Large Group Full Time Implementation

Sep 10, 2015

  1. RayNY
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    Group with 60 people.

    10 are full time administrators (offered benefits).

    50 are "part time" 30-hour per week employees who are not currently offered benefits.

    Group contract renews 4/1/16.

    The question is: do these 50 employees who are now "full time" have to be enrolled effective 1/1 or 4/1?

    My gut says 1/1, as "newly eligible" employees in order to comply, since there's no pro-rating for the employer penalties. Does anyone have any support? I've exhausted the IRS/HC.gov, nothing specifically addresses this situation.
     
    RayNY, Sep 10, 2015
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  2. STIBROKER
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    STIBROKER Like My post and enter the DRAWING,,,, Moderator

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    well the emp's that all ready have coverage are taken out of the mix....then with the uninsured have to meet the participation requirements to keep the group alive....now the people that have other coverage and if it is with a subsidy employees would lose their subsidy if the employer plan is adequate (60% actuarial value), and affordable at less than 9.5% of their household MAGI. ........
     
  3. toddoxley
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    Under transitional relief this group had to comply with the employer mandate at the 2015 renewal. So they need to comply with IRS section 6055 reporting from April through December 2015. They do get a 80 ee deduction for penalty purposes, reduces to 30 in January 2016. They need to do a pay / play analysis.
     
    Last edited: Sep 10, 2015
  4. Ann H
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    Todd is correct.
     
    Ann H, Sep 10, 2015
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  5. RayNY
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    No need for a pay/play analysis, group is willing to just cover everyone, they just want to make sure they comply with law.

    Affordable QHP is already in place with the 4/1 renewal, the group is just wondering whether these people are added 1/1 or 4/1
     
    RayNY, Sep 11, 2015
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  6. toddoxley
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    RayNY, I stand corrected on my response to your post. This group has 60 full timers ( 30 hours or more per week) and under transitional relief this size group is NOT subject to the Employer Mandate until there renewal in 2016. It is ONLY 100 + employer groups that the employer mandate is applicable to in 2015.

    See attached Humana pdf.
     
  7. Ann H
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    Argh. RayNY, I failed you. Apparently I didn't read your original post well enough myself!

    I think your question was actually about timing, too. For employers with 50 to 99 FTE employees, the penalty is effective for the first PLAN YEAR beginning on or after January 1, 2016.

    By the way, you said that 50 employees were part-timers at 30 hours a week. Thirty hours is "full-time" for the purpose of the Employer Mandate Penalty, even though they may be "Part-Time" for other purposes.
     
    Ann H, Sep 12, 2015
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  8. RayNY
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    So the penalty is for the PLAN YEAR, I.E. 4/1 in this situation? So as of renewal, these 50 "30-hour part timers" have to be included? No penalty for 1/1-3/31?

    I know 30hrs is full time now. Mandate is only in effect for 100+ in 2015, in 2016 it extends to 50-99, which is why the question came up.

    Carrier reps aren't much help, no one has a solid answer.
     
    RayNY, Sep 14, 2015
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  9. Ann H
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    Yes, those "30-hour-a-week part timers" are really full-timers for this employer mandate, and they must be included in the group plan in 2016 or else there is a penalty applicable. Everything I have read states that it is for the PLAN YEAR in 2016 (2015 for large group). Verify with the carrier what this group's Plan Year is. I have seen groups renew in one month, but actually still have a plan year in another month -- weird, but I've seen it.

    From the IRS are answers to your questions:
    Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act

    34. Is additional transition relief available for employers with at least 50 but fewer than 100 full-time employees (including full-time equivalents)?

    Yes. For employers with fewer than 100 full-time employees (including full-time equivalents) in 2014, that meet the conditions described below, no Employer Shared Responsibility payment under section 4980H(a) or (b) will apply for any calendar month during 2015. For employers with non-calendar-year health plans, this applies to any calendar month during the 2015 plan year, including months during the 2015 plan year that fall in 2016.
    In order to be eligible for the relief, an employer must certify that it meets the following conditions:
    (1) Limited Workforce Size. The employer must employ on average at least 50 full-time employees (including full-time equivalents) but fewer than 100 full-time employees (including full-time equivalents) on business days during 2014. (Employers with fewer than 50 full-time employees (including full-time equivalents) on business days during the previous year are not subject to the Employer Shared Responsibility provisions.) The number of full-time employees (including full-time equivalents) is determined in accordance with the otherwise applicable rules in the final regulations for determining status as an applicable large employer.
    (2) Maintenance of Workforce and Aggregate Hours of Service. During the period beginning on Feb. 9, 2014 and ending on Dec. 31, 2014, the employer may not reduce the size of its workforce or the overall hours of service of its employees in order to qualify for the transition relief. However, an employer that reduces workforce size or overall hours of service for bona fide business reasons is still eligible for the relief.
    (3) Maintenance of Previously Offered Health Coverage. During the period beginning on Feb. 9, 2014 and ending on Dec. 31, 2015 (or, for employers with non-calendar-year plans, ending on the last day of the 2015 plan year) the employer does not eliminate or materially reduce the health coverage, if any, it offered as of Feb. 9, 2014. An employer will not be treated as eliminating or materially reducing health coverage if (i) it continues to offer each employee who is eligible for coverage an employer contribution toward the cost of employee-only coverage that either (A) is at least 95 percent of the dollar amount of the contribution toward such coverage that the employer was offering on Feb. 9, 2014, or (B) is at least the same percentage of the cost of coverage that the employer was offering to contribute toward coverage on Feb. 9, 2014; (ii) in the event of a change in benefits under the employee-only coverage offered, that coverage provides minimum value after the change; and (iii) it does not alter the terms of its group health plans to narrow or reduce the class or classes of employees (or the employees’ dependents) to whom coverage under those plans was offered on Feb. 9, 2014.​

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    Also, Ray, anytime a group is near that 50 FTE mark, one wonders if they really are a 50+ size group, since the ACA allows so many ways to count to 50. You use the PRIOR calendar year's employment count. There are rules for counting hours of part-timers, and rules for seasonal employees, variable hour employees, etc, which could knock the group size lower than 50.
     
    Ann H, Sep 14, 2015
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  10. RayNY
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    RayNY Guru

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    Thanks so much! That's what I was looking for.

    I know there's multiple ways to count, but this is a simple case. No one seasonal/temporary, no one variable, and nothing has changed from last year.
     
    RayNY, Sep 14, 2015
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