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DIVISION MEMORANDUM 2016-04

 TO THE HEADS OF ALL STATE AGENCIES

July 5, 2016

ATTENTION: Personnel and Payroll Officers, Chief Human Resources, Payroll and Benefits Managers
SUBJECT: Affordable Care Act--Notices of Employee Eligibility for Premium Assistance

I. INTRODUCTION

The Affordable Care Act (ACA) requires large employers like the State of Connecticut to provide affordable healthcare coverage to full-time employees. Large employers may be subject to an assessment of penalties if they fail to offer affordable and minimum essential value coverage to at least 95 % of their full-time equivalent (FTE) employees. For purposes of the ACA, an employee is deemed FTE if he or she works an average of 30 hours per week.

When an employee obtains health insurance through the Marketplace (either Healthcare.gov or one of the state healthcare exchanges, such as Access Health CT) the employer may be assessed an Employer Mandate tax penalty if one of its FTE employees is given a tax credit. Where the employee qualifies for a tax credit, the exchange will issue a Notice of Eligibility for Premium Assistance to the employer.

The purpose of this Memorandum is to advise agencies what to do if they receive a Notice of Employee Eligibility for Premium Assistance from Access Health CT or any other healthcare exchange and the importance of forwarding that Notice to the Healthcare Policy & Benefit Services Division promptly for evaluation of whether an appeal should be filed on behalf of the state.

II. CONTENT AND PURPOSE OF THE NOTICE EMPLOYEE ELIGIBILITY

The Notice of Employee Eligibility for Premium Assistance (a sample of the Access Health version is attached to this Memorandum) identifies the employee by name but will not indicate whether coverage is being provided for the employee or a dependent. An employee seeking healthcare coverage through a state or federal exchange is the source of information about the identity of the employer, how much employer-provided healthcare benefits cost, his or her healthcare eligibility status, and household income.

The issuance of the Notice by the exchange starts the time for the employer to submit an appeal demonstrating any reasons why the employee's coverage through the exchange should not subject it to a penalty assessment. The employer has only a 90-day window of time to submit an appeal.

If your agency receives a Notice of Employee Eligibility for Premium Assistance, you should forward it immediately to the Central Benefits Unit of the Healthcare Policy & Benefit Services Division, which will evaluate the facts and submit an appeal to the exchange if it is warranted.

III. INFORMATION NEEDED FOR ACA APPEAL

An employer appeal can be based on one or more of the following reasons: The person identified in the notice is not a FTE employee; the employee has separated from employment; the employee was offered affordable and minimum value coverage for himself and his dependents.

In order for the Central Benefits Unit to determine whether an appeal should be filed, the agency receiving the Notice should verify all applicable facts concerning the named employee's eligibility for state health benefit coverage (hours worked, seasonal or temporary status, etc.), whether health benefit coverage was offered, and if so, any known reasons for lack of enrollment.

Thus far, the majority of Notices received have involved individuals who do not work sufficient hours to qualify as FTE employees under the ACA. Another recent Notice concerned an employee who was offered coverage but missed the deadline for enrolling a dependent child after a status change.

Agencies should forward the Notice to osc.benefitcorrections@ct.gov.  Please include in the email all pertinent facts relating to the employee's hours or status, offers of coverage, or enrollment.

III. CONCLUSION

Your assistance in forwarding these Notices promptly is critical to helping the State of Connecticut demonstrate its compliance with the Employer Mandate provisions of the ACA.

Any questions pertaining to this memorandum may be directed to the Healthcare Policy & Benefit Services Division at (860) 702-3486.

Very truly yours,

Thomas C. Woodruff, Ph.D., Director

Attachment - Sample Notice

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