PPACA coverage cops are calling your group clients

Tele-detectives are calling employers now to see whether some public health insurance exchange users lied when they swore they lacked access to a minimum level of employer-sponsored coverage.

The Center for Consumer Information & Insurance Oversight (CCIIO), a unit of the Centers for Medicare & Medicaid Services (CMS), has described the employer coverage verification study in a section on a new employer initiatives Web page.

Investigators working for a CMS contractor started calling employers for the study in April, and will be placing calls at least until June.

The calls take place from 9 a.m. to noon and from 1 a.m. to 5 p.m., local time, and a typical call is expected to last from 10 to 15 minutes, CCIIO officials say. Employer participation in the study is voluntary.

See also: Hatch: HHS blew through its own PPACA deadline

“Employer participation will enable CMS to evaluate for plan year 2016 whether an employee, or a sample of employees, correctly attested that he or she was not offered [employer sponsored coverage] that met affordability and minimum value requirements,” officials say. 

The Patient Protection and Affordable Care Act (PPACA) makes premium tax credit subsidies and cost-sharing reduction subsidies available to some exchange plan users who meet subsidy income requirements, buy the right kinds of exchange plans, and lack access to affordable coverage with a minimum value from their employers, or from other sources.

PPACA imposes an “individual shared responsibility” penalty on some individual taxpayers who fail to have what federal agencies have classified as “minimum essential coverage” (MEC).

PPACA also imposes “employer shared responsibility” penalties on some employers that fail to offer affordable coverage with a minimum value to certain employees, if those employees end up qualifying for premium tax credit subsidies through the PPACA exchange system.