Employer Marketplace Notice Has Short, 90-Day Appeal Window

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. 

• The Marketplaces are looking for verification that the employer has met the shared responsibility (employer mandate) requirements under the Affordable Care Act (ACA). 
• Employers may appeal the notice if the employee waived affordable minimum value coverage or enrolled in employer-sponsored minimum essential coverage  for 2016.
• The appeal may determine that an employee received subsidies through the Marketplace at the same time the employer offered him or her affordable health coverage.
• If the employer is successful, the Marketplace will send a notice encouraging the employee to update the Marketplace application to show that he or she was offered or was enrolled in other qualifying coverage. The notice will also explain that the failure to update the application may result in tax liability.
• Important: This appeal will not determine if an employer has to pay the shared responsibility payment.  Only the Internal Revenue Service, not the Health Insurance Marketplace or the Marketplace Appeals Center, can determine which employers will have to make the required payment. The employer notice, however, appears to be the first step in that process.
• Learn more about the employer shared responsibility payment on IRS.gov.

Background
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.

• The notice will identify the specific employee and include a statement that the employee is enrolled in Marketplace coverage with a subsidy.
• The notice will not contain the employee’s personal health information or federal tax information.
• As part of the appeal, the employer can explain why the employee should not have been eligible for subsidies through the Marketplace.

Employers should follow instructions for how to respond or appeal that accompany the notice.  Or employers may access the appeal request form or obtain additional information here.

How to appeal a Marketplace decision
EMAIL
Decisions employers can appeal

• Decisions you can appeal
• Your eligibility notice
• How to appeal your Marketplace eligibility
• Appeal forms
• After you file an appeal
• Expedited appeals
• Getting help filing an appeal
• Decisions employers can appeal
• How to appeal a SHOP Marketplace decision

Under the health care law, certain employers with 50 or more full-time employees (or equivalents) must offer health insurance coverage to their full-time employees (and their dependents) that meets certain minimum standards or pay a fee called the Employer Shared Responsibility Payment.
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:

• Is affordable and
  
• Meets minimum value standards

This appeal may determine if an employee (and any household members) got help with costs through the Marketplace at the same time their employer offered them affordable health coverage that met the minimum value standard.

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 :

• Fill out the Employer Appeal Request Form (PDF)
  
• Submit a letter with the following information:

o    Business name
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:

• The appeals process
  
• Your rights as an employee, plus instructions for how to submit documents for consideration in the appeal
  
• How your employer's appeal may affect your eligibility for advance payments of the premium tax credit and cost-sharing reductions (if applicable) for the coverage year.

Getting help in a language other than EnglishVisit the Marketplace language resource page.
Questions?Have questions about the health care law and business? Contact the ACA Employer Call Line at:

• 1-800-355-5856

Have questions about an appeal? Call the Marketplace Appeals Center at:

• 1-855-231-1751 (TTY: 1-855-739-2231)

Hours of operation for both numbers are Monday through Friday 9:00 a.m. to 7:00 p.m. ET.
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Thank you,
Russ Caforio
630-495-2901

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