Affordable Care Act

He’s My Type

100

2.25 hours for every classroom hour.

What is the safe harbor for determining hours worked for adjuncts?

200

The type of employee that does not have to be offered coverage if they work less than 90 days.

What is any employee who works less than 90 days?

300

This employee cannot be employed for more than 6 months without an offer of coverage.

What is a seasonal employee? New guidance provides that a seasonal employee is one that provides work based on seasonal conditions or demands, whose work does not exceed 6 months.

400

An employee that receives an academic credit, grade, and/or federally recognized work-study funds.

What is a student worker? Such hours do not have to be counted as hours worked in determining status as an ACA FT employee.

500

An employee who has not been employed for a full measurement period.

What is a "new employee" for purposes look-back, measurement and coverage stability periods?

Fact or Fiction

100

Spouses, stepchildren, and foster children do not have to be given an offer of coverage.

Fact. Children, which excludes stepchildren and foster children must be covered to the end of the month in which they reach age 26.

200

An employer must use a measurement or look-back period for determining eligibility for all variable hour employees.

Fiction. All look back and measurement period methods of determining eligibility as full time or not with respect to ACA are voluntary. The monthly method with measures hours worked with one month and then recognizes elgiblity the month following is also allowed.

300

An employer must credit 2.25 hours for every classroom hour and hour for hour for administrative time in determining hours worked for adjuncts.

Fiction. The 2.25 hours for every one hour of classroom time is a voluntary safe harbor. An employer may still use any other reasonable method, but may be called upon in a DOL audit to defend the method.

400

An employer can establish a measurement /look back period for all employees, including salaried employees, as long as the method is consistent for that job classification. There is no requirement to offer coverage during the measurement period, but at the end of the measurement period eligibility for coverage or not must be locked in for the greater period of 6-months, or for same length of the measurement period, if longer.

Fiction. If the facts and circumstances available at the time of hire/placement are sufficient to provide a reasonable assumption of the number of hours the employee is expected to work, a monthly eligibility method must be used. It is correct that the measurment method used a class of employees must be consistent. However, these classifications are limited to fulltime/partime, collectively bargained or not, different collectively bargained groups and employees in different states.

500

If an employer adopts a policy to cover all employees who work at least 30 hours or more per week, and does not charge for employee only coverage does not have to worry about ACA or penalties.

Fiction. ACA requires more than policies and practices that are consistent with the intent to cover all employee who on avergae work more than 30 hours per week. ACA includes coverage mandates, bans on waiting periods of more than 90 days, the application of a true out of pocket maximum, and reporting requirements as well as other conditions. All employers are wise to track coverage and hours work each month to ensure there are no classification or others errors that could trigger penalties and as a basis for required yearend reporting.

Safety

100

9.5% of the employee’s earnings as recorded in box 1 of their W-2 form.

What is one of the available sfae harbors for ensuring health care affordability? Federal poverty, and rate of pay methods are other safe harbors.

200

A notice is published in plan materials about this, I have not decreased the formula or cost share percentage used to determine employer cost sharing, I have not increased any plan deductible by more than 15% plus inflation, since March 23, 2010. What am I?

What is a grandfathered health plan with respect the ACA?A plan that existed prior to March 23, 2010 can maintain status as a grandfathered plan with respect to ACA if all of the following conditions have been maintained since this date: 1. The Plan has NOT eliminated benefits for any necessary element to diagnose or treat a condition is considered the elimination of all or substantially all benefits to diagnose or treat a particular condition. 2.The plan has not changed the employee premium sharing percentage by more than 5% for any tier (i, e, employee only, employee + 1, family). This is a total accumulation for every change made since March 23, 2010. 3. The plan has not made accumulative changes to the employee’s share of fixed costs (other than co-payments) at the point of service; such as a deductible or out-of-pocket maximum of more than 15% plus allowed inflation. 4. The plan has not increased a fixed-amount copayment such that the increase measured from March 23, 2010 exceeds the greater of the maximum percentage increase, or an amount equal to $5 plus medical inflation. 5. The plan has not added or decreased an overall annual limit on benefits.

300

An employee would pay $0.00 for Plan H for employee only coverage, but he elects Plan J, which has an employee only cost of $150 per month and adds his spouse and children on for whom he pays the full premium of more than $1300.

