Employer Appeals of Exchange Subsidy Notice

Employer Appeals of Exchange Subsidy Notice

Beginning in spring 2016, employers will receive notices from the Exchange if any of their employees are deemed eligible for health insurance subsidies through an Exchange. Employers that 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, although Exchanges have been permitted to delay implementation of an electronic appeals process. Guidance issued in March 2016 further delays the Exchanges’ deadline to implement electronic appeals processes, until 2017.

Employers—especially applicable large employers (ALEs)—should prepare to appeal any incorrect Exchange subsidy eligibility determinations. To prepare, employers should:

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

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