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
- Sample 2016 Employer Notice (PDF)
- Fact Sheet: Spring 2016 Employer Notices (PDF)
- Frequently Asked Questions Regarding The Federally-Facilitated Marketplace’s (FFM) 2016 Employer Notice Program (PDF)
- Employer Appeal Request Form
- Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act
- Employer Coverage Tool
- ACA Anti-retaliation provision
- Employer Appeal Document Verification Guide (PDF)
- Individual Coverage Health Reimbursement Arrangements: Pre-Open Enrollment Period Training, Fall 2019 (PDF)
- Individual Coverage HRA (ICHRA) Employer Premium Resources
To help employers determine whether an ICHRA offer is considered affordable for purposes of avoiding the employer responsibility payment, CMS is publishing the ICHRA Employer LCSP Premium Look-up Table. The table allows users in states participating in the Federally-facilitated Exchange (FFEs) and State-based Exchanges on the Federal Platform (SBE-FPs) to access individual market Qualified Health Plans (QHP) lowest cost silver plan (LCSP) data by geographic location.
For additional information, please review the ICHRA Employer LCSP Premium Look-Up Table and the associated ICHRA Employer LCSP Premium Look-up Table Data Dictionary, as well as the proposed rule. "Application of the Employer Shared Responsibility Provisions and Certain Nondiscrimination Rules to Health Reimbursement Arrangements and Other Account-Based Group Health Plans Integrated With Individual Health Insurance Coverage or Medicare"
Plan Year 2019
Plan Year 2020
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.
- March 5, 2020 Information Related to COVID–19 Individual and Small Group Market Insurance Coverage
- March 12, 2020 FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19)
- March 18, 2020 FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency
- March 24, 2020 FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets
- April 11, 2020 FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation
*This document was updated on April 15, 2020, to correct an error in footnote 10 regarding the current end date of the public health emergency related to COVID 19.
- April 13, 2020 Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV)