Marketplace Appeal Letters – Pay Close Attention!

Marketplace Appeal Letters – Pay Close Attention!

Recently, some groups are receiving letters from the Health Insurance Marketplace indicating that a person listed in the letter submitted an application for health coverage through the Marketplace and that the employee was found eligible for an advanced premium tax credit. The letter serves as a notification that the company “may” have to pay an Employer Shared Responsibility payment. Marketplace Appeal Letters are important, do not overlook them.

The letter gives the opportunity for the employer to file an appeal to the Marketplace if the employer believes there has been a mistake regarding the employee’s eligibility for an advance premium tax credit. The letter gives 90 days from the date of the notice to request an appeal from the Marketplace and a website to obtain the appeal form.

According to Health Insurance Marketplace representatives, these letters are being sent to employers who are not Applicable Large Employers (ALEs) because the individuals applying to the Marketplace are not asked to make the determination of whether or not their employer is an ALE; an individual generally would not even have that knowledge. Thus, small employers not subject to the Employer Shared Responsibility rules may get these letters but would not need to file appeals according to the representatives.

For employees who were offered affordable, minimum value coverage but have generated a notice of eligibility for the advanced premium tax credit, an appeal form must be filed for each employee. In other situations, the employees have not been eligible as their average hours during the measurement period were too low. Marketplace Appeal Letters will also need to be filed.

Get a head start on reviewing the Marketplace Appeal Letters and Instructions by going to