Affordable Care Act (ACA) – The Patient Protection and Affordable Care Act (Public Law 111-148, and the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), as amended by the Medicare and Medicaid Extenders Act of 2010 (Public Law 111-309), the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 (Publix Law 112-9), the Department of Defense and Full-Year Continuing Appropriations Act, 2011 (Public Law 112-10), and the 3% Withholding Repeal and Job Creation Act (Publix Law 112-56).
Applicable Large Employer – An employer that employed an average of at least 50 full-time employees on business days during the preceding calendar year.
Bona Fide Volunteer – An employee of a government entity or a 501© organization that is exempt from taxation under section 501(a) whose only compensation from that entity or organization is in the form of reimbursement for reasonable expenses incurred in the performance of services by volunteers or reasonable benefits and nominal fees customarily paid by similar entities in connection with the performance of services by volunteers. Services performed by 'Bona Fide Volunteers' are not included as hours of service for ACA.
Break in Service (Educational Organization) – An employee who resumes providing services to (or is otherwise credited with an hour of service for) an applicable large employer after a period during which the employee was not credited with any hours of service may be treated as having terminated employment and having been rehired, and therefore may be treated as a new employee upon the resumption of services, only if the employee did not have an hour of service for the applicable large employer for a period of at least 26 consecutive weeks immediately preceding the resumption of services.
Break in Service (Non-Educational Organization) – An employee who resumes providing services to (or is otherwise credited with an hour of service for) an applicable large employer after a period during which the employee was not credited with any hours of service may be treated as having terminated employment and having been rehired, and therefore may be treated as a new employee upon the resumption of services, only if the employee did not have an hour of service for the applicable large employer for a period of at least 14 consecutive weeks immediately preceding the resumption of services.
Change in Employment Status – A change in full-time or part-time status.
Educational Organization - An educational organization is an organization whose primary function is the presentation of formal instruction, who normally maintains a regular faculty and curriculum, and who normally has a regularly enrolled body of pupils or students in attendance at the place where its educational activities are regularly carried on.
Eligible Employer-Sponsored Plan – A group health plan or group health insurance coverage offered by an employer to the employee which is any plan or coverage offered in the small or large group market within a State.
Employer Shared Responsibility – Mandate requiring large employers (50 or more employees) to offer affordable medical insurance to their ACA 'full-time' employees.
Employment Break Period – A period of at least four consecutive weeks (disregarding special unpaid leave), measured in weeks, during which an employee of an educational organization is not credited with hours of service for an applicable large employer.
Exchange – Governmental agency or non-profit entity that makes qualified health plans available to individuals and/or qualified employers.
Excluded Hours – Hours of Service does not include any hour for services performed by a Bone Fide Volunteer.
Federal Poverty Line Safe Harbor – Employer's offer of coverage to an employee is treated as affordable if the employee's required contribution for the calendar month for the lowest cost self-only coverage that provides minimum value does not exceed 9.5% of a monthly amount determined as the federal poverty line for a single individual for the applicable calendar year, divided by 12.
Full-Time Employee – An employee reports an average of 30 or more service hours per week (130 or more service hours per month). This definition of full-time is for ACA purposes ONLY.
Form 1094-C – Header for the 1095-C form.
Form 1095-C – Employee statement on employer provided health insurance offer. (The State of Idaho is not a self-insured employer so the information about the employee's coverage will be provided to the employee by Blue Cross.) All employees who worked at full-time hours during at least one month during the calendar year will receive a 1095-C form.
Hour of Service – Each hour for which an employee is paid, or entitled to payment, for the performance of duties for the employer; and each hour for which an employee is paid, or entitled to payment by the employer for a period of time during which no duties are performed due to vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty or leave of absence.
Initial Administrative Period – Period of time no longer than 90 days beginning immediately following the end of the initial measurement period and ending immediately before the start of the initial stability period. The initial measurement period and the initial administrative period cannot exceed 13 months. The State of Idaho's initial administrative period is no more than two months. The administrative period allows the employer time to offer full-time insurance coverage if necessary and allows the employee time to sign up for insurance coverage before the stability period starts.
Initial Measurement Period – A period selected by the employer of at least three consecutive months but not more than 12 consecutive months used to determine an employee's full-time status based on the hours of service reported during the measurement period. The State of Idaho's initial measurement period is 11 months.
Initial Stability Period – A period selected by the employer that immediately follows, and is associated with, an initial measurement and administrative period. The initial stability period must be at least three consecutive months and not shorter than the initial measurement period. During the initial stability period, an employee who was determined to be full-time after the initial measurement period is classified as full-time for the entire period. The State of Idaho's initial stability period is 12 months.
Limited Non-Assessment Period for Certain Employees – A limited period during which an employer will not be subject to a penalty for reasons including but limited to: employee's first month of employment where they are not eligible for insurance coverage, the initial measurement period for a new variable or seasonal employee, etc.
Look-Back Measurement Method – The employer determines each employee's full-time status buy looking back at a specified measurement period and then treating employees who are determined to have been employed as 'full-time' during that measurement period as full time employees during the subsequent stability period, regardless of the employee's number of hours of service during the stability period.
