Yesterday we learned how the Federally Facilitated Marketplace (FFM) can notify employers about any employees that enrolled in Marketplace coverage with advanced premium tax credits (APTCs) and cost-sharing reductions (CSRs). Today, we’ll look at how to appeal those notifications.
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What if We Receive a Notice and Want to Appeal?
The short answer: Act promptly. You have just 90 days from the date of the notice to request an appeal.
An employer may appeal an employer notice by asserting that it provided the employee access to affordable, minimum-value, employer-sponsored coverage or that the employee is currently enrolled in employer coverage and therefore is ineligible for APTCs.
If the employer is successful, the FFM will send a notice to the employee encouraging the employee to update his or her Marketplace application to reflect that he or she has access to or is enrolled in other coverage. The notice will also explain that failure to update the application may result in a tax liability.
How Do We Submit an Appeal?
An employer appeal request form will be available here: https://www.healthcare.gov/marketplace-appeals. You must mail your completed appeal request to the below address or fax it to 877-369-0129.
Health Insurance Marketplace
465 Industrial Blvd.
London, KY 40750-0061
What About 2015?
This new initiative is focusing on coverage for 2016 and beyond only. Employers will be liable for the employer shared responsibility payment for 2015 if a full-time employee receives a premium tax credit for coverage received through a Marketplace in that year. The Internal Revenue Service will independently determine any liability for the employer shared responsibility payment without regard to whether the Marketplace issued a notice or if the employer engaged in any appeals process.
Anything Else I Should Know?
When someone seeks insurance in the Marketplace, there’s generally no cross-check on what coverage (if any) the person has been offered by his or her employer. There’s also no check on whether this person is actually one of your full-time employees as defined by the Affordable Care Act; he or she could be, for example, a freelancer or part-timer.
So, the bottom line is that you as an employer may have fully complied with all of your play-or-pay obligations and still receive a notice that a full-time employee (or someone claiming to be a full-time employee) has received subsidies—putting you squarely in line for penalties unless you take prompt action and file your appeal.
The FFM is not the sort of pen pal any of us is looking for, but it’s important to keep a close eye on your mailbox now and in coming months all the same.