How to Configure ACA Eligibility Profiles

An Affordable Care Act (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.

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.

   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.