Got a Notice from the Federal Health Insurance Marketplace?

Sep 6

If you are an employer, you might have received a notice (or several) over the past month from the Federal Health Insurance Marketplace/Exchange.

The notices are being issued to employers with employees who applied for Marketplace/Exchange coverage and determined eligible for health care tax subsidies.

Why are these notices important? Under the Affordable Care Act (ACA), employers with 50 or more full time equivalents (FTEs), are required to make an offer of affordable, minimum value health care coverage to employees who average 30 or more hours per week (considered full time under the ACA). If your employees applied for coverage through the Marketplace/Exchange (regardless of whether you offered them coverage) and were then determined eligible for subsidies, then the notice is a forewarning that you may be eventually be targeted for penalties under the ACA employer mandate.

So what should you do when you receive a notice?

First, don’t panic.

The notices actually offer you, the employer, a first line of defense. You now know about the problem, and you have an opportunity to resolve it. We recommend that (if you did, indeed make an offer of affordable minimum value coverage to employees) you file an appeal as soon as possible. You have 90 days to respond to the notice (from date of issuance).

Due to confusion, delays and misinformation swirling around the initial launch of the program, many employees, regardless of industry, were mistaken about employer availability of coverage – submitting claims for which they were initially approved, but ultimately, were not eligible. In the majority of cases, employees are not eligible for tax subsidies if their employer makes the offer of affordable, minimum value coverage. These situations are unfortunate for both employer and employee, as the employee will be required to pay back the amount of the subsidies, and the employer must file an appeal in order to avoid penalties.

When making an appeal, include as much evidence as possible to demonstrate that the employee was offered coverage. It’s also a good idea to double-check the status (full-time vs. part-time) of the employee, using the ACA regulations.

If an employer did, in fact, fail to make an offer of affordable, minimum value coverage to employees, they will eventually be assessed ACA penalties. If you aren’t fully confident that you are compliant with ACA rules and regulations, call TRA’s Tim Sekiya, Director of Insurance at (512) 457-4100 and/or visit the National Restaurant Association’s healthcare resource center


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