News & Updates
April 20, 2016
A final Notice of Benefit and Payment Parameters from the U.S. Department of Health and Human Services (HHS) provides clarification regarding the employer notice program, which generally requires the Health Insurance Marketplaces (Exchanges) to notify any employer whose employee has been determined eligible for advance payments of the premium tax credit and cost-sharing reductions (which may trigger penalties under the Affordable Care Act's "pay or play" provisions).
Receipt of Notices
Under the final rule, Marketplaces must notify employers within a reasonable timeframe following any month of the employee's eligibility determination and enrollment. Previously released FAQs indicated that the Marketplaces would begin sending out employer notices in spring 2016, with additional notices to follow throughout the year.
While the Marketplaces are permitted to send employer notices either on an employee-by-employee basis or in groups of employees, for 2016 the Marketplaces intend to send notices in groups of employees.
Employer Appeals Process
Appeal of an employer notice generally must be made within 90 days. In the appeal, the employer may assert that it provides its employee access to affordable, minimum value employer-sponsored coverage or that its employee is enrolled in employer coverage, and therefore that the employee is ineligible for advance payments of the premium tax credit. For more on the appeals process, click here.
Check out our section on the Premium Tax Credit for Individuals to learn more about the premium tax credit's eligibility requirements.