We received a Marketplace notice in the mail, stating that one of our employees has enrolled in medical insurance coverage from the Marketplace and reported she was not offered health coverage from us. We admit that she wasn’t offered insurance, but only because she works 25 hours per week. Do we need to appeal the employer notice?
Probably not. You only need to consider appealing a Marketplace employer notice if the information contained in the notice is inaccurate. Under the Affordable Care Act (ACA), an applicable large employer (an employer who employees at least 50 full-time equivalent employees), is required to offer affordable, minimum value health insurance coverage to full-time employees (employees who work an average of at least 30 hours per week). Because your employee only works an average of 25 hours per week, the company is not required to offer her medical insurance. Since the information on the employer notice is accurate, there is nothing for you to appeal. If, however, the information had been inaccurate, the company has 90 days from the date of the Marketplace notice to file an appeal, if you choose to do so. Since the ACA is a highly specialized area of law, you should work with an experienced benefits attorney to make sure you are meeting your obligations.
This website presents general information in nontechnical language. This information is not legal advice. Before applying this information to a specific management decision, consult legal counsel.