Health Insurance Marketplace Subsidy Notices

  • Health Insurance Marketplace Subsidy Notices

    Health Insurance Marketplace Subsidy Notices

    The US Department of Health and Human Services (HHS) has reportedly sent out hundreds of thousands of notices to employers indicating that one or more employees are receiving a subsidy from the health care exchange. These notices are being sent in order to give you a chance to appeal the employee’s eligibility for the credit and eliminate your potential penalties. Employees who were offered health insurance by you are generally not eligible for these subsidies. In some cases, employees may have misunderstood the marketplace application and accidentally input incorrect information.


    What you need to know

    • Do not discuss these notice with the employees listed on the notice.
    • The notices are sent to the address listed by the employee as their work address. Therefore, if you have multiple locations, then you should notify all of your locations to look out for these notices. HHS provides only 90 days to respond.
    • You should send an appeal in the following situations:
    1. The employee is enrolled in coverage through your company.
    2. You offered the employee coverage that met the minimum value requirements.
    3. The employee was part time and ineligible for coverage.
    • No appeal is necessary if you did not offer affordable health insurance coverage.
    • The penalties in 2016 are $270 per month per employee that received a subsidy from the exchange.


    How do I appeal?

    Appeals must be filed within 90 days of the date of the marketplace notice.

    Review your files to determine if you offered the employee health insurance during the last year. If you offered the employee affordable health insurance coverage of if the employee was ineligible for coverage, then you should file an appeal with the Health Care Marketplace. The form to appeal can be found at www.HealthCare.gove/marketplace-appeals/employer-appeals.


    You should include documentation to support your reason for the appeal, such as a benefits waiver form signed by the employee, proof of enrollment, or a payroll report showing total hours.


    If I do not appeal, will a penalty be assessed?

    No, these are notices from HHS and only the IRS has the authority to assess penalties. However, the IRS will most likely assess a penalty, in the future. The IRS will have a separate process to appeal.


    If you need assistance with the appeal or have any questions, please contact the contact or call 843-851-2289 and ask to be directed to the HCM department.

    Sylwia Majewski

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