Affordable Care Act

Notification to Employer of Employee Subsidy

Situation

Under the Affordable Care Act (ACA) each state has a Health Benefit Exchange where individuals may purchase health insurance. Employees of Prestige Care may apply for individual coverage through the Health Benefit Exchange, no matter their status. However, since Prestige Care offers the Tier 1/Base Medical Plan which meets the definition of essential coverage and affordability under the ACA, full-time and HCR benefit eligible employees will generally not be eligible for a health care subsidy through the state.


You may begin receiving notifications from the state regarding employees who have applied for health benefit coverage through the Exchange that have been deemed as meeting criteria for a subsidy with an attachment titled "Employer Request for Hearing".


We want to prevent Full-time and HCR benefit eligible employees from owing funds and/or penalties to the state at the end of the year (vary by state) for receiving a subsidy which they are not eligible; therefore we have summarized action steps below you can take to assist the employee.


Please continue to read this notice to understand what steps you and the affected employee may need to take.

Action

If any of the following situations exist, you do NOT need to take action:

  • The individual is not currently an employee of Prestige Care
  • The individual is not benefit eligible for Prestige Care Benefits (works less than 30-hours per week)
  • The individual did not purchase health insurance through the state Exchange


If you receive this notification for an employee who is Full-time or HCR Eligible, COMPLETE the following actions:

  • Forward the notification and attached paperwork to the Prestige Plus Benefits Team at Central Support
  • Ask the employee to update their application through the state; the Tier 1/Base Medical Plans meet all criteria under ACA.
  • If the employee is unwilling to update their application, notify the Benefits Team at Central Support


If applicable, the Prestige Plus Benefits Team at Central Support will complete all Employer Request for Hearing Notices and represent the Plan.


Please note that in the event a subsidy is awarded a $3,000 penalty (per employee who receives a subsidy) will be assessed to your location.

Questions

You may direct questions to the Prestige Plus Benefits Team at Central Support.


Thank you,

Wendy DeHaart, SPHR, SHRM-SCP

Benefits Manager