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The Center for Consumer Information & Insurance Oversight

 

Employer Initiatives

This section provides information about employer-related programs administered by the CMS Center for Consumer Information & Insurance Oversight (CCIIO) and provides additional guidance and resources for employers.

Guidance and Resources

Employer Notice and Appeals

The Affordable Care Act and implementing regulations require each Health Insurance Marketplace to notify an employer whose employee enrolled in a Qualified Health Plan with Marketplace financial assistance.  An employer that receives an employer notice may appeal the Marketplace’s determination that it does not offer minimum essential coverage that is affordable to the employee and meets minimum value. The IRS will independently determine any liability for the employer shared responsibility payment. Whether or not an employer chooses to appeal will not have any effect on the IRS’s determination of liability for the employer shared responsibility.  

Employer Verification Study

CMS is requesting information from some employers about the Employer-Sponsored Coverage (ESC) offered to employees for the 2016 plan year. A CMS contractor may contact employers by telephone between April 2016 and June 2016 during the hours of 9 AM to 12 PM and 1 PM to 5 PM (local time for each business). Each call is expected to last 10-15 minutes.

Employer participation will enable CMS to evaluate for plan year 2016 whether an employee, or a sample of employees, correctly attested that he or she was not offered ESC that met affordability and minimum value requirements:

  • Affordability: An employer-sponsored plan is affordable if the employee’s share of the annual premium for the lowest cost self-only plan (LCSOP) that meets the minimum value standard is less than 9.66% of individual’s annual household income in 2016.
  • Minimum Value: A health plan meets this standard if it’s designed to pay at least 60% of the total cost of medical services for a standard population, and if its benefits include substantial coverage of inpatient hospital and physician services. This information should be in the Summary of Benefits and Coverage (SBC) Sheet. You also may have a Report of Minimum Value Certification from an actuary accredited by the American Academy of Actuaries (AAA).

Employers will be asked to provide information regarding the lowest-cost self-only health plan that they offered for plan year 2016, as well as their employees’ eligibility for employer-sponsored coverage.

Participation in this study is voluntary.

If you are an employer and have any questions, please contact the Marketplace Employer Hotline at 1- 800-355-5856 (TTY: 711), open Monday through Friday 9 am – 7 pm ET.

 
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