Access Health, the state’s health insurance exchange, has adopted an appeals process for employers who receive a warning that they may face penalties under Obamacare. 

Under federal law some employers may face financial penalties if they do not provide minimum affordable health insurance coverage as defined by the law.

[CBIA’s Healthcare Reform website has complete information on who faces penalties and when.] 

A warning letter may be sent to a business if an employee signs up for health insurance coverage from the state’s exchange and receives a premium tax credit.

Sometimes an employee will tell Access Health, either by accident or on purpose, that their employer did not offer affordable, minimum coverage (as defined by law)—when the business actually did. 

Here’s the catch--individuals who are offered minimum, affordable coverage by their employers are not eligible for tax credits.

So if the employee misinforms Access Health, the employer could be put--unfairly--at risk because of the tax credit issued, meaning potential financial penalties for the employer.

Up until now, employers had no way to formally appeal their employees receipt of a tax credit. Last week Access Health’s board adopted an Appeals Procedure process on an emergency basis. This new process will become effective February 2nd.

In brief:

  • Employers have from the later of 90 days from the date the warning letter was sent or from the start of the plan year to appeal 
  • Employers must fill out an appeals request form and demonstrate that their employer sponsored coverage meets affordability thresholds and minimum value

Access Health will initiate a review, notifying the employer of the process and any other actions the business must take. Written notice of the decision will be provided within 90 days of receiving the appeal, or “within a reasonable time period due to administrative feasibility.”

The appeal form is not yet available but we will update you once it is.

This procedure is effective February 2 because it was adopted on an emergency basis but it will eventually go through the public comment process, so please email your comments to Jennifer Herz.

For more information, contact CBIA’s Jennifer Herz at 860.244.1921 | jennifer.herz@cbia.com | @CBIAjherz