Under the Affordability for Employer Coverage for Family Members of Employees IRS rule, “family members” are individuals who will be on the same federal income tax return — so, an individual, plus their spouse if married and filing jointly, plus any dependents that they (and their spouse, if applicable) claim. The “family premium” is the premium for the lowest-cost employer plan that would cover all members of the tax household who are offered coverage by the employer.

  • If the tax household includes just an employee and spouse, then the family premium is the lowest cost premium that would cover those two people, such as a “self plus one” plan option, if offered.
  • If the tax household includes tax dependents, then the family premium is the one that would cover both the spouse (if there is one) and all dependents who are offered the employer coverage, even if those dependents aren’t seeking Marketplace coverage.

Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.