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