FFM Sending Marketplace Subsidy Notices to Employers

The Federally Facilitated Marketplaces (FFMs) have begun sending notices informing employers that employees have enrolled in an FFM and were determined to be eligible for premium subsidies.

Some employers in states supported by the Federal Exchange may receive a Health Insurance Marketplace Notice from HHS regarding employees who have received financial assistance with their health plan coverage purchased on the Exchange.  Such letters are the first step in the process for assessing ACA penalties on applicable large employers (50 or more full-time equivalent employees) that failed to offer affordable, minimum-value coverage to full-time employees who go to the Exchange and qualify for a premium subsidy.  Employers should receive a notice for any employee who purchased health coverage through the Exchange and was granted a subsidy for any month in 2016.  The employee should not be eligible for a tax subsidy if that employee was offered affordable, minimum-value coverage.  Small employers are not subject to the shared-responsibility penalties and can ignore the notice.

Employers who did make qualifying offers should appeal the determination, supported by strong evidence that the employee was actually offered coverage (e.g., W-2 or payroll statements, ID cards).  If the employee in question is a part-time employee, employers should confirm the hours the employee actually worked, using ACA guidelines, when appealing the determination.  Although employers will have another opportunity to appeal the determination, an early appeal may save them time in the future.  If the appeal is successful, HHS will revoke the individual’s financial assistance and will not inform the IRS that a penalty has been triggered on the employer.  The deadline for appealing the benefits determination is 90 days after the date of the notice, and the notice itself has clear instructions on how to appeal.

If you have questions about the Marketplace subsidy notices, call ASR Health Benefits at (616) 957-1751 or (800) 968-2449.