Eligibility Examples - Affordable Care Act

Scenario: Change in Employment Status FT- PT

  • An employee is in their stability period and measured as full-time at their agency.
  • The employee then chooses to take a part-time position within the agency, only working 18 hours a week.

The Agency must continue to offer Tier 1 insurance for the employee because they are still in the stability period from working full-time.

  • The employee must remain at Tier 1 insurance for the duration of the stability period (and possibly the next stability period).
  • Note: This employee is no longer eligible for retirement, leave or holiday pay.

 
Scenario:  Hiring a Previous State Employee

  • An employee who is in their stability period and measured as full-time for Agency 'A' quits.
  • They are then hired 2 weeks later at Agency 'B' working 15 hours a week.

Agency 'B' must now offer Tier 1 insurance for the employee because they are still in the stability period from working at Agency 'A'.

The employee must remain at Tier 1 insurance for the duration of the stability period (and possibly the next stability period).

Note:  This employee is no longer eligible for retirement, leave, or holiday pay.

 

Scenario: Returning Retirees

  • An employee who in their stability period and measures as full-time at their agency decides to retire.
  • They are then hired back within 14 weeks, on a part-time basis for a project.
  • Agency must continue to offer Tier 1 insurance for the employee because they are still in the stability period from when they measured as full-time.
  • The employee must remain at Tier 1 insurance for the duration of the stability period.

Note: This employee is not eligible for retirement, leave or holiday pay.
 
Scenario: Dual Employment

  • An employee is in their stability period and measured as part-time for Agency 210 (15 hours a week).
  • Employee also measured as part-time with Agency 185 (15 hours a week)
  • Average hours for the employee is 30 hours per week.
    • BOTH agencies must offer Tier 1 insurance
    • BOTH agencies will have the sweep deduction taken for insurance

***This scenario also applies to Board Members
 
Scenario:  Employees with extended leave without pay

  • An employee in their stability period measures as full-time at their agency has to take an extended FMLA leave of absence.
  •  The employee is out for 6 months.
  • The employee is no longer covered under FMLA.
  • When the employee returns to work they will begin an initial look-back period, and will be considered a new employee.

The employee should still be offered Tier 1 insurance if they are expected to work full-time hours.

Scenario: Change in Employment Status PT-FT

  • An employee is in their stability period and measures as part-time at their agency.
  •  The employee chooses to take a full-time position within the agency.
  • The Agency must immediately offer Tier 1 insurance

 
Scenario: 8-Month Temp Employees

  • An employee is considered an "8-Month Temp" employee. They will be measured the same as every other type of employee in the state.
  • If the employee measures as full-time during the measurement period, the agency MUST offer Tier 1 insurance.
  •  Even if the employee does not measure as full-time under ACA definitions, the Office of Group Insurance rules could possibly require insurance to be offered.


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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