What do each one of these check boxes mean for eligibility management and reporting?
We need to know certain things about the plans:
- Self-Funded: This will automatically be checked if the plans were marked as self-funded when the benefit was added. This tells the system to populate Part III of the 1095-C, or if the group is a small employer to produce the B series form.
- Enforce ACA Eligibility: A check within the system that allows Employee Navigator to calculate the correct eligibility dates for different enrollments. If this is checked, the ACA classification of Variable Hour will not be eligible for benefits until passing their measurement period.
- Provides Minimum Value: A plan is minimum value if it covers at least 60% of the cost of benefits expected to be incurred under the plan.
- Provides Minimum Essential Coverage: MEC includes any major employer-sponsored medical plan, including retiree-only coverage, such as a retiree-only health reimbursement arrangement (HRA).
- Is Low Cost: Check the lowest cost plan that is offered to your employees. For example, if you employees were offered a base plan and a buy-up plan, you would select the base plan to be the low cost plan. We are going to pull the cost from this plan to populate Line 15 of the 1095 form. There can be more than one low-cost plan.
- Spouse Coverage Excluded: When the plan does not offer the spouse coverage.
- Children Coverage Excluded: When the plan does not offer the child coverage.
- Conditional Offer to Spouse: A conditional offer is an offer of coverage that is subject to one or more reasonable, objective conditions (for example, an offer to cover an employee’s spouse only if the spouse is not eligible for coverage under a group health plan sponsored by another employer). Conditions attached to an offer may impact the spouse’s eligibility for a premium tax credit.
We will use this information to generate codes for Line 14 of the 1095. For example, if a plan is marked as providing Minimum Value, providing Minimum Essential Coverage, Low Cost, and Children Coverage offer, we can determine that Code 1C would be used on Line 14.
You are also able to enforce Enforce ACA Eligibility on Dental and Vision plans because many Variable Hour employees are not eligible for these benefits unless they work enough hours.