News & Updates
May 17, 2016
The U.S. Department
of Health and Human Services (HHS) has released a sample
employer notice, to be used by the federally-facilitated and certain
state-based Health Insurance Marketplaces, that notifies employers that one of
their employees has been determined eligible for advance payments of the
premium tax credit and cost-sharing reductions and has enrolled in a Marketplace
plan. Because these events may trigger employer penalties under the Affordable
Care Act's "pay or play" provisions, an employer
appeal request form has also been provided by HHS.
Receipt of Notices
Under HHS rules, 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 the Pay or Play section of your online HR library for step-by-step guidance, worksheets, and calculators that can help employers understand if they will be subject to a penalty and how to calculate it.