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Health Exchanges Must Notify Employers About Employees Eligible for Subsidies: HHS

Among other things, exchanges will have to provide a notice to employers that identifies by name the employees who have applied for and have been determined by exchange administrators as eligible for premium subsidies.

March 13, 2012
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State health insurance exchanges will be required to notify employers when any of their employees are determined to be eligible for health insurance premium subsidies, under final Department of Health and Human Services regulations.

Among other things, exchanges will have to provide a notice to employers that identifies by name the employees who have applied for and have been determined by exchange administrators as eligible for premium subsidies.

According to the HHS regulations, which were released March 12, the notice also will have to inform employers of their right to appeal a determination of an employee's premium subsidy eligibility.

Under the health care reform law, premium subsidies will be offered, starting in 2014, to individuals earning up to 400 percent of the federal poverty level. If employer coverage is "unaffordable" and the employee opts for exchange-provided coverage, the employer is liable for a $3,000 non-tax deductible penalty.

Coverage is unaffordable if the premium charged by an employer exceeds 9.5 percent of family income. The Internal Revenue Service, though, has proposed a safe harbor in which premiums would be considered affordable as long as the premium contribution for single coverage did not exceed 9.5 percent of an employee's W-2 wages.

Jerry Geisel writes for Business Insurance, a sister publication of Workforce Management. To comment, email editors@workforce.com.

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