Creating an ACA Offer of Coverage Plan

An offer of coverage plan contains information about the health coverage for employees. Assign them to employees from the employee record, or to multiple employees from the pre-filing section of the ACA landing page. For more information, see Assigning an ACA Offer of Coverage Plan to an Employee and Assigning an ACA Offer of Coverage Plan to Multiple Employees.

To create an ACA offer of coverage plan:

1. Go to Payroll and HR > Payroll > Affordable Care Act (Payroll Manager).

2. If you have a NetSuite OneWorld account, select the subsidiary from the View list.

3. Click Add Coverage.

4. In the Name field, enter the name of the plan.

5. If a carrier provides coverage, enter the name in the Carrier field.

6. If the plan is self-insured, check the Self Insured box. If you check this box, then make sure to enter the covered individuals for a self-insured plan. For instructions, see Adding Covered Individuals to an Employee.

   Note:

   If this offer of coverage plan is assigned to an employee, then you cannot change the self-insured status of the plan.

7. Select the offer of coverage code from the Code list. Codes specify the type of coverage available to the employee, their spouse, and dependents. For more information about coverage codes, visit https://www.irs.gov/instructions/i109495c.

   The list of coverage codes includes:

   • 1A - Qualifying Offer: Minimum essential coverage providing minimum value. It is offered to full-time employee with employee contribution for self-only coverage equal to or less than 9.5% mainland single federal poverty line. It is at least minimum essential coverage offered to spouse and dependent(s).

   • 1B - Minimum essential coverage providing minimum value offered to employee only.

   • 1C - Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) (not spouse).

   • 1D - Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to spouse [not dependent(s)].

   • 1E - Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) and spouse.

   • 1F - Minimum essential coverage not providing minimum value. It is offered to the employee, employee and spouse or dependents, or employee, spouse and dependents.

   • 1G - Offer of coverage to employee who was not a full-time employee for any month of the calendar year. This may include one or more months in which the individual was not an employee. It may also include an employee who enrolled in self-insured coverage for one or more months of the calendar year.

   • 1H - No offer of coverage. The employee was not offered any health coverage, or the employee was offered coverage that is not minimum essential coverage. This may include one or more months in which the individual was not an employee.

   • 1J - Minimum essential coverage providing minimum value offered to the employee. It provides at least minimum essential coverage conditionally offered to spouse. It does not provide minimum essential coverage to dependents.

   • 1K - Minimum essential coverage providing minimum value offered to the employee. It provides at least minimum essential coverage offered to dependents, and at least minimum essential coverage conditionally offered to the spouse.

   • 1L - Individual coverage health reimbursement arrangement (HRA) offered to you only with affordability determined by using employee’s primary residence location ZIP code.

   • 1M - Individual coverage HRA offered to you and dependents (not spouse) with affordability determined by using employee’s primary residence location ZIP code.

   • 1N - Individual coverage HRA offered to you, spouse and dependents with affordability determined by using employee’s primary residence location ZIP code.

   • 1O - Individual coverage HRA offered to you only using the employee’s primary employment site ZIP code affordability safe harbor.

   • 1P - Individual coverage HRA offered to you and dependents (not spouse) using the employee’s primary employment site ZIP code affordability safe harbor.

   • 1Q - Individual coverage HRA offered to you, spouse and dependents using the employee’s primary employment site ZIP code affordability safe harbor.

   • 1R - Individual coverage HRA that is NOT affordable offered to you, employee and spouse or dependents, or employee, spouse, and dependents.

   • 1S - Individual coverage HRA offered to an individual who was not a full-time employee.

   • 1T - Individual coverage HRA offered to an employee and spouse (no dependents) with affordability determined using the employee’s primary residence ZIP code.

   • 1U - Individual coverage HRA offered to an employee and spouse (no dependents) using employee’s primary employment site ZIP code affordability safe harbor.

8. If you select any coverage code in the 1B–1U range, note the following. Enter the employee’s lowest monthly premium for self-only minimum essential coverage in the Lowest Cost of Employee Coverage field. Enter a Start Month and a Start Year.

9. If you select coverage codes 10, 1P, 1Q, or 1U, you can enter a Default ZIP Code for the employee’s primary employment site.

10. Click Add.

11. If the premium changed throughout the reporting year, add additional lines. Dates cannot overlap.

12. Click Save.

Making an ACA Offer of Coverage Plan Inactive

Make plans inactive to prevent them from appearing in lists. A plan is still assigned to an employee when it is inactive.

To make an ACA offer of coverage inactive:

1. Go to Payroll and HR > Payroll > Affordable Care Act (Payroll Manager).

2. Click the Coverages link beside Set Up & Assign Coverage.

3. Click Edit next to the plan to inactivate.

4. Check the Offer of Coverage Inactive box.

5. Click Save.

Deleting an ACA Offer of Coverage Plan

Delete a plan when it is unassigned and not needed.

To delete an ACA offer of coverage plan:

1. Go to Payroll and HR > Payroll > Affordable Care Act (Payroll Manager).

2. Click the Coverages link beside Set Up & Assign Coverage.

3. Click Edit next to the plan to delete.

4. Select Delete from the Actions menu.

5. Click OK.

Related Topics

Identifying Part-Time Employees

Assigning an ACA Offer of Coverage Plan to Multiple Employees

Setting Up Employer Information

ACA Pre-Filing

General Notices