HHS Issues Appeal Request Form

The Department of Health and Human Services (HHS) has issued a form employers can use to appeal Marketplace notices. If an employer received a Marketplace notice stating that it may be subject to the Employer Shared Responsibility Payment, it can request an appeal by submitting this form or mailing a letter that includes the information requested on this form.

Employers should use this form if appealing a notice received from:

  • The Federally-facilitated Health Insurance Marketplace

A State-based Marketplace operating in:

  • California
  • Colorado
  • District of Columbia
  • Kentucky
  • Maryland
  • Massachusetts
  • New York
  • Vermont

This appeal may determine if an employee was eligible for help with the costs of coverage (also known as a subsidy) through the Marketplace at the same time that an employer may have offered them affordable health coverage that met the minimum value standard.

This appeal will NOT determine if an employer has to pay the Employer Shared Responsibility Payment (also known as a penalty). Only the Internal Revenue Service (IRS), not the Health Insurance Marketplace or the Marketplace Appeals Center, can determine which employers are subject to the Employer Shared Responsibility Payment. Even though the HHS appeal form will not dictate what the IRS does, failing to file an appeal with HHS could be used by the IRS of evidence of liability. Therefore, all employers are well advised to file appeals whenever appropriate.

IMPORTANT:  For 2015, the Employer Shared Responsibility Payment will generally apply to employers with 100 or more full-time equivalent (FTE) employees, and may apply to certain employers with 50 or more FTE employees (those that reduced the size of the workforce to get under 100 employees or that eliminated or significantly reduced benefits). Starting in 2016, the Employer Shared Responsibility Payment applies to employers with 50 or more FTE employees.

If an employer wants to appeal a Small Business Health Options Program (SHOP) eligibility decision, it should visit HealthCare.gov – How to Appeal a SHOP Marketplace Decision for more information.

An employer must submit an appeal request form within 90 days of the date of the Marketplace notice.

An employer may authorize a secondary contact to help with the appeal. The secondary contact may act on the employer’s behalf, talk with the Marketplace Appeals Center, view the employer’s case file, and receive all correspondence regarding the appeal. To authorize a secondary contact, an employer should complete Section 2: Designate a secondary contact.

The instructions say an employer should complete and sign this form, and mail it with copies of any supporting documents to:

Health Insurance Marketplace

Department of Health and Human Services

465 Industrial Blvd.

London, KY 40750-0061

An employer can also fax the form to a secure fax line: (877) 369-0129.

Employers will receive all future correspondence about the appeal from the Marketplace Appeals Center. The Marketplace Appeals Center is different from the Health Insurance Marketplace.

 


John Garner

About John Garner

John Garner has over thirty five years of experience in employee benefits. He specializes in compliance, health care reform, the Health Insurance Portability and Accountability Act (HIPAA), the Consolidated Omnibus Budget Reconciliation Act (COBRA), and the Employee Retirement Income Security Act (ERISA). He helps clients with life, health, and disability benefits, cost containment, flexible benefits, and claim consulting.

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