August 3, 2016
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Employers may receive notices from the Marketplaces indicating that they may be subject to the shared responsibility payment because an employee requested and received a subsidy. Employers have a short window of 90 days to respond and provide documentation if they wish to appeal information in the notice, so it is important to act quickly.
Starting in 2016, under the ACA, certain employers with 50 or more full-time employees or full-time equivalents must offer health insurance coverage to their full-time employees and dependents. The health plan offered must meet minimum standards for coverage, provide minimum value and be affordable. Otherwise the employer may be subject to a penalty.
How to Appeal
The notice outlines the actions and timetable an employer has to respond if they wish to appeal. There is only 90 days from the date of the notice the employer receives from the Marketplace to request an appeal. And, there is only one opportunity to appeal.
How to appeal a Marketplace decision
Decisions employers can appeal
Employers that get a notice from the Marketplace stating they may be subject to the fee can file an appeal if they believe they offered coverage to an employee that both:
IMPORTANT: This appeal will NOT determine if an employer has to pay the fee. Only the Internal Revenue Service (IRS), not the Health Insurance Marketplace or the Marketplace Appeals Center, can determine which employers are subject to the fee. Learn more about the Employer Shared Responsibility Payment on IRS.gov.
How an employer can file an appealEmployers have 90 days from the date stated on the notice from the Marketplace to file an appeal. This appeal can be filed 2 ways :
o Employer ID Number (EIN)
o Employer’s primary contact name, phone number and address
o The reason for the appeal
o Information from the Marketplace notice received, including date and employee information
Mail your appeal request form or letter and a copy of the Marketplace notice to this address:
Department of Health and Human Services
Health Insurance Marketplace
465 Industrial Blvd.
London, KY 40750-0061
After an appeal is filedThe employer will get a letter saying the appeal was received. It will provide a description of the appeals process and instructions for submitting additional materials if needed.
If your employer requests an appealIf your employer requests an appeal through the Marketplace Appeals Center, you’ll get a letter describing:
Questions?Have questions about the health care law and business? Contact the ACA Employer Call Line at: