Employer Appeals of Exchange Subsidy Notices

Employer Appeals of Exchange Subsidy Notices

Employers may receive notices from the Health Insurance Marketplace (“Exchange”)if any of their employees were deemed eligible for health insurance subsidies.  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.

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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