Employer “Pay or Play” and Marketplace Notices – What Employers Need to Know

If you were to ask someone on the street what the Patient Protection and Affordable Care Act is, they may say, “Free Health Insurance.”

If you were to ask that same question of any CEO, CFO, Human Resources Manager or anyone on the Human Resources team, the answer would be very different but would likely include one of these key words: Costly, Confusing, Cumbersome, or Constricting.

It is no secret that the Affordable Care Act has placed an enormous burden on employers, both financially and administratively.  The ACA Employer Information Reporting alone requires great time and attention, not to mention superb record keeping and data management to produce the information required in the tight time frame given by the IRS to report this information. For companies distributing 250 or more 1095-Cs, electronic filing requirements demand outsourcing to meet the IRS’s XML coding schema.

It is overwhelming for many companies.

So, let’s say you made it through the Employer Reporting for 2015 successfully but you receive a letter in the mail from the Health Insurance Marketplace / Department of Health and Human Services referring to an employee (or former employee) of yours who received subsidies and now an employer penalty will be assessed by the IRS. What do you do now?

First, make sure all of your documentation is in order; enrollment forms, waiver or declination forms with employee signatures, electronic communication, etc. If you have offered an employee health insurance which meets the ACA standards of affordability and meets minimum value, you have met your requirements as the employer. Now you just have to prove it.

A process has been developed for employers using an Employer Appeal Request Form. This form allows you, as the employer, to dispute any assessed penalties by providing proof that coverage was offered to an employee. There is a time frame of 90 days to appeal the information provided on the notice.

Oliver-VanDyk Insurance counsels clients to promptly contact our Employee Benefits Department team members upon receipt of the initial Marketplace Notice. Within the Appeals Process, an employer may designate a secondary contact who can speak to HHS on their behalf. As a trusted benefit advisor, Olivier-VanDyk Insurance is poised to advocate on behalf of our clients in this appeals process.

Many employers who are uninformed or unassisted in this process will find themselves receiving penalties under the ACA Employer Pay or Play Mandate simply because they didn’t know or couldn’t keep up with all of the changes that the ACA has brought to their company.

If you are interested in learning how Olivier-VanDyk Insurance can assist you with understanding and navigating the ACA, feel free to contact our team of expert advisors. Each company is different and each situation requires attention – attention that we are dedicated to provide our clients.

Contact the Olivier-VanDyk Insurance Employee Benefits Team Today!