Appealing Marketplace Decisions

Starting in 2016, the Health Insurance Marketplaces must notify employers that one or more of their employees has been determined eligible for advance premium tax credits and cost-sharing reductions and has enrolled in a Marketplace plan. Because these events may trigger penalties under the Affordable Care Act's pay or play provisions, applicable large employers subject to these provisions—generally those with at least 50 full-time employees, including full-time equivalent employees, may seek to appeal an employee's eligibility determination. 

Note: An appeal will not determine if the employer is subject to a "pay or play" penalty, as only the IRS, not the Marketplace or the Marketplace Appeals Center, can make such determinations. 


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