Shutter Stock photo

Connecticut’s health insurance exchange board voted Thursday to create an appeal process for employers whose workers may have erroneously reported that their company plan was not up to federal standards and received coverage and subsidies through the exchange.

Under the Affordable Care Act, employers with 50 or more employees face tax penalties if they don’t offer health insurance that meets ACA requirements. Under the ACA, those same employers have the right to appeal such penalties if an employee inaccurately reports that their company plan is not up to ACA standards. However, the federal government has yet to adopt any appeal procedures.

Virginia Lamb, legal counsel for Access Health CT, recommended Thursday that Access Health CT’s board should set up an appeal process for employers who may fall into this category, and the board agreed to do so.

What’s been happening in some instances is that an employee will get coverage on the exchange, instead of through their employer, and in doing they essentially tell the government that their employer doesn’t offer a qualified, affordable health insurance plan.

The exchange has received 163 calls from employers asking for information about how to proceed in challenging their potential penalty.

Jennifer Herz, assistant counsel at the Connecticut Business and Industry Association, said she believes creating an appeals process is a “good thing” for businesses who have been trying to do the right thing by complying with the law.

She said her organization also has fielded several phone calls from its members who received notices that their employees signed up for coverage on the exchange. Up until Thursday, her organization has been able to tell them how to go about reconciling the situation.

“It really puts the businesses in an intolerable situation,” Paul Philpott, a Access Health CT board member, said.

Chad Booker, a staff member with Access Health CT, said there’s no way to reconcile the premium subsidies that people received from the exchange despite being offered coverage by their employers in 2014. That will change in 2015 when the IRS is able to reconcile the 1095 tax forms, which are sent to individuals who received the Advanced Premium Tax Credits, or APTC’s, under the Affordable Care Act.

“The IRS understands that in 2014 there are some gaps in their compliance,” Booker said.

Lamb said that means some of these issues won’t impact the employers or the employees who got coverage in 2014 because the IRS is having difficulty “trueing” the information.

In the meantime, the staff of Access Health CT will create a 180-day appeal process for businesses looking to prove they bought health insurance coverage of the minimal value or if they are self-insured and can prove the value of the health insurance it offered its employees.

Office of Policy and Management Secretary Ben Barnes said he’s concerned about the retail worker, whose big-box employer may barely meet the requirements under the law, but whose employees may still find the coverage offered unaffordable.

“I’m troubled by an appeals process that could result in the deprivation of families of healthcare,” Barnes said.

He said he would rather have a few people owing money to the IRS, than have a whole bunch of people without health care for months and months because the plan offered by the employer was “poorer and more costly than what was available with the APTC [advanced premium tax credit] through the exchange.”

Lt. Gov. Nancy Wyman said she also wants to make sure the interest of the employee is considered during the appeals process.

“To make sure we’re not throwing them off for no reason,” she said.

She also stressed that it’s important for the exchange to understand how much it will cost to create this appeals process. She said the Department of Social Services currently doesn’t have the money to handle an appeals process.


Enrollment in the exchange, which ends Feb. 15, has continued to climb. As of Thursday, more than 108,000 residents had signed up through the exchange since it opened its second round of enrollment in November. Most of those, about 83,749, qualified for Medicaid, while 24,287 residents enrolled with one of the four private health insurance companies.

There were another 65,582 individuals who re-enrolled for a private health insurance plan on the exchange.

Total membership across all plans and programs stands at 471,881 individuals. Of those, about 382,012 are enrolled in Medicaid and 89,869 are enrolled with one of the four private insurance carriers. Of those enrolled in private insurance plans, 69,205 are receiving subsidies and 20,664 are enrolled in plans without any subsidy.

“Enrollment has been very strong, with consistent activity at our call center and our in-person enrollment locations,” Access Health CT CEO James Wadleigh said. “There’s been a trend in enrollment spiking around key milestones, and today is our second-to-last major milestone.”

Thursday was the last day to enroll in coverage beginning Feb. 1. The deadline to enroll in a plan through the exchange or face tax penalties for going without health insurance coverage is Feb. 15.