Insurance

Affordable Care Act

The Affordable Care Act (ACA), or Health Care Reform law, is federal legislation passed in 2010. This new law is complex, multi-faceted and has an impact on both employers and employees.

Employer impact

The new law requires that employers with 50 or more full-time employees offer medical insurance to full-time employees and their children up to age 26. Employers not offering medical insurance may have to pay a penalty to the government. The University of North Dakota already offers medical insurance to benefit-eligible employees.

The Affordable Care Act has many requirements with various implementation dates, but most of the requirements are effective January 2015. As an employer, the University of North Dakota has significant responsibilities under the law. In compliance with the ACA, the University of North Dakota will offer medical coverage to eligible employees for coverage beginning January 2015.

Employee impact

The law also requires that most Americans have medical insurance by January 1, 2015. The law ensures that Americans have access to medical insurance they can afford—whether they get it from an employer, an insurance company or from the government. Individuals that do not have medical insurance as of January 1, 2015, may have to pay a tax penalty.

ACA Resources

General ACA Information

Decline ACA Health Insurance Coverage

ACA Rates and Information

Eligibility Criteria

ACA Decision Chart

FTE Calculator for Part-Time Instructors

Marketplace Notice

ACA Payroll Deduction Form

A person employed through a temporary staffing service is an employee of the staffing service as long as the staffing service fulfills the common-law definition of the employer, including controlling the details of how services are performed, providing compensation and benefits, and acting as the employer for payroll tax purposes.

Standard Measurement Period

The time period of between 3 and 12 consecutive months where employer tracks on-going employees’ hours of service and determines if employees works an average of 30 hours per week and are considered full-time. (Employer also uses “Initial Measurement Period” for new employees).

Administrative Period

Optional time period between Measurement and Stability periods to calculate full-time status, communicate status to employee and conduct open enrollment. (The combined length of Initial Measurement Period + Administrative period for New Employees, determined to be full-time, cannot exceed the first of the month following new employee’s one-year anniversary from hire date.)

Stability Period

Time period of not less than 6 months that employees determined to be full-time during the Standard measurement period are offered full-time coverage. Stability period can correspond to the plan year or to another time period as defined by employer.

Full-Time Employee

Position is defined as full-time with the expectation that employee will work an average of 30 or more hours per week.

Variable Hour Employee

Employer cannot determine if position is “reasonably expected” to average 30 or more hours per week and can utilize a safe harbor look-back measurement period to determine if employee is full-time.

Seasonal Employee

Position occurs during the same season each year and is 6 months or less in duration (Final Regulations). Positions determined to be seasonal can be subject to a look-back measurement period if applicable.

Part-Time Employee

Position is defined as not full-time with the expectation that employee will always work less than 30 hours per week and is not a variable hour or seasonal employee.

Yes, once you determine an employee meets the ACA definition of FTE, you will need to offer them coverage effective the first of the month following date of hire.  You should also visit with them regarding the affordability of coverage, and what their premium requirement would be if they elect coverage.

ACA would have you sum the hours within the same employer to determine if the individual meets ACA FTE definition and should be offered coverage.

If the employee is reasonably expected to work at least 30 hours per week/130 hours in a month, then you would want to offer them coverage effective 1st of month following hire. If you cannot determine this, then you would need to do an initial measurement period and determine at the end of this period. If eligible, you would offer coverage during the stability period. If not, no coverage offer is needed.

If the variable hour employee is determined eligible during the measurement period, they remain eligible during the following stability period, regardless of how many hours they work during the stability period. If they do not qualify when looking at the next measurement period, you no longer offer them coverage after December 31.

As long as employment hours are below 6 months and position is a recurring seasonal position, you would start the measurement period over each year when they return.

If work study employee, employee is still a seasonal employee.   If not under a work study program, the employee no longer qualifies as a seasonal employee and will be tracked as a variable hour employee.

Hours and weeks worked as a non-workstudy are counted toward the ACA during the measurement period.

The look-back period would determine eligibility and since exceeded, the employee would meet the requirements and should then be offered coverage.

No, once person terminates, the obligation of the employer to pay ends the month following the month of termination.

The individual is moving from a monthly measurement as a permanent employee to the look-back determination as a variable hour employee, if they meet the required hours,including the hours as a permanent employee, then they will be entitled to the insurance for the full stability period. If they remain a variable hour employee, then they will roll into the next year’s look back period and will be eligible only if they meet the necessary hours ongoing.

General guidance appears to indicate that once a person changes their hours where it is reasonably expected that they will meet the ACA FTE definition, they should be offered coverage rather than waiting to the end of the look-back measurement period.

12 month university employees are subject to the 26 week rehire rule.

If there is a chance a summer intern could be retained for Additional hours beyond the summer, it would not be allowed to classify them as a “seasonal worker”. For interns that return the following summer, as long as there is a break of more than 13 weeks in employment, which I believe in this case there would be, they would be considered a new hire when they return whether it is to intern or for more permanent employment following graduation. They would at that time be evaluated for whether they are working full time (more than 130 hours/month) and offered insurance, or if they are deemed seasonal, then it would not be required to offer them insurance.

Yes, COBRA is available any time a covered individual loses eligibility to the insurance plan.

Yes, it will be the same plan.

Yes, according to the ACA, an employee who meets eligibility must be offered coverage regardless of being covered by a spouse’s or parent’s plan.

The employee may purchase coverage for dependents, but not their spouse. Contact Payroll for the cost of dependent coverage 701.777.5128.

Anyone can apply for coverage on the exchange. However, if employer coverage was offered and it is deemed affordable, then the individual will not be eligible for the subsidy.

The rates are set through June 30, 2016 and do not include an Individual + Dependent Coverage so this will not be offered at this time.

NDPERS will bill the employer for the full premium. The agency will then need to collect the required premium from the employee, whether through payroll deduction or personal check.

The State of North Dakota will be the employer for all state organizations.  For reporting purposes, there will be two Large Employer Members within the state, which are 1) state agencies & 2) higher education.

The state is the employer and therefore, the total hours worked within the measurement period for the state would need to be considered for determining eligibility.

As long as the student is a non-workstudy employee, they would be treated like any other employee.

Decline Offer of Coverage form should be completed by the spouse that is not the contract holder. The form should be completed each year.

They are to be tracked under ACA guidance, however since they are being offered coverage, concerns of penalty do not apply.

Departments with eligible employees that accept the offer of medical insurance, must fund it from their department budgets. If the employee’s salary is paid from appropriated funding the cost will be charged to the appropriated fringe benefit pool.

After identifying the eligible employees that are not currently on benefits, but have worked an average of 30 hours or more (non-workstudy), will be sent an offer of health insurance coverage middle of November. Eligible employees will have until December 5, 2014 to either accept or waive coverage in writing.

As the Human Resources office calculates hours worked during the Measurement Period by temporary employees, respond as quickly as possible to any requests for information. Assist in following up with eligible employees in returning either their enrollment forms or waivers.

Employees hired in a position that is not regularly funded at 30 hours or more per week, will be immediately offered ACA health insurance coverage.