CENTRAL SUSQUEHANNA INTERMEDIATE UNIT Application: Payroll/Personnel. ACA Reporting Setup Learning Guide

Transcription

1 CENTRAL SUSQUEHANNA INTERMEDIATE UNIT Application: Payroll/Personnel ACA Reporting Setup Learning Guide 2015 Central Susquehanna Intermediate Unit, USA

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3 Table of Contents Introduction... 1 ACA Regulations... 2 Mandated #1: "Play or Pay" Mandate... 2 Mandate #2: Affordability/Minimum Value Mandate... 2 How does ACA define a Full-Time employee?... 3 Hours considered during look-back measurement:... 3 Types of new employees to consider upon hire:... 3 Employees who should be Offered Coverage within 90 Days... 3 Employees who can be Measured at Hire... 3 Special Guidance for Educational Institutions:... 3 Tracking in Payroll... 4 Average Hours and Days Report... 4 Employee Status... 5 Check History Pay Status... 6 Verify Status in Check History... 6 Tracking Insurance Information in Personnel... 8 Actuary Insurance Plans... 8 Insurance Parameters/Insurance Plans... 8 Insurance Parameters/Insurance Types... 9 Setup Waiver of Coverage Maintain Employee Insurance Information Tracking Dependents Mass Update Dependent Coverage Dependent Report Central Susquehanna Intermediate Unit, USA

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5 INTRODUCTION This Learning Guide will review setup for Affordable Care Act Reporting in the Payroll and Personnel applications. Employer Share - Coverage Requirements How are Full-Time employees defined New Hire considerations Average Hours/Days Report Tracking Employee Status Setup Insurance Information Reporting Waived Coverage Tracking Dependents Mass Update Dependent Coverage Dependent Report This information will be used to generate Section 6056 Reporting: Form 1095-C - Employer-Provided Health Insurance Offer and Coverage Form 1094-C - Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 1

6 ACA REGULATIONS Large employers with 100 or more full-time equivalent employees must comply with the Employer Shared Responsibility provision of Affordable Care Act in the following two ways: Mandated #1: "Play or Pay" Mandate Employers are required to offer minimum essential coverage to substantially all full-time employees and their dependents. Minimum Essential Coverage - Any health coverage recognized by HHS(Health & Human Services), including employer-sponsored plans, government-sponsored plans, grandfathered health plans and plans in the individual market. Substantially All - At least 95% Full-Time - Employees averaging 30 hours per week (or 130 per month). Dependents - Child dependents (spouses not included) The penalty is $2,000 multiplied by the total number of full-time employees minus the first 30. The penalty is triggered when one employee receives subsidized coverage in the Marketplace. Mandate #2: Affordability/Minimum Value Mandate Coverage that is offered to full-time employees must meet minimum value and affordable standards. Full-Time - Employees averaging 30 hours per week (or 130 per month). Minimum Value - Plans having actuarial value of at least 60%, meaning the plan pays 60% of the average claims cost for each individual. Affordable - Coverage is affordable if the Single/Employee Only coverage employee premium cost on the minimum value plan is less than 9.5% of an employee's household income. Because household income is unknown, the Department released safe harbors for guaranteeing "affordability" for employer penalty purposes: 1. W-2 Wages - Employee's Single coverage contribution does not exceed 9.5% of wages reported in Box 1 of the W Federal Poverty Line - Employee's Single coverage contribution does not exceed 9.5% of the federal poverty line. The penalty for offering coverage that is NOT minimum value or affordable if $3,000 multiplied by each employee who is not offered coverage and received subsidized coverage in the Marketplace. The penalty is only triggered if an employee purchases coverage through the Marketplace AND qualifies for a subsidy. Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 2

