Form 8928 Return Of Certain Excise Taxes Under Chapter 43 {8928}

Form 8928 (Rev. May 2016), Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code (Under sections 4980B, 4980D, 4980E, and 4980G), Group health plans or employers file this form to report the tax due on the following failures. • A failure to provide a level of coverage of the costs of pediatric vaccines (as defined in section 2612 of the Public Health Services Act) that is not below the coverage provided as of May 1, 1993. • A failure to satisfy continuation coverage requirements under section 4980B. • A failure to meet portability, access, renewability, and market reform requirements under sections 9801, 9802, 9803, 9811, 9812, 9813, and 9815. • A failure to make comparable Archer MSA contributions under section 4980E. • A failure to make comparable health savings account (HSA) contributions under section 4980G. www.FormsWorkflow.com