The Affordable Care Act and Employee Eligibility at NC State University

DisclaimerThe NC State HR Benefits Office designs these pages to be as current as possible; however, the information contained on these pages is subject to change at any time. This information cannot alter, modify or otherwise change the prevailing laws in any way, nor can any right accrue by reason of any inclusion or omission of any statement on these web pages. The Benefits Office provides this information solely as a convenience to employees of the University. Nothing on this web page affirms actual eligibility for health insurance.

If you hire people at NC State, consider the following for Affordable Care Act (ACA) compliance

  • Effective January 1, 2015, the ACA requires that anyone working 30 or more hours per week averaged over a 3 month time period must be offered employer-provided health insurance. The offer may be made after the person has worked at least three months or earlier.
  • The ACA employer mandate means that we must look at all employees including temporary employees, student employees, graduate RA/TA’s, non-tenure track faculty, lecturers…anyone employed and paid by the University.  Many of these may not have been eligible in the past, but may be eligible now. Employer-provided health insurance may be the State Health Plan or the State’s ACA Health Plan- not student health insurance, graduate support plans, etc.
  • It is important to associate correct FTE (full-time equivalency) to job data and length of appointment in the HR System. The HR Benefits Office will be responsible for monitoring for eligible employees.
  • Temporary employees, student workers hired or rehired after January 1, 2015 – The Affordable Care Act (ACA) law states that any one hired or rehired after January 1, 2015 that are listed in the HR System and will work 30 or more hours per week for 3 months or more, must be offered the chance to enroll in the ACA health plan within their first 30 days of employment.  Those that work less than 30 hours per week initially, but later begin to average over 30 hours will be identified by an eligibility query that looks back over the last 12 months.The General Assembly has enacted legislation that states if a rehired retiree becomes eligible under the Affordable Care Act for the ACA High Deductible Health Plan, then they must terminate their retiree health coverage. HR Benefits recommends that rehired retirees work no more than 29 hours/week.
  • ACA Work Hour Exception Form – An ACA Work Hour Exception Form must be completed for any undergrad that works over 20 hours per week during the academic year or over 29 hours per week during summer; a grad student who works over 29 hours per week; or any non-tenure track faculty who teach over three 3-hour classes.
  • The General Assembly has enacted legislation that states if a rehired retiree becomes eligible under the Affordable Care Act for the ACA High Deductible Health Plan, then they must terminate their retiree health coverage. HR Benefits recommends that rehired retirees work no more than 29 hours/week.

Step 1 – Determine eligibility by looking at work hours and how long the Job/Assignment/Contract will last

The HR Benefits Office will monitor eligibility and compliance for the ACA for everyone that is paid by the University.  In making hiring decisions, you may use the tool below for assistance in determining eligibility for ACA health coverage.

Determining Eligibility for the Affordable Care Act (ACA)

 

Step 2 – Understand measurement periods, look back period, stability periods and breaks in service

Our standard measurement period will be October 1-September 30 and conducted on an annual basis. 

  • We will use a 12 month look back period to determine if the temp/employee averaged 30 or more hours per week over the prior 12 month period (measurement period).  If the person averaged 30 or more hours per week, health coverage must be offered within 60 days (adjustment period).
  • If eligible and the person accepts the health coverage, it must last for at least 12 months regardless of hours worked.  After this 12 months of coverage, if the person’s work hours average less than 30 hours per week, the coverage may be canceled.  If the person terminates employment, the coverage will end.

For all non-benefits eligible employees or temps hired on or after January 1, 2015

  • If hiring for at least 30 hours or more per week AND at least for 3 months or more, health coverage must be offered within the first 30 days of hire and could begin on the first day of the month following the hire date.
  • If it cannot be determined if the position will work 30 or more hours per week OR if there is uncertainty as to the length of the assignment, the HR Benefits Office will monitor eligibility on a month to month basis.

Break in Service Rules

TYPE OF UNPAID BREAK IMPACT ON ACA MEASUREMENT PERIOD
Less than 4 consecutive weeks 0 hours will be factored in to the average to determine average hours for up to a 3 week maximum
4-26 consecutive week and Break DOES NOT EXCEED length of pre-break employment, which includes:

  • rehired employees
  • unpaid non-FMLA leaves
  • unpaid non-USERRA (military) leave
Measurement period average will be used for each week during the break to determine average hours.

  • NOT treated as a period during which 0 hours are credited
  • NOT eligible for new measurement period
4-26 consecutive week and Break EXCEEDS length of pre-break employment, which includes:

  • rehired employees
  • unpaid non-FMLA leaves
  • unpaid non-USERRA (military) leave
New measurement period starts the first of the month following the return to work or rehire date.
More than 26 consecutive weeks New measurement period starts the first of the month following the return to work or rehire date.

 

Step 3 – Look at examples to determine how a hiring decision may impact your department budget for ACA health care.

The cost for the ACA Health Plan for temporary employees for 2018 is:

$136.30  Employer/Department Cost (direct cost to department)

$  96.00  Temporary Employee Cost (billed by the plan on a monthly basis       For dependent costs paid by employee, click here

For more information, feel free to contact your Benefits Consultant