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Why is my client receiving a letter from Covered California and what should I do?
We have recently seen an uptick in the number of letters sent from Covered California to employers (here’s a sample).
Covered California is obligated to notify an employer when an individual is approved for a subsidy (APTC) and states they are employed. An employee cannot qualify for APTC if their employer offers coverage that meets certain requirements. If the employer receiving the letter is an Applicable Large Employer (ALE), they are being put on notice that the employee has told Covered California that they were not offered qualified coverage. If not true, the employer’s normal ACA reporting will prove this out. If true, the employer may be subject to a penalty. The penalty can be substantial, so it is critical that ALE’s take these letters seriously and act on them quickly.
Since Covered California has no idea if an employer is an ALE when sending the notice, even those who are not ALE’s and have no obligation to offer coverage may be notified. Those who are not an ALE can view the letter as informational, however, those who are an ALE should take the letter seriously and act quickly if necessary.
We have developed this informational piece: Responding to an APTC Letter from Covered California that should help you understand the rationale behind the letter and provide concrete next steps for you and your client.
There may be a more recent answer to this question. Contact Claremont for an update.