By the time July kicked off, many employers received notices from theHealth Insurance Marketplaceaka “the Exchange,” provided by the Affordable Care Act where individuals and families can obtain affordable health care. The notices were alarming to most, as any government notice can feel ominous. However, it’s not always a bad sign; in fact most of the time it’s just that: a notice. Here are the DOs and DON’Ts of notices from the Health Insurance Marketplace.
DO: Understand the Notice.
A notice from the Health Insurance Marketplace is simply a notification explaining that one or more of your employees named you as their employer and either sought financial assistance for health care (due to either high premiums or lack of affordable minimum essential health care from your company) or purchased a plan from the Health Insurance Marketplace.
DON’T: Ignore the Notice.
While many times this notice is merely an acknowledgement of Marketplace-purchased health care, it can mean something deeper for your company if you didn’t offer minimum essential coverage that meets minimum value and was affordable to your employees.
DO: Check your records.
Confirm the employee on the notice is a full-time employee at your company, first and foremost. If they are, review your health insurance options. Did your plans provide minimum essential coverage that met minimum value, defined as covering 60% of medical expenses, largely doctors’ visits and in-patient hospitalization? Are the plans affordable, defined as no more than 9.56% of a household income in 2015 or 9.66% of a household income in 2016?
DON’T: Rush to file an appeal.
Oftentimes employers will appeal without having their facts on their qualifying coverage. Figure out if you’re in the wrong first to save yourself the time and effort.
DO: Appeal if you feel it’s best for your company.
If you provided minimum essential coverage that was affordable and met minimum value, yet your employee still received a Premium Tax Credit, then an appeal may be appropriate. While some employers choose to not move forward with an appeal, others understand that they may be required to make a shared responsibility payment when it was not required. Also, if you’re in the right and don’t appeal, you may be contacted later on by the IRS if they come for said employee down the road.
DON’T: Assume that penalties are cheap.
They’re not. If an employee received premium assistance due to either a lack of affordable health coverage or coverage that did not meet minimum value, your penalties for 2015 could be $260 per month where assistance was needed. In 2016, that moves up to $270 per month. The numbers add up.
DO: Know where to appeal.
Should you take the step and appeal, click here.