Appeal request form available for employers who received Marketplace notice

The Department of Health and Human Services (HHS) has issued instructions and a form for employers who have received a Marketplace notice stating they may be subject to the Employer Shared Responsibility Payment. Employers can request an appeal by submitting the form or mailing a letter that includes the information requested on the form. The appeal request form must be submitted within 90 days of the date of the notice.

The instructions indicate that employers should use the form if they are appealing a notice received from either the federally-facilitated Health Insurance Marketplace or a state-based Marketplace operating in California, Colorado, District of Columbia, Kentucky, Maryland, Massachusetts, New York or Vermont.

Appeal addresses eligibility, not penalty. The appeal may determine if an employee was eligible for help with the costs of coverage through the Marketplace at the same time that an employer may have offered the employee affordable health coverage that met the minimum value standard. The instructions emphasize that this appeal will not determine whether an organization has to pay the Employer Shared Responsibility Payment. Only the Internal Revenue Service (IRS), not the Health Insurance Marketplace or the Marketplace Appeals Center, can determine which employers are subject to the Employer Shared Responsibility Payment under Code Sec. 4980H.

How to submit the form. The instructions indicate that employers should complete and sign the form, and mail it with copies of any supporting documents to the following address: Health Insurance Marketplace, Dept. of Health and Human Services, 465 Industrial Blvd., London, KY 40750-0061.

The form also can be faxed to a secure fax line: 1-877-369-0129. According to the instructions, the employer will receive all future correspondence about the appeal from the Marketplace Appeals Center. Note that the Marketplace Appeals Center (Center) is different from the Health Insurance Marketplace.

Next steps. The instructions explain that after an appeal request is received, the following will occur:

1. The Center will send the employer a notice letting the employer know that the Center received the appeal request. If there’s a problem with the appeal request, the Center will tell the employer how to correct the issue. HHS also will send a notice to the employee listed on the notice received from the Marketplace.

2. The Center will review the appeal, including any additional documentation provided by the employer and/or the associated employee. The Center may request additional information.

3. The Center will send appeal decision notices explaining the outcome of its review to the employer and to the associated employee.

SOURCE: https://www.healthcare.gov/downloads/marketplace-employer-appeal-form.pdf

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