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. Current Revision Form 8928PDF Instructions for Form 8928 (Print VersionPDF) Recent Developments Taxpayer Relief for Certain Tax-Related Deadlines Due To Coronavirus Pandemic -- 14-APR-2020 New Mailing Addresses for Certain Forms -- 22-MAR-2019:Mail Form 8928 to: Department of the Treasury Internal Revenue Service Center Kansas City, MO 64999 Other Items You May Find Useful All Revisions for Form 8928 About Form 7004, Application for Automatic Extension of Time To File Certain Business Income Tax, Information, and Other Returns Other Current Products
