Marketplace Notice

The Health Insurance Marketplace is sending a notice to certain employers regarding the Affordable Care Act’s employer mandate¹. The notice is sent because an employee:

• enrolled in a qualified health plan on the Marketplace for 2016;
• was determined eligible for advance payments of the premium tax credit or cost-share subsidies for at least one month during 2016 to help pay for Marketplace coverage, and indicated that:
  • his or her employer did not offer employer-sponsored health coverage;
  • did have an offer of health coverage, but it was not affordable or did not provide minimum value; or
  • was in a waiting period and unable to enroll in health coverage.

Next steps
According to the Marketplace:

• Employers may file an appeal within 90 days of the date of the letter if they believe there has been a mistake regarding the employee’s eligibility for premium tax credits or cost-share subsidies.
• Filing an appeal could also eliminate reports from the Marketplace to the IRS that employees received premium tax credits or cost-share subsidies following an appeal decision in an employer’s favor.

However, filing an appeal won’t necessarily affect whether employers have to pay an employer mandate penalty to the IRS, because the IRS will determine independently whether employers face penalties. For more information, visit IRS.gov/aca or call the IRS at 800-829-4933 Monday through Friday from 7 a.m. to 7 p.m. (local time).

For employers that file appeals, the Marketplace will consider evidence provided by both the employer and employee to determine if the employee is eligible for premium tax credits or cost-share subsidies.

Follow this link for a sample notice.

¹ACA’s Shared Responsibility for Employers Regarding Health Coverage Rule