ACA - How Would an Employer Appeal a Marketplace Notice?


ACA - How Would an Employer Appeal a Marketplace Notice?

Most employers have yet to experience a Marketplace notice (Sample). We want to share the steps you should consider to appeal or respond to a Marketplace request if one does appear in your mailbox. If you are using Flock, we automatically track this ACA offer of coverage data from the HRIS/Benefits and the Compliance module. Also, reach out to your trusted broker for any advice and direction they can provide from internal counsel. 

  1. Employers have 90-days from the date stated on the Marketplace notice to file an appeal.
  2. If applicable, file an appeal and assert you provided employees access to either:
    • An affordable and minimum value employer-sponsored plan and/or
    • The employee was or is currently enrolled in the medical plan you offer

Any of the above reasons will generally satisfy the applicable large employer requirements, which will exempt your organization from any fines/penalties. The employee will be ineligible for advance payments of the premium tax credit or cost-sharing reductions etc.

You can submit an appeal in two ways:

  1. Filling out the Employer Appeal Request Form or
  2. Submitting a letter with the following information:
    • Company name;
    • Federal Employer ID Number (FEIN);
    • Your primary info, phone number, and address;
    • The reason for the appeal; and
    • Information from the Marketplace notice received, including date and employee information.

Mail the appeal with a copy of the Marketplace notice to:

Department of Health and Human Services -Health Insurance Marketplace
465 Industrial Blvd.
London, KY 40750-0061

After the appeal is filed, you will get a letter saying the appeal was received. The letter will provide a description of the overall appeals process and further instructions for submitting additional materials if required. Generally, the Marketplace must inform employers of its decision and mail its response to you within 90 days of when the Marketplace receives your appeal request.

The information provided here is for illustrative purposes only, and does not constitute, nor serve as a substitute for legal advice. Please consult legal counsel to ensure all facts and circumstances are taken into account in complying with applicable state and federal law.



Research derived from: 

  1. https://www.healthcare.gov/marketplace-appeals/employer-appeals/
  2. https://www.irs.gov/affordable-care-act/employers/questions-and-answers-on-employer-shared-responsibility-provisions-under-the-affordable-care-act