7 How does ACA define a Full-Time employee? A full-time employee is described as an employee who on average works 30 or more hours per week. ACA requires that employees are measured to determine whether or not they are "full-time". There are two methods for measurement: Monthly Measurement Method - Employees averaging 30+ hours per week (or 130 per month) during a given month are considered full-time for the month. Look-back Measurement Method - Employees averaging 30+ hours per week (or 130 per month) during an established measurement period would be classified as "full-time" during a stability period that follows. (Recommended method for most employers) Hours considered during look-back measurement: Paid work hours Paid leave (vacation, holidays, sick time) Special unpaid leave : FMLA, Jury Duty (this non-work time should not be counted against the employee) For educational institutions, unpaid leave of at least 4 consecutive weeks during time when school is generally not in session should not be counted against the employee. EXAMPLE: During a 12 month look back period, a teacher aide works 960 hours through 30 weeks of the school year, has 12-week FMLA and the school is closed for 10 weeks during the summer in which the aide doesn't work. Total Average Hours: 960 / 30 weeks = 32 hours/week Even though the measurement period is 52 weeks long, the District can only count 30 of these weeks to determine hours, given the rule above. (FMLA or summer break do not count against the employee) Types of new employees to consider upon hire: Employees who should be Offered Coverage within 90 Days Full-time Employees - If employee is hired and expected to average 30+ hours of work per week going forward, they should be offered coverage within the first 90 days of employment. Employees who can be Measured at Hire Part-time Employees - If an employee is hired and expected to work less than 30 hours per week, they can have their hours tracked over an initial measurement period to determine if they should be offered coverage. Variable Hour Employees - if it cannot be determined whether employees will work more or less than 30 hours per week, their hours can be measured at hire to determine if they should be offered coverage. Seasonal Employees - If a new employee is seasonal (meaning their occupation typically last 6 months or less) their hours can be measured at hire. Special Guidance for Educational Institutions: 4 Week Break Rule: - If an employee has 4 or more consecutive weeks of unpaid leave when school is typically not in session, the time cannot be counted against them as zero work hours in the measurement period. Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 3

8 This is meant to ensure that the employer will not count the summer months against an employee who is not working during that time. Summer hours should be counted at the equivalent rate that the employee worked during the school year or excluded from the denominator of total weeks counted for the period. TRACKING IN PAYROLL Average Hours and Days Report PAYROLL > REPORTS > MISCELLANEOUS > AVERAGE HOURS AND DAYS Generate this report for Payroll History hourly and daily information used for verification, record keeping, and government Affordable Care Act reporting purposes. It generates a report of employee total hours and days worked for a period of time entered by the user. It calculates the average hours and days per week for each employee based on the No. of weeks entered. The report also shows if the employee currently has health insurance or not. A total line is provided along with a total count of employees whose average hours are over the hours entered by the user. NOTE: We recommend generating monthly for tracking purposes. Start Date - Enter a Start date for selecting records from Payroll History. End Date - Enter an End date for selecting records from Payroll History. SSN / ID Selection - Select the employee identifier to display on the report, employee ID (I), Social Security number (S), or neither (blank). Class Code - Select employee class code(s) to include in report. Number of Weeks - Enter a Number of weeks used to calculate average weeks. Hours Over - Enter the Minimum hours per employee to include on report. Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 4

9 Employee Status UPDATE SCREENS>EMPLOYEE MASTER>GENERAL TAB All Full-time employees must be reported in the ACA Reporting. Employees who are determined to be full-time at any point during employment should be designated as such in the Status field on the EMPLOYEE MASTER/GENERAL TAB and saved in their CHECK HISTORY each pay. Employees who are not full-time but have insurance are also to be included in the ACA reporting. Status - Required. Select the employee's Status (Full-time, Part-time, or Inactive) to define the employee's work status for ACA Reporting. It will now be important to update the Status in a timely manner because this is now stored in CHECK HISTORY during payroll processing. Use the Query-by-Example function to verify employees have a correct Status. If the employees current Status is incorrect, update the EMPLOYEE MASTER/Status and Pay Status in CHECK HISTORY. The Pay Status was defaulted from the EMPLOYEE MASTER/Status field to update all checks dated in Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 5

10 Check History Pay Status UPDATE SCREENS > CHECK HISTORY Pay Status - Defaults from the EMPLOYEE MASTER/GENERAL TAB when PAYROLL is processed. It will be used to determine the employee status each month for ACA reporting. If the Status on the EMPLOYEE MASTER was not updated in a timely manner you will need to update the Pay Status field as needed per check date in CHECK HISTORY. Verify Status in Check History REPORTS > REPORT WRITER To verify the Pay Status in Check History a query can be created in Report Writer by selecting the CHECK HISTORY DATA DICTIONARY. Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 6

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12 TRACKING INSURANCE INFORMATION IN PERSONNEL Actuary Insurance Plans DIRECTORIES > ACTUARY INSURANCE PLANS The ACTUARY INSURANCE PLANS DIRECTORY screen allows you to identify insurance plans with userdefined codes. The codes you establish will be used on the INSURANCE PARAMETERS DIRECTORY to differentiate between various insurance plans for actuary reporting required by GASB Act 45 and government Affordable Care Act reporting purposes. Plan - Required. Enter a user-defined code to identify each Insurance Plan with a different code. Description - Required. Enter a description of the plan. Type - Required. Plan types have been pre-loaded for your convenience. Select a type of plan: M (Medical), P (Prescription), D (Dental), V (Vision), or O (Other). NOTE: - The Actuary Plan Type must be Medical for all Medical Plans and Waivers used in ACA reporting. Insurance