Appeals Processes Similar For ACA Penalties, UI Claims

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Understanding the process for appealing employer shared-responsibility penalties under the Affordable Care Act, assessable in 2016 for the first time, could be easy for employers familiar with the unemployment benefits appeals process, a health-care specialist said April 21.

The unemployment benefits appeals process, which may lead to lower state unemployment tax rates or prevent rate increases, is similar to appealing employer ACA penalties after a full-time employee acquires a premium tax credit for buying coverage in a health insurance marketplace, said Susan Force, a certified health-care reform specialist with Automatic Data Processing Inc.

Full-time employees are allowed to acquire a marketplace premium tax credit only if they were not offered sufficient health insurance by their employer, Force said.

Employers may be assessed an ACA shared-responsibility penalty only if they are applicable large employers and one of their full-time employees who was not offered sufficient health insurance acquires such a credit.

When an employee applies for a marketplace premium tax credit, just as when a former employee applies for an unemployment benefits claim, the individual generally is presumed to be eligible and it is an employer's responsibility to prove that an individual who truly should not have qualified was ineligible, Force said. After a government agency certifies an individual as eligible, the employer would receive a notice indicating the individual's receipt of the credit or benefits.

The employer then would choose whether to appeal the individual's eligibility or accept the disadvantages of that eligibility, Force said.

By Howard Perlman