Determine Your Liability
Under the Affordable Care Act, employees may be eligible for premium tax credits or a cost-sharing reduction depending on the coverage available (or not available) through their employer. If their employer does not offer minimum essential coverage (MEC), then an employee can apply for the aforementioned credits and reductions. Employers that choose not to offer MEC must also consider their liability - as there is a provision regarding the employer shared responsibility to pay these credits and reductions.
Receive and Read the Notification
The Marketplace must notify employers when they may be held liable for payments, and that is exactly what they did recently. Employers are currently receiving notifications and may be confused as to where to go next. If your company does provide minimum essential coverage, there is an appeals process.
Confirm Your Plan is Affordable
First, you must make sure your coverage is indeed affordable. To review, affordable coverage (under the ACA employer mandate) is defined as costing no more than 9.5% of household income (or 9.5% of W-2 Wages, 130 hours multiplied by the hourly rate of pay, or the poverty level for safe harbors).
Fill Out and Submit the HHS Appeal Form
Once you are sure that you do provide affordable minimum essential coverage, you can access the HHS’s appeal form online.
- Section One covers your company’s information. You’ll need your business’ general information, EIN, and a main contact person.
- Section Two allows you to designate a back-up contact. Both representatives need to have a thorough understanding of your company’s benefits and have authorization to represent your business in the Marketplace.
- For Section Three, you’ll need the notice you received from the Marketplace. This will have the date of the notice and the employee’s application number. You will also need the employee’s full name and birth date. You will also explain your company’s health plan and how it meets affordability requirements.
- In Section Four, you sign, reaffirming the truth of the information you’ve provided.
You can then submit the form (within 90 days of receipt) via secure fax line 1-877-369-0129 or by mail:
Health Insurance Marketplace
Dept. of Health and Human Services
465 Industrial Blvd. London, KY 40750-0061
Receive the Decision
After receiving your appeal, you’ll receive a notice that your request has been received. You’ll receive additional requests for further information or documentation if necessary, and then you and your employee will receive appeal decision notices.