Configure Benefits for Affordable Care Act Reporting

You must configure the following on Oracle Fusion Cloud Human Resources Benefits.

• Each benefits plan or program

• ACA eligibility profiles

Configure your benefits plans or programs

You can define benefit plans specific to the Affordable Care Act (ACA) or use qualifying existing plans.

Set the following for each plan.

What you need to do	How you do it
Define the minimum essential coverage and minimum value	For each plan or program: Determine if the plan meets minimum essential coverage and minimum value requirements according to the ACA. For further info, see your benefits supplier documentation. If so, start the Benefit Plan Details task and click Plan. Search for and select the plan. Navigate to Additional Configuration. Select Yes for the following. Minimum Essential Coverage Minimum Essential Coverage
Set the primary funding method	To self-fund your benefits: Start the Benefit Plan Details task, and click Plan. Search for and select your plan. Navigate to Additional Configuration. Select the Self-insured primary funding method. Set this value at the program or plan level, depending on your program configuration.
Set the lowest cost option	When adding an option to a plan, to designate it as the lowest cost option: Start the Benefit Plan Details task, and click Plan. Search for and select your plan. In the Option region of Basic Details, edit an existing option or create one. In Select and Add, select Yes for Minimum Value. Ensure that you designate only one option as the lowest cost option.

Note: These are the minimum instructions for configuring benefits for ACA compliance. For further info, see the Oracle Global Human Resources Cloud Implementing Benefits guide on the Help Center.

Configure your ACA eligibility profiles

An ACA eligibility profile is associated with an ACA eligibility. When you run the ACA Eligibility Process flow, it:

1. Assigns the appropriate eligibility to employees belonging to that profile.

2. Updates the ACA fields on the employee assignments.

You must define a profile for each ACA eligibility you support in your organization, and you must ensure all employees belong to one of them. Available eligibilities are:

ACA eligibility	What it means
Always	Person is always eligible for benefits.
Exclude	Person is excluded from eligibility evaluation. You are determining their eligibility elsewhere.
Never	Person is never eligible.
No-monthly	Person is an hourly employee who is initially ineligible for benefits at time of hire. Their eligibility is reevaluated at the end of a monthly measurement period. For example, if an employee is hired as No-monthly, but they work full-time hours after their initial measurement period, they would become Yes-monthly.
No-weekly	Person is an hourly employee who is initially ineligible for benefits at time of hire. Their eligibility is reevaluated at the end of a weekly measurement period.
Yes-monthly	Person is an hourly employee who is initially eligible for benefits at time of hire. Their eligibility is reevaluated at the end of a monthly measurement period.
Yes-weekly	Person is an hourly employee who is initially eligible for benefits at time of hire. Their eligibility is reevaluated at the end of a weekly measurement period.

For further info, see Eligibility Profiles in the Help Center.

To define an eligibility profile:

1. From Benefits, click Eligibility Profiles.

2. Select Create, and click Create Participant Profile.

3. Set the following.

   Field name	What you do
   Name	Provide a meaningful name for the profile.
   Description	Provide any additional info on the profile.
   Assignment to Use	Select Primary employee assignment only - legal employer.
   Profile Usage	Select Benefits.
   Status	Select Active.

4. Use the tabs under Eligibility Criteria to define general employee eligibility rules.

   Each tab offers different kinds of eligibility criteria.

   An employee is considered eligible if they meet the criteria on at least one.

5. Use the Legal Entities tab if you have multiple legal employers, and you want to define different eligibility for each.

6. Once you defined the criteria for your general employee population, you can define rules that set eligibility for specific employees.

   To grant eligibility to an employee that doesn't already meet the eligibility criteria, include them on the profile.

   Note: You can also set their eligibility directly on their assignment. However, running the ACA Eligibility Process flow clears these overrides, so you must set their eligibility to Exclude.For further info, see Configure Employee Assignments for Affordable Care Act Reporting in the Help Center.

   To exclude employees, you have two options.

   • Exclude their assignment category from the eligibility profile.

     1. Under Eligibility Criteria, click Employment.

     2. Click Assignment Category.

     3. Click Exclude for the assignment category.

   • Add them to an exclusion profile.

7. Save your changes.