UNDERSTANDING THE 13-WEEK BREAK-IN-SERVICE...
Transcript of UNDERSTANDING THE 13-WEEK BREAK-IN-SERVICE...
In SummaryThe Question is: How Do You Classify a Returning Employee?
The ACA rules for calculating Full Time status make it difficult for staffing companies to determine how to treat employees that are off or in-between assignments.
If an employee is considered full time when they go off-assignment, do you consider them full time when they return or subject them to another “look-back” (initial measurement period) or new waiting period?
The Answer is: It Depends.
Break in Service Rules:If the break in service is longer than 13 weeks, the employee can be subjected to either new waiting or measurement periods BUT they can also be applied IF the break is longer than 4 weeks (not exceeding 13 weeks) AND the break in service was longer than the period of employment (this is known as the “Rule of Parity”).
For Example:John works for you on-assignment for 5 weeks. If John has no new assignments until you rehire him 8 weeks later, he can be treated as a new hire and subjected to a new measurement period or waiting period for benefits.
Is there ahire date or1st paycheck
date onfile?
Enrollmentform has been
received byPAI & entered
into EnrollmentSystem
Y
YN
N
Enrollment record is
complete; enrollee added
to claims processing
system and ID cards are
mailed out
Enrollee is reported toclient on SF
weekly report. ACA coverage begins on 1st of
the month following the receipt of thefirst premium
Has the employee stopped working?
Has the employee returned within 13 weeks?
Coverage is terminated in
the enrollment system
Employer / Client reports return date to PAI’s MSR to
request reinstatement of ACA coverage
Enrollment form is held
in the enrollment
system awaiting the 1st paycheck date
Is 1st
paycheckreceviedwithin 6months?
The form expires (a new enrollment form must be
submitted once the employee starts working)
Coverage remains terminated
Y Y Y
N
Is there ahire date or1st paycheck
date onfile?
Enrollment form has been received by PAIand entered into Enrollment System
Y
YN
N
Enrollment record is
complete; enrollee added
to claims processing
system and ID cards are
mailed out
Enrollee is reported toclient on SF
weekly report. ACA coverage begins on 1st of
the month following the receipt of thefirst premium
Has the employee stopped working?
Has the employee returned within 13 weeks?
Coverage is terminated in
the enrollment system
Employer / Client reports return date to PAI’s MSR to
request reinstatement of ACA coverage
Enrollment form is held
in the enrollment
system awaiting the 1st paycheck date
Is 1st
paycheckreceviedwithin 6months?
The form expires (a new enrollment form must be
submitted once the employee starts working)
Coverage remains terminated
Y Y
Y
N
UNDERSTANDING THE 13-WEEK BREAK-IN-SERVICE RULE
The simplest way to understand the Break
in Service rule is: if an eligible full time
employee has a break in service, they are
returning to work within 13 weeks, and they
meet the Rule of Parity, they should be
treated as eligible again immediately upon
their return to an assignment. Coverage
can be reinstated with a simple notification
to PAI whose process will automatically
terminate coverage on employees with a
break in service longer than 13 weeks. If the
employee returns to work before that period
and wishes to re enroll, notify PAI and they
will reinstate the employee’s coverage.
THE ACA ENROLLMENT PROCESS