The U.S. Department of Health and Human Services (HHS) has released a sample employer notice that the federally-facilitated and certain state-based Health Insurance Marketplaces (Exchanges) will use as part of the employer notice program, which generally requires the Marketplaces to notify 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 the HHS Notice of Benefit and Payment Parameters, 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.