Eligibility Rules
An employee moves from part-time to full-time status. What event may trigger benefit eligibility?
Becoming benefits eligible due to a status change.
What does HSA stand for?
Health Savings Account
What is the primary purpose of Open Enrollment?
To allow employees to enroll or make benefit changes.
What does ACA stand for?
Affordable Care Act.
An employee gets married. Is this a qualifying event?
Yes
True or False. Employers can apply eligibility rules differently for employees in the same class.
FALSE
Can an employee contribute to an HSA while enrolled in a general-purpose healthcare FSA?
No
True or False: Employees can generally change medical plans mid-year without a qualifying event.
FALSE
What form is commonly provided to employees for ACA reporting?
Form 1095-C.
An employee has a baby and wants to enroll the child. What should they do?
Submit enrollment changes within the 31 day qualifying life event (QLE) window
An employee is hired on September 5 with benefits effective the first of the month following 30 days. What is the earliest effective date?
November 1.
A healthcare FSA can reimburse you before all payroll deductions have been made.
TRUE
An employee misses Open Enrollment and has no qualifying event. What typically happens?
They must wait until the next Open Enrollment period.
Who is generally responsible for tracking employee hours for ACA purposes?
The employer.
An employee declines coverage during Open Enrollment and then wants to enroll one month later because they changed their mind. Can they?
No, because there is no qualifying life event that is occurring
True or False. A spouse losing eligibility under their employer's plan is a qualifying event.
TRUE
Which account is limited to the amount actually contributed at the time of reimbursement?
What enrollment strategy helps reduce employee confusion?
Clear communications, reminders, and enrollment education.
Under ACA measurement methods, why are hours important?
To determine full-time status and eligibility.
An employee terminates employment on Friday and asks if claims incurred after their termination date of coverage can be submitted under the plan.
Not allowed! Claims must be incurred while the employee has active coverage under the district
What documentation is commonly requested when adding a newborn or newly acquired dependent?
Birth certificate, hospital record, adoption placement paperwork, or similar proof.
What happens to an employee's HSA if they leave their employer?
It goes with the employee
What is the difference between active enrollment and passive enrollment?
Active enrollment requires elections each year; passive enrollment rolls elections forward when allowed.
What threshold is generally used to identify a full-time employee under ACA rules?
30 hours per week (or 130 hours per month).
A newly hired employee says they already have coverage through a spouse and declines coverage. Three months later the spouse loses coverage. May the employee enroll?
Yes, due to loss of other coverage (special enrollment event).