Verification Process for Exchange Premium Assistance

Posted March 11, 2013 Company News

Starting in 2014, an applicable large employer that does not offer minimum essential benefits, or the benefits offered are not of minimum value and affordable, could receive a certification that one of its employees has been determined to be eligible for premium assistance or a cost sharing reduction in the Exchange. HHS regulations require Exchanges to establish a procedure that coordinates eligibility and enrollment so that an individual applying for health coverage in the Exchange will be notified of premium assistance eligibility at the point of application. This is possible because proposed regulations permit the disclosure of income and other personal information to HHS so that premium and cost-sharing assistance can be approved when the application for coverage has been made.
When the Exchange makes the determination that an applicant is likely eligible for premium subsidies and cost-sharing reductions, the employer will be notified. Information disclosed to the employer when subsidized coverage has been approved will include the employee’s identity, a statement that indicates the employer may be liable for a shared responsibility payment (penalty) and information indicating that the employer has an opportunity to appeal the determination.

The Expected Process:


The Expected Process

Please note that the information contained in this document is designed to provide authoritative and accurate information, in regard to the subject matter covered. However, it is not provided as legal or tax advice and no representation is made as to the sufficiency for your specific company’s needs. This document should be reviewed by your legal counsel or tax consultant before use.

Additionally, the messages and content within the Pittsburgh Health Care Reform group do not reflect the advisory services of Henderson Brothers, Inc.


Contributing EXPERT: Shari Herrle


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