MARKETPLACE DECISIONS THAT EMPLOYERS CAN APPEAL
Under the health care law, certain employers with 50 or more full-time employees (or full time equivalents) must offer health insurance coverage to their full-time employees (and their dependents) that meets certain minimum standards or pay a fee called the Employer Shared Responsibility Payment.
Employers that get a notice from the Marketplace stating they may be subject to the fee can file an appeal if they believe they offered coverage to an employee that both:
1. Is affordable AND
2. Meets minimum value standards
This appeal may determine if an employee (and any household members) got help with costs through the Marketplace at the same time their employer offered them affordable health coverage that met the minimum value standard.
IMPORTANT: This appeal will not determine if an employer has to pay the fee. Only the Internal Revenue Service (IRS), not the Health Insurance Marketplace or the Marketplace Appeals Center, can determine which employers are subject to the fee. Learn more about the Employer Shared Responsibility Payment on IRS.gov.
HOW AN EMPLOYER CAN FILE AN APPEAL
Employers have 90 days from the date stated on the notice from the Marketplace to file an appeal. This appeal can be filed in two ways:
1. Fill out the Employer Appeal Request Form
2. Submit a letter with the following information:
-Employer ID Number (EIN)
-Employer’s primary contact name, phone number and address
-The reason for the appeal
Information from the Marketplace notice received, including date and employee information.
Mail your appeal requests form or letter and a copy of the Marketplace notice to this address:
Department of Health and Human Services
Health Insurance Marketplace
465 Industrial Blvd.
London, KY 40750-0061
AFTER AN APPEAL IS FILED
The employer will receive a letter saying the appeal was received. It will provide a description of the appeals process and instructions for submitting additional materials if needed.
IF YOUR EMPLOYER REQUESTS AN APPEAL
If your employer requests an appeal through the Marketplace Appeals Center, you will get a letter describing:
1. The appeals process
2. Your rights as an employee, as well as instructions for how to submit documents for consideration in the appeal
3. How your employer’s appeal may affect your eligibility for advance payments of the premium tax credit and cost-sharing reductions (if applicable) for the coverage year.