why your eligibility for employer health coverage can change presented by touchstone consulting...
Post on 28-Dec-2015
216 Views
Preview:
TRANSCRIPT
Why Your Eligibility for Employer Health Coverage Can Change
Presented by Touchstone Consulting Group© 2014 Zywave, Inc. All rights reserved.
Background
• Affordable Care Act (ACA) requirements– Applicable large employers must offer health
insurance to full-time employees and their dependents
• Must be “affordable”
• Must provide “minimum value”
– is an applicable large employer, and we offer health coverage to our full-time employees
• Variable-hour employees may flex between full- and part-time status, meaning your eligibility for health coverage may change
What counts as full-time employment?
• For periods of time where you are considered a full-time employee, you are eligible for health insurance
• Full-time employment is defined as one of the following:– Average of at least 30 hours of service per week, OR– 130 hours in a calendar month
What are hours of service?
• Hours of service are those that count toward your full-time designation. They include the following:– Hours worked– Hours for which you were entitled to pay, such as:
• Vacation
• Leave of absence
• Jury duty
• Disability
How are hours calculated?
• There are two methods:– Monthly measurement period– Look-back measurement period
• Certain specified categories of employees must have their employment status determined with the same method.
Monthly Measurement Method
• Your hours are tallied each calendar month to determine whether you were full-time
• With a variable-hour schedule, you could switch between full- and part-time status each month– May be offered coverage on a month-to-month basis
to match each month’s eligibility status
Look-back Measurement Method
• Three parts:– Standard measurement period (SMP)
• Three to 12 months
• Determines full-time status
– Stability period• As long as or longer than SMP
• Full-time status or not based on prior SMP
– Administration period• Time during which eligibility determinations and
coverage offers to eligible employees are made
• An initial measurement period applies for new employees and typically overlaps with the first SMP
How this affects you
• will monitor the hours you work each month, calculate your status according to the appropriate method and inform you of your status regarding insurance coverage.
Summary
• Health coverage eligibility depends on full-time employment status
• Full-time status determined in one of two ways:– Monthly measurement method
• Eligibility can change from month to month
– Look-back measurement method• Eligibility can only change with a new stability period
• Other factors besides full-time status may affect your eligibility for employer-sponsored health coverage
top related