How to appeal a Marketplace decision
Decisions employers can appeal
If you’re an employer, you can appeal if the Marketplace said the coverage you offered your employees doesn’t meet the minimum standard requirements by law.
- Certain employers with 50 or more full-time employees (or equivalents) must offer coverage to full-time employees (and their dependents) that meet certain minimum standards.
- If you’re required to meet these standards, and don’t, the Internal Revenue Service (IRS) may tell you that you owe a fee, called the Employer Shared Responsibility Payment. Get more details about the fee on IRS.gov.
The Marketplace doesn't decide if you're subject to a fee. The IRS makes this decision.
If your business applied for the Small Business Health Options Program (SHOP), learn how to appeal a Marketplace decision about participating in SHOP. You can also get information about SHOP eligibility appeals by calling 1-800-706-7893. TTY users can call 711.
Employer appeals in the Marketplace
Your appeal needs to let the Marketplace know that your employee(s) were enrolled in or offered health coverage that meets minimum value. You must be able to show that the employee coverage you offer is both:
- Provides
If you file an appeal, it won't change whether you have to pay the IRS fee. You'll have to file a separate appeal with the IRS for the fee.
How appealing impacts your employees
The outcome of your appeal may impact whether your employees (and any of their household members) qualify for cost savings and premium tax credits through the Marketplace.
Employees enrolled in employer coverage or offered affordable health coverage that provides minimum value aren’t eligible for savings through the Marketplace. They may have to pay back some or all of the savings they got in the past when they file their taxes.
When you file an appeal, your employees will get a letter describing the appeals process, how it may affect their eligibility for savings, their rights, and how to submit documents to be considered in the appeal.
How to file an employer appeal
Your business has 90 days from the date on the Marketplace notice to file an appeal.
2 ways to file your appeal:
- Complete the appeal form.
Include copies of documents that verify:- Coverage was offered to the employee listed on the Marketplace notice.
- The coverage was affordable.
- The coverage provides minimum value. Get a list of documents to verify offer, affordability, and minimum value (PDF, 147 KB).
Get employer appeal form (PDF)
- Send a letter that includes your:
- Business name
- Employer ID Number (EIN)
- Business’ primary contact (name, phone number, and address)
- Reason for the appeal
- Information listed on the Marketplace notice you got, including date and employee information
- Copies of documents that verify offer, affordability, and minimum value for these employees
Mail or fax your completed form or letter to the Marketplace Appeals Center:
- Mail: Health Insurance Marketplace
Attn: Appeals
465 Industrial Blvd.
London, KY 40750-0061 - Secure fax: 1-877-369-0131
Questions?
- For appeal questions: Call the Marketplace Appeals Center at 1-855-231-1751 Monday-Friday 7 a.m. to 8:30 p.m. Eastern time (ET). TTY users can call 711.
- For IRS fee questions: Contact the IRS.