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In our rapidly changing world, innovation is no longer just a buzzword and instead has become part of the everyday business vernacular. For the healthcare industry in particular, innovation is the name of the game these days with the ACA driving creative entrepreneurs to develop increasingly progressive and transparent options – resulting in better and more affordable healthcare.  For traditional brokers and insurance carriers who have been in the game for decades, there is a sudden urgency to get on board or get off the train.

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Most grandfathered plans are offered by smaller organizations* (less than 200 people) that have typically offered traditional fully-funded plans through insurance carriers.  But while grandfathered plans may have some cost-containment advantages, they also significantly limit the amount of change that can be made to coverage – in costs, delivery, and services. In addition, grandfathered plans don’t cover many of the key consumer benefits that newer ACA plans do. Consequently, employees could face disadvantages when it comes to securing the same patient benefits, rights and regulations as those on updated plans.

As we close in on the 2016 healthcare enrollment period, it may be time to look at whether your organization still offers – and hopes to keep – at least one grandfathered healthcare plan. Employer-sponsored grandfathered plans are those that have had at least one person enrolled since March 23, 2010 and have not significantly cut benefits or increased costs for employees. Grandfathered plans are not required to cover preventative care or certain patient rights and responsibilities.

When it comes to the employer mandate, there will always be exceptions and special circumstances that will add another layer of challenge to determining full-time equivalency (FTE) – which in turn determines who receives group health coverage.  Two particular circumstances are unpaid leave (e.g. FMLA, educational employment breaks) and COBRA.

In previous posts on employment status under the ACA, we have focused on full-time equivalency (FTE) and how it’s determined for applicable large employers (ALES), and the various types of employment and how they accrue up to FTE. Today’s post centers on the ever-important measurement periods, set amounts of time that employers use to establish full-time (FT) or part-time (PT) employment status.

A recent New York Times article reported on the lack of employees enrolling in employer-sponsored healthcare, especially among small-midsize businesses that pay lower hourly wages (e.g. retail and hospitality).  One of the biggest reasons for the dearth of employee enrollment in these industries is that the government definition of “affordable” coverage (9.5% or less of annual income) can mean something very different for a minimum-wage employee. 

On October 7, 2015 President Obama signed into law the Protecting Affordable Coverage for Employees (PACE) Act, allowing organizations with 51-100 employees to maintain large employer status. 

As part of our series around ACA employment questions – namely how to determine full-time equivalency (FTE) – today we continue with a look at the various types of employment, how/if they play a role in FTE, and calculating the number of hours worked for each employee.

In the midst of looming ACA reporting deadlines and the fast approaching open enrollment period (leading to thoughts around planning for employee health in the 2016 tax year), questions around what constitutes full-time equivalency abound.  Determining full-time versus part-time employees can prove maddening especially when variable and seasonal workers enter the fray. In addition, measurement periods play a key role in establishing full or part-time status, and therefore must be utilized properly to ensure compliancy.

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