The Affordable Care Act and Employees
The Affordable Care Act (ACA) and your OCU benefits: What you need to know
There are many components to this complex law that affect both individuals and employers including overall expansion of access including the creation of the health care exchanges, expansion of covered preventive services, the individual mandate requiring health care coverage for individuals, health plan value standards and the requirement for large employers to offer coverage.
The following is an overview on how you become eligible for health insurance benefits and other important information.
The ACA requires employers like OCU to offer health insurance to all full-time employees. The University already offers health insurance to all benefit-eligible employees.
The ACA also requires employers offer plans that meet certain standards. OCU’s medical plan meets these standards including providing minimum essential coverage, allowing dependents to remain covered to age 26, ensuring affordability per the ACA, covering preventive services at 100%, removing annual and lifetime maximums, counting prescription copays and copays toward out-of-pocket maximums, eliminating pre-existing conditions and other requirements.
The ACA required most citizens have insurance effective Jan. 2, 2014. The law allows people to acquire affordable, comprehensive coverage in many different ways including employer provided coverage, coverage from a private insurance company or coverage from the government. People who are not covered may have to pay a tax penalty.
Learn more about the ACA at www.healthcare.gov.
Employees currently enrolled in health insurance coverage do not need to take any action. Under the law, employees must secure the required minimum essential coverage. Current full-time, benefits eligible employees are offered health insurance by the university that this requirement.
As mentioned above, employers must offer health insurance to all eligible full time employees. Eligibility for full-time status for the purposes of health insurance coverage is determined by measurement periods.
A measurement period is a period of time during which the University will look back to see how many hours of service per week employees were credited on average. The University uses that average to determine the eligibility or continued eligibility for health insurance benefits for those employees.
A stability period is a period of time during which an employee will either be considered to be a full-time or non-full-time employee for purposes of for health benefits. An employee that is determined to be full-time during the immediately prior measurement period will be considered a full-time employee eligible for health benefits for the immediately subsequent stability period.
A stability period is a period of time during which an employee will either be considered to be a full-time or non-full-time employee for purposes of for health benefits. An employee that is determined to be full-time during the immediately prior measurement period will be considered a full-time employee eligible for health benefits for the immediately subsequent stability period.
An administrative period is a period of time, between the measurement period and the stability period, during which the University will determine which employees are eligible for coverage. The University will also notify and enroll eligible employees. For ongoing employees, the administrative period occurs after the measurement period ends and before the associated stability period begins.
You are eligible for coverage if:
- You were originally hired as a full-time employee; or
- You are credited with at least 30 hours of service per week during a measurement period. This option is available for employees initially hired in a less than full-time capacity who serve in variable hour, part-time roles (such as adjunct faculty and temporary employees)
No. Employees may waive or decline coverage but should arrange for coverage from another source.
A full-time employee is an employee with at least 130 hours of service per month or an average of 30 hours of service per week. For variable hour employees, the University determines the average number of hours of service per week or per month during a 12-month measuring period. An employee that works on average at least 130 hours per month or 30 hours per week during the measurement period is considered a full-time employee for health insurance coverage eligibility beginning with the next stability period.
Regular full-time employees are considered benefits-eligible and offered a comprehensive package of health benefits. The ACA does not require that these employees make any changes to their benefits. Most employees at OCU fall into this category.
A variable-hour employee is an employee whose hours of service are indeterminate. We therefore cannot determine at the time of hire if the employee will average at least 30 hours of service per week. For example, an employee hired and scheduled to work 12 hours one week, 32 hours the next week, and an unknown number of hours the following weeks and months is a variable-hour employee. At OCU, most variable employees are student employees, temporary employees, and adjunct faculty.
Student with positions funded by federal work study are not covered by the ACA employer mandate.
Students serving as RAs may be eligible for health coverage per the ACA. Eligible RAs must have at least an average of 30 service hours of service per week (or at least an average of 130 hours of service per month) during the measurement period.
The University will use a reasonable method for crediting hours of service for any on-call hour for which an RA is paid. This may include hours for which an RA must remain on-call on premises, or for which an RA’s activities while remaining on-call are subject to substantial work-related restrictions.
An RA that averages at least 30 hours of service per week (or an average of 130 hours of service per month) during the initial measurement period will be eligible for health benefits from Jan. 1 through Dec. 3. To maintain coverage, RAs must elect coverage, pay the employee insurance contribution and continue to be employed by the University during this period. These same students are eligible for the student health plan.
That depends. OCU is following the IRS “safe harbor” guideline to determine eligibility for adjunct faculty. If you are an adjunct faculty member, you will be credited with 2.25 hours of service per week of teaching or classroom time (representing a combination of teaching or classroom time and time performing related tasks such as class preparation and grading of examinations or papers). Most of OCU’s adjuncts work less than 30 hours per week using the counting hours method adopted by the University.
To account for breaks in the academic calendar that are greater than four weeks but less than 26 weeks, we will determine your average hours of service per week, excluding the employment break period, and use that as the average for the entire initial measurement period. For example, if you average 32 hours of service per week during January through May and September through December, and have a period without any hours of service in June, July and August, we will only include the hours of service credited for January through May and September through December in determining whether you qualify as a full-time employee for purposes of health insurance coverage.
Adjunct faculty who perform functions other than or in addition to teaching will be required to document and certify their hours worked. This is not an attempt to move these employees from salary to hourly wages, but to track eligibility for health insurance benefits.
If you average at least 30 hours of service per week (or an average of 130 hours of service per month) during the initial measurement period, then you will be eligible for health benefits from Jan. 1 through Dec. 31. You will be notified of your eligibility in October and must elect coverage between Nov. 1 and Dec. 31 for coverage effective on Jan. 1. You must pay the employee insurance contribution and continue to be an employee during the calendar year in order to maintain coverage.
If you are a newly hired employee and your hours of service will be determined based upon a measurement period, we will track your hours of service beginning with your date of hire. This period is called your initial measurement period. If during this period, it is determined that you meet the eligibility threshold, you will be considered full-time for the purposes of offering health benefits to begin with the following stability period.
If you change positions within the organization, your eligibility for health benefits could change because some positions may be benefit eligible whereas others are not. If a change in position causes a change in your health benefits eligibility, then you have experienced what is referred to as a change in employment status.
If your hours of service drop after you are enrolled in health coverage as part of a current stability period, you will continue to be covered as long as you make the required contributions and are an active employee. However, your reduced hours will count toward the current measurement period, and you may lose coverage after the end of the current stability period if you do not continue to meet threshold for eligibility.
Coverage may be obtained through the Marketplace during open enrollment or special enrollment periods. In the Marketplace, you may be eligible for a premium tax credit and/or cost-sharing reductions. To enroll in a Marketplace plan, visit www.healthcare.gov or contact a Marketplace Navigator for assistance.
Supervisor/hiring manager impact
The ACA employer mandate means that the university must look at all “variable hour” employees to determine health benefit eligibility. For OCU, this means tracking and measuring work time for temporary (term) employees, student employees and adjunct faculty during measurement periods. Previously, these employee classes were benefits ineligible, but now, work hours for each employee must be monitored on an ongoing basis for potential health insurance eligibility. As you make hiring decisions throughout the year, it is important to understand that those employees working more than 30 hours per week on average during their measurement period will be eligible for health insurance coverage, which will impact your budget. Currently, OCU allows hiring managers to fill temporary and adjunct positions on an as-needed basis without regard to total number of working hours, however, this position could change to manage the financial impact of employer paid health insurance contributions to budgets.
OCU has developed several resources to provide employees, departments,and supervisors the tools necessary to assist the university in complying with the ACA.
Disclaimer
The OCU Human Resources office designs this information to be as current as possible; however, the information contained within 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. Human Resources provides this information solely as a convenience to employees of the University.
