Over the past two weeks, employers have begun to receive notices from the Federal Health Insurance Marketplace regarding their shared responsibility—and potential for fines—based on employees who have gone to health insurance marketplaces, purchased some type of medical coverage, and qualified for tax credits. While these notices are in some cases unexpected, they are explainable. You should take them seriously and deal with them in a timely manner.

Employers of all sizes, whether reportable or not under section 6055, will be receiving notices on any employee who has gone to a health insurance marketplace and initially seems to fit one of the following circumstances:

  • No offer of coverage from employer
  • An offer that was not deemed affordable
  • Was in a waiting period or limited non-assessment period and unable to enroll in employer sponsored coverage

While it would seem that there would be a link between what was reported by large and self-insured employers via form 1095-B and/or -C, that does not seem to be the case.

Our recommendation is that any company that is providing qualified offers to employees should take the time to appeal each and every one of these notices. These notices are not bills or demands for payment of any kind; however, they are the first step in creating the potential for a penalty.

As you decide how to address these notices, keep the following points in mind:

  • There has not yet been a penalty assessed
  • Receiving such a notice does not mean that your company will ever be assessed a penalty
  • The notice was auto-generated based on an employee going to a health insurance marketplace and qualifying for a subsidy, regardless of what your company reported via form 1095-C for 2015
  • There is a link to the appeal paperwork
  • You have 90 days to process your appeal

If you are uncertain whether your offer to an employee is a qualified offer, please consult on that issue and then move forward with the appeals process. If you have any further questions or concerns, please contact the professionals at Axiom Human Resource Solutions.