Minimum Essential Coverage – Coverage under an eligible employer-sponsored plan. OGI has determined the State's insurance plan meets the minimum essential coverage requirements.
Minimum Value – Employees required contribution with respect to the plan exceeds 9.5% of the applicable taxpayers household income. The plan has to cover at least 60% of the total cost of benefits and covers substantial inpatient hospital and physician services. OGI has determined the State's insurance plan meets the minimum value requirements.
New Employee – A new employee is a person who has been employed by an applicable large employer for less than one complete standard measurement period. (See definition for Break in Service)
Offer of Coverage – Employee has to have an effective opportunity to enroll in the coverage at least once with respect to the plan year. The opportunity to enroll includes the adequacy of notice of the availability of the offer of coverage. An employee's election of coverage from a prior year that continues for the next plan year unless the employee affirmatively elects to opt out of the plan constitutes an offer of coverage for purposes of section 4980H.
Ongoing Employee – An employee who has been employed by an applicable large employer for a least one complete standard measurement period. (See definition for Break in Service)
Part-time Employee – a new employee who the applicable large employer reasonably expects to be employed on average less than 30 hours of service per week (130 hours of service per month) during the initial measurement period, based on the facts and circumstances at the employee's start date.
Pay Period Rule – An employer is permitted to use payroll periods of two weeks instead of actual dates for the measurement periods. The State of Idaho is using a payroll measurement period that begins on the first day of the payroll that follows the payroll period that includes the date that would otherwise be the first day of the measurement period provided the measurement period ends on the last day of the payroll period that includes the date that would otherwise be the last day of the measurement period.
Plan Year – A plan year must be 12 consecutive months. The State of Idaho's insurance plan year is July 1st through June 30th.
Rule of Parity (Educational Organization) – For purposes of determining the period after which an employee may be treated as having terminated employment and having been rehired, an applicable large employer may choose a period, measured in weeks, of a least four consecutive weeks during which the employee was not credited with any hours of service that exceeds the number of weeks of that employee's period of employment with the applicable large employer immediately preceding the period and that is shorter than 26 weeks.
Rule of Parity (Non-Educational Organization) – For purposes of determining the period after which an employee may be treated as having terminated employment and having been rehired, an applicable large employer may choose a period, measured in weeks, of a least four consecutive weeks during which the employee was not credited with any hours of service that exceeds the number of weeks of that employee's period of employment with the applicable large employer immediately preceding the period and that is shorter than 14 weeks.
Seasonal Employee – An employee who is hired into a position for which the customary annual employment is six months or less.
Seasonal Worker – A worker who performs labor or services on a seasonal basis as defined by the Secretary of Labor.
Section 4980H(a) Applicable Payment Amount – If the employer offered affordable insurance to less than 95% of its employees, the penalty would be 1/12 of $2,000 (this amount will be adjusted for inflation each year) multiplied by all full time employees (less 30) for each month insurance was not offered.
Section 4980H(b) Applicable Payment Amount - If the employer offered affordable insurance to at least 95% of its employees, the penalty would be 1/12 of $3,000 (this amount will be adjusted for inflation each year) multiplied by all full time employees receiving the premium tax credit for each month insurance was not offered.
Self-Only Coverage – Health insurance coverage provided to only one individual, usually the employee.
Special Unpaid Leave – Unpaid leave that is subject to the Family Medical Leave Act of 1993 (FMLA), is subject to the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), and is on account of jury duty.
Standard Administrative Period - Period of time no longer than 90 days beginning immediately following the end of the standard measurement period and ending immediately before the start of the standard stability period. The administrative period must overlap the prior year's stability period. The State of Idaho's standard administrative period is from May 1st through June 30th of each year. The administrative period allows the employer time to offer full-time insurance coverage if necessary and allows the employee time to sign up for insurance coverage before the stability period starts.
Standard Measurement Period - A period selected by the employer of at least three consecutive months but not more than 12 consecutive months used to determine an employee's full-time status based on the hours of service reported during the measurement period. The State of Idaho's standard measurement period is from May 1st through April 30th each year.
Standard Stability Period - A period selected by the employer that immediately follows, and is associated with, a standard measurement and administrative period. The standard stability period must be at least six three consecutive months and not shorter than the standard measurement period. During the standard stability period, an employee who was determined to be full-time after the standard measurement period is classified as full-time for the entire period. The State of Idaho's standard stability period is July 1st through June 30th each year. This matches the insurance plan year.
Start Date – The first date on which an employee is required to be credited with an hour of service with an employer. (See definition for Break in Service). The State of Idaho uses a start date that begins on the first day of the payroll that follows the payroll period when the first hours of service were reported.
Variable Hour Employee – An employee if, based on the facts and circumstances at the employee's start date, the applicable large employer cannot determine whether the employee is reasonably expected to be employed on average at least 30 hours of service a week (130 hours of service per month) during the initial measurement period because the employee's hours are variable or otherwise uncertain.
Work-Study Program – Hours of Service does not include any hour for services to the extent those services are performed as part of a Federal Work Study Program or a substantially similar program of a state or political subdivision thereof.
Note: ACA's policy states 13 weeks. However, due to biweekly payroll processing, a 14-week break is required in order to be considered a new employee.
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