The Health Insurance Marketplace has begun sending notices to employers where at least one employee enrolled in the Exchange/Marketplace and who was determined to be eligible for an advance premium tax credit (APTC) or cost sharing reduction (CSR). This employee has reported to the Marketplace that they were NOT offered minimum affordable coverage by their employer.
If you are an applicable large employer and find yourself in this situation, you may have recently received a Health Insurance Marketplace letter stating that the employee was determined eligible for subsidized Marketplace coverage.
If you believe the employee was offered appropriate coverage, there is time to appeal.
Employers have 90 days from the date of the notice to file an appeal. This appeal will NOT determine if your organization has to pay the Employer Shared Responsibility Payment. Only the Internal Revenue Service (IRS) can determine which employers are subject to the Employer Shared Responsibility Payment as stated under section 4980H of the Internal Revenue Code.
IMPORTANT: For 2015, the Employer Shared Responsibility Payment will generally apply to employers with 100 or more full-time equivalent (FTE) employees, and may apply to certain employers with 50 or more FTE employees. Starting in 2016, the Employer Shared Responsibility Payment will apply to employers with 50 or more FTE employees.
Employer Action Points:
1. If appealing a Marketplace determination, it is recommended to provide the least amount of detail required to respond.
2. It is important to remember that any retaliation or discrimination against an employee because he/she received subsidized Marketplace coverage is prohibited.
3. Create a policy surrounding Marketplace notices and which members of your Human Resources team should review and respond. Consider creating a firewall between those responding to notices and those making employment decisions.
4. Train your managers on your policy regarding the Marketplace letters and the rules surrounding retaliation and discrimination in the Affordable Care Act to limit potential missteps.