You Received a Health Insurance Marketplace Notice from HHS – Now What?

Allison B. Bans • August 18, 2016

Take a deep breath.  The HHS Health Insurance Marketplace Notice (the “Notice”) may seem to be a nuisance, but it does not necessarily mean that you will be subject to employer shared responsibility penalties.

First, the IRS, not HHS, assesses employer shared responsibility penalties, and the IRS does so only after it provides employers with:  (1) a “certification” that one or more employees received a premium tax credit; and (2) an opportunity to respond to the certification.

Second, an individual may have incorrectly reported on his application that he was eligible for a premium tax credit (or cost-sharing reductions) because:  (1) he did not receive an offer of health coverage from you; (2) he did receive an offer of health coverage from you, but it was unaffordable or it failed to provide minimum value, or (3) he was in a waiting period and was unable to enroll in health care coverage.  Therefore, the employee’s eligibility for a premium tax credit (or cost-sharing reductions) might have been a mistake.

Third, you may not be subject to the employer shared responsibility rules (and any penalties thereunder) if, for example, you are not a “large” employer.  See our Employer Shared Responsibility Penalties: A Checklist for Employers to determine whether you are a “large” employer.

Fourth, if you think that the Notice incorrectly identifies an individual as an employee eligible for a premium tax credit (or cost-sharing reductions), you may file an appeal with HHS within 90 days of the date on the Notice, which could potentially eliminate reports from the Marketplace to the IRS that your employee received a premium tax credit (or cost-sharing reductions) and reduce the individual’s potential tax liability.

Unfortunately, filing an appeal with HHS may not resolve the issue entirely.  For example, HHS may contact you for more information regarding your appeal.  Furthermore, although the appeal may prevent the Marketplace from reporting incorrect information to the IRS, ultimately the IRS will independently determine whether you are subject to any employer shared responsibility penalties.

Employee burnout: what it is and how to prevent it

By Mardy Gould • May 24, 2024
Employee burnout has become an epidemic in today’s modern workplace. So much so that the World Health Organization (WHO) officially recognizes it as an “occupational phenomenon.”1 While many used to consider mounting workplace stress an individual employee problem, these days, it’s become an employer’s responsibility to prevent burnout before it hurts productivity and business performance—not to mention your employees’ physical and mental health. Luckily, you can prevent burnout from affecting your workforce in several ways. This article will explore the causes and signs of employee burnout and the steps you can take to create a positive work environment where employees feel safe from toxic stress levels.

Form 720 and PCORI fee FAQs

By Mardy Gould • May 23, 2024
If you're a small business owner, you may have heard of the acronym PCORI and the fees that come with it. But what is PCORI, and how does it apply to your organization? Under the Affordable Care Act (ACA), sponsors of self-insured health plans must pay a fee to fund the federal Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent organization the ACA created to conduct research to help healthcare consumers make better decisions for their specific needs and outcomes. It also performs research related to clinical effectiveness. Employers offering a self-insured medical reimbursement health plan, such as a health reimbursement arrangement (HRA), must pay this fee by July 31 each year via Form 7201. This fee was initially set to expire in 2019, but Congress extended it through September 30, 20292, due to the Further Consolidated Appropriations Act of 20203.
More Posts