Employers Have 90-Day Appeal Window for Healthcare

Employers Have 90-Day Appeal Window for Healthcare

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If employers wish to appeal their shared payment responsibility, they only have 90 days to do so. 

Employers may receive letters of notification from the Healthcare Marketplaces saying they may be subject to a shared responsibility payment because the employee requested and received a subsidy. Employers who wish to contest this have a short 90-day window to respond and provide full documentation if they wish to appeal information in the notice, so it is important to act hastily.

  • The Healthcare Marketplaces are looking for evidence to verify that the employer met the shared responsibility requirements under the Affordable Care Act (ACA).
  • Employers have the option to appeal the notice if the employee waived affordable minimum value coverage or enrolled in the employer-sponsored minimum healthcare coverage for 2016.
  • The appeal may show that the employee received subsidies through the marketplace at the same time the employer offered them affordable health coverage.
  • If the employer is successful in their appeal, the marketplace will notify the employee encouraging them to update the Marketplace application to show that they were offered or were enrolled in coverage. The notification will also tell them that failure to do so may result in tax penalties.

Important to note: The appeal will not determine if the employer must pay the shared responsibility payment as only the Internal Revenue Service, not the Health Insurance Marketplace can determine which employers will have to make the required payment. The employer notice is simply the first step in that process.

The notice you receive will outline the actions employers must take in order to properly appeal the notice.

To be covered for health-related expenses, you need the proper health insurance. Contact your insurance agent to discuss coverages.   Your team at Hoffman Brown Company in Sherman Oaks, California is happy to help you.