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Exchange Subsidy Appeals May Remain Paper-Based until 2017

May 26, 2016

Exchanges will begin notifying employers that they may be liable for ACA penalties when their employees are eligible for health insurance subsidies. Employers have 90 days to appeal Exchange determinations. The requirement for Exchanges to accept appeals online has been delayed.

Overview

Beginning in spring 2016, employers can expect to receive notices if any of their employees are deemed eligible for health insurance subsidies through an Exchange. Employers who receive these notices will have 90 days to file an appeal if they feel the eligibility determination was made in error.

Department of Health and Human Services (HHS) regulations require appeals to be accepted online, by phone, by mail and in person. However, guidance issued in March 2016, delayed (for the second time) the Exchanges’ deadline to implement electronic appeals processes.

Action Steps

Employers, especially Applicable Large Employers (ALEs), should prepare to appeal any incorrect Exchange determinations. To prepare, employers should:

  • Become familiar with the appeals process; and
  • Maintain complete and accurate records regarding the health insurance coverage they offered to employees.

To learn more, read our full legislative brief.

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