47 Reviewing Employee Eligibility

This chapter contains these topics:

47.1 Determining Employee Eligibility

The Hours of Service report creates employee eligibility information, or it can be manually entered. The Human Resources system enables you to designate an employee's Affordable Care Act (ACA) eligibility status, and to track additional supporting information that pertains to an employee. Under ACA section 4980H, an employee's eligibility for health coverage is based on their hours of service. The information created by the Hours of Service process helps you to determine for certain employees whether an employee should be considered eligible for health coverage.

You can use an employee's eligibility status and the eligibility effective date to determine eligibility for benefits enrollment.

47.1.1 Limited Non-Assessment Period

A Limited Non-Assessment Period (LNAP) generally refers to a period during which an ALE Member will not be subject to an assessable payment under section 4980H(a), and in certain cases section 4980H(b), for a full-time employee, regardless of whether that employee is offered health coverage during that period.

For purposes of reporting on Forms 1094-C and 1095-C, an employee in a Limited Non-Assessment Period is not considered a full-time employee during that period. LNAPs are therefore used in reporting Line 16 of the Form 1095-C.

The beginning of the limited non-assessment period coincides with the effective date of the ACA eligibility record, but the ending date of the limited non-assessment period could be prior to the ending effective date of the ACA eligibility record.

The following periods are described as LNAP:

  • First Year as ALE Period.

  • Waiting Period under the Monthly Measurement Method.

  • Waiting Period under the Look-Back Measurement Method.

  • Initial Measurement Period and Associated Administrative Period under the Look-Back Measurement Method.

  • Period Following Change in Status that Occurs During Initial Measurement Period Under the Look-Back Measurement Method.

  • First Calendar Month of Employment.

Note:

The Instructions document for Forms 1094-C and 1095-C posted on the IRS website provides more details on the LNAP periods.

47.2 Manually Entering Employee Eligibility Data

Navigation

From Human Resources (G08), choose Affordable Care Act

From Affordable Care Act (G08ACA), choose Employee Eligibility

The ACA Employee Eligibility application displays information from the Employee ACA Eligibility File (F081161) as well as Timecard Detail information from the ACA Home Company Summary File (F081163).

You can determine the ACA eligibility of an employee by the employee's number of hours or weeks with the company, and the dates specified in the employee eligibility form.

To manually enter data to track employees ACA eligibility

On Employee Eligibility

  1. Enter the employee number to determine an employee's eligibility for ACA.

  2. To add eligibility information for an employee, complete the following fields:

    • ACA Eligibility

    • Effective Date

    • ALE ID

    • Current Record

    • Hours of Service Version

    • New/Ongoing

    • Calculation method

    • Measurement weeks

    • Measurement begin date

    • Measurement end date

    • Administrative period begin date

    • Administrative period end date

    • Stability period begin date

    • Stability period end date

Field Description
ACA Eligibility A user-defined code that indicates the current Affordable Care Act (ACA) status of the employee as it pertains to eligibility for benefits. For example:

  • S: Standard Eligibility

    The employee is always eligible and does not need to be included in an Hours of Service process. For example, an employee whose employment status is already full time.

  • Y: Eligible

    The employee was processed by the Hours of Service process, and meets or exceeds hours-per-week or hours-per-month eligibility threshold.

  • X: Not Subject

    The employee is not subject to the Hours of Service process. For example, volunteers, students, or members of religious orders.

  • N: Not eligible

    The employee was processed by the Hours of Service process and average hours are below the hours-per-week or hours-per-month threshold.

  • U: Unknown or to be determined

    The employee's eligibility is unknown or cannot be determined through the Hours of Service process. This employee needs further review by human resources.

Note: ACA Eligibility Status Codes are defined in UDC 00/SE. The Special Handling Code in this UDC determines eligibility: The one in the Special Handling Code indicates eligible, and two indicates not eligible.
Effective Date The effective date is used generically.

It can be a lease effective date, a price or cost effective date, a currency effective date, a tax rate effective date, and so on.
Current Record This identifies whether an Employee Eligibility Detail (F081161) record is the current record for an employee. Values are:

Y - This is the current eligibility record for the employee.

N - This is not the current eligibility record for the employee.
ALE ID A user-defined value used to identify a business entity that employs 50 or more full-time employees. Applicable Large Employer (ALE) is used with processes relating to the ACA.
Hours of Service Version A user-defined set of specifications that control how applications and reports run. You use versions to group and save a set of user-defined processing option values, and to save data selection and sequencing options.
New/Ongoing Specifies whether an employee is categorized as new or ongoing as it pertains to the ACA. A new employee has a start date that falls within the measurement period. Values are:

N - New employee with a start date that falls within the measurement period

O - Ongoing employee
Calc. Method A user-defined code that indicates the ACA Employer Shared Responsibility Calculation method used to determine an employee's full-time status. Values are:

  • L: Look Back Measurement Period

    A period of time in history that is used to determine the employee's full-time status.

  • M: Monthly Period

    A month of time in history that is used to determine the employee's eligibility.
Measurement Weeks The number of weeks for a measurement period.
Measurement Begin Date This is the start date for an ACA Hours of Service Measurement Period.
Measurement End Date This is the end date for an ACA Hours of Service Measurement Period.
Admin. Begin Date This is the start date of an ACA Administrative Period. This is an optional period between the Measurement Period and the Stability Period.
Admin. End Date This is the end date of an ACA Administrative Period. This is an optional period between the Measurement Period and the Stability Period.
Stability Begin Dt. This is the start date for an ACA Stability Period. The employee's eligibility status remains constant during this period.
Stability End Date This is the end date for an ACA Stability Period. The employee's eligibility status remains constant during this period.
Limited Non-Assessment Period Flag Select the flag to indicate if the employee is in a limited non-assessment period for part or all of the period covered by this ACA eligibility record.

Blank - Employee is not in a limited non-assessment period.

X - Employee is in a limited non-assessment period for part or all of the period covered by the ACA eligibility record.
Limited Non-Assessment Period Reason Enter a value from UDC table 08/NA to specify as per IRS guidelines, why an employee is in a limited non-assessment period.
Non-Assessment Period End Date Specify the end date of an employee's limited non-assessment period.

The beginning date of an employee's limited non-assessment period is the Effective Date of the eligibility record.

47.2.1 Reviewing TimeCard Detail

When Employee Eligibility records are entered manually, you cannot enter the ACA Home Company Summary information (Timecard Detail) by using the application. The Timecard Detail information is generated by the Hours of Service process.