What is an offer of affordable health care to the employee, spouse, and children? If the employee is offered a plan, even he does not enroll in it, in which the cost of employee only coverage meets ACA affordability standards, his plan is affordable even if he choses a plan that requires him to pay more. Even if the employee must pay 100% of the cost of coverage for the spouse and children, if the employee only cost offering is affordable, then by default to sposue and children are consiered to have been offered affordable coverage.

400

An employee has retired, but will return to his regular position after 30 days for up to an 18-month period while a search is conducted for his replacement. What type of employee or how would he be regarded in terms of ACA?

What is an ongoing employee with regards to ACA? ACA requires a break in service of at least 13 weeks, 26 weeks in a educational setting, before an employee can be considered as a new hire with regards to deteminign benefits under ACA. The only exception is that if the employees previous employment was less than 26 weeks, then a break that is as long as the service may be applied.

500

An non-exempt employee in an educational setting works only during the academic year, about 9 months of the year. She works between 25 and 35 hours per week. During the nine month period that she worked 1170 hours, an average of 130 for each month work. In determining eligibility for benefits 130 hours was added for the three months of the academic summer break.

What is the crediting method? ACA applies special rules for employers in an educational setting. An employer may either disregard the break by dividing the 1170 by only 9 months, or may use a crediting method that inputs the average hours worked each month for the months of the break, and then divides the total by 12 months. Under either method the same total should result.

Gotcha

100

$2000 times all ACA FT employees, minus the first 70 employees when more than 70% are not offered minimum value coverage.

What is the 4980H(a) Employer Shared Responsibility penalty for 2015? After 2015, employers must cover more than 95% and can exclude only the first 30 in calculating the penalty.

200

True or False. An employer who offers coverage to employees who they are not required to cover such as 20 hour per week workers, can still have a waiting period before benefits begin of more than 90 days

False. Any offer of coverage cannot inlcude a waiting period that is more than 90 days.

300

True or False. If my plan year, is October 1st, I do not have to change waiting periods of more than 90 days until October 1, 2014.

False. The ban on waiting period of more than 90 days was effective for all plans on January 1, 2014.

400

True or False. 6056 reporting are reports transmitted by the employer to the IRS. The are no reports that must be prepared for employees.

False. 6056 reports are also provided to each employee no later than January 31st of each year for the year prior.

500

97% of all fulltime ACA employees their children through age 26 are offered minimum value coverage that is affordable, but this employee triggers a penalty. Who is this employee, what was the penalty, and why was it triggered?

What is one of 3% of the remaining 100% that meets the ACA definition of FT who was not offered coverage, obtains coverage from Cover Oregon and receives a subsidy? The penalty is $3000 annualized ($250) for each month that this one employee continues to recive subsidized in the Exchange. This penalty, the 4980H(b) penalty is not triggered just when coverage is not affordable, but also when the employers has avoided the 4980H(a) penalty, but someone got missed and receives subsidized coverage.

Why or What?

100

Funds collected by the government from all self-funded and fully insured plans to fund research into equally as effective, but lower cost therapies, with the intent to lower the cost of health care.

What is the PCORI or Comparative Effectiveness Reseach Fee?

200

Fees charges to create a federal funding source, available to the State or Federally run exchanges to ensure that the Exchange does not fail.

What is the Transitional Reinsurance Fee?

300

An employer has added a new, less rich, plan option. It has an individual and out-of-pocket maximum benefit of $6350. What ACA purpose might the employer be trying to accomplish?

What is avoid the 4980H(a) Employers Shared Responsibility penalties regarding eligibility. An offer of minimum value coverage avoids this penalty. If the coverage is also affordable, less than about $106 per month for the employee only; then the (b) penalty can also be avoided.

400

6056 Reporting of coverage and plan information is required on or before February 28, 2016 for 2015. Non-Calendar Year Plans have until 60 days following the end of their first plan year which begins after Jan 1, 2015, True or False?

False. There are no exception for non-calendar year plans. IRC 6056 Reporting to begin in 2016 for 2015 regarding coverage options offered to all full-time employees: Employer information, whether minimum value coverage is offered, the length of the waiting period, the months during the year that it was offered, monthly premium for the lowest cost option, emloyer’s share of the total allowed costs of benefits, the number of full-time employees each month, nName, address, and TIN of each full-time employee during the year, and the months during the year covered under plan.

500

When an employees hours meet or exceed 130 hours in a month and then the employee is offered coverage in the next month; and/or when an employees hours drop below 130 hours in one month and are end in the next; what is this?

What is monthly method of determining eligibility?