Employee Health Coverage Updates

Did you recently receive a letter from the Exchange? 

In Spring of 2016, the Exchange, also known as the Marketplace, began sending letters to employers if employees applied for insurance and were deemed eligible for subsidies through the Exchange. The Exchange is the government backed “department†for people shopping for coverage that need a subsidy or premium assistance based on income qualifications.

What does this mean?

If you received this letter it means that an employee from your business has applied for health coverage through the Health Insurance Marketplace in Florida. When the employee applied he or she reported that:

  1. Health insurance coverage was not offered by your business
  2. There was an offer of coverage but it either wasn’t affordable or didn’t provide the minimum value
  3. There was a waiting period and the employee was unable to enroll

The employee stated on the letter was found eligible for either advance payments for the premium tax credit (APTC) or cost-sharing reductions (CSRs). Eligibility for these subsidies may mean that you have to pay a fee to IRS in the future.

Does this apply to my business?

If you currently employ 50 or more full-time employees or the equivalent then you may have to pay a fee for every month that each employee is receiving health coverage with a subsidy. If your business is not an applicable large employer then this letter need not apply.

What is the next step?

If you feel that there has been a mistake with the evaluation of your employee and their eligibility for subsidies you are entitled to appeal. Appeals must be made within 90 days from the date of the notice you receive in order to be evaluated. Appeals are accepted online, by phone, by mail, by fax, or in person. Make sure to include a copy of your notice with appeals.


Check back on our website and connect with us on social media for updates as we receive them.