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Federal Health Insurance Marketplace / Exchange Update

Jul 2016
Posted in ACA 101

Employers have begun to receive notices from the Federal Health Insurance Marketplace / Exchange regarding employees who applied for Exchange coverage and were determined to be eligible for a tax subsidy to help pay for the cost.  If you receive a notice, you should handle it quickly to determine whether you should appeal it or not.

  • In states that are supported by the Federal Exchange, you should receive a notice if an employee went to the Exchange to purchase health coverage and was granted a subsidy for any month in 2016.
  • In most cases, a full-time employee should not be eligible for a tax subsidy if the employer made an offer of affordable, minimum value coverage.
    • Because this is so new to all, many employers were either confused or provided incorrect information and as a result these employees are not entitled to the assistance.
      • If an employee received a subsidy they are not entitled to, they will need to pay back that money. However, if employers do not repeal these notices and this issue is not correct it will result in the employer paying a penalty for failing to offer appropriate coverage.
      • The deadline for appealing the benefits determination is 90 days after the date of the notice.
      • If you receive a notice for a part-time employee who was not offered coverage, you should confirm the hours the employee worked.
      • If you receive a notice for an employee who was offered coverage, you should proceed with an appeal.

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