 2023 or 2018. Qualified Health Plan Qualification Rules (23) Provides coverage that is at least as comprehensive and affordable as the minimum essential coverage required under section 5000A of the Internal Revenue Code of 1986. (24) Includes all services (except emergency services, hospitalization, and prescription drugs) required to be covered under part A of title XVIII of the Social Security Act for adults. The term does not include coverage for services furnished by a person to an individual who is not an adult, including services covered under part B of such title (42 U.S.C. 1395w-4 and 1395ww-4).

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