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Employer Appeals of Marketplace Subsidy Notices

Jul 21, 2016

Employers have started receiving notices from Health Insurance Marketplaces (or Exchanges) when their employees are eligible for subsidies. While employers are not required to appeal incorrect Exchange eligibility determinations of their employees, doing so may be advantageous.

Appealing incorrect determinations can help protect applicable large employers (ALE) from employer shared responsibility penalties and help ensure that individuals do not mistakenly receive health insurance subsidies. An appeal will allow an employer to correct any inaccurate information the Exchange may have received from an employee who was incorrectly deemed eligible for a subsidy.

If the employer wishes to appeal a subsidy eligibility determination after receiving an Exchange certification, it must file an appeal request within 90 days of the date the notice was sent.

Employers that receive notices should consider the following:

  • An employee who is offered affordable, minimum value health coverage is not eligible for a subsidy. The employer may appeal the incorrect determination.
  • If the employer is an applicable large employer (ALE), an appeal of an incorrect subsidy determination may help avoid pay or play penalties.
  • An employee who is not offered affordable, minimum value health coverage may be eligible for a subsidy. Appeals of correct subsidy determinations are not necessary or appropriate.

To learn more, read our full Legislative Brief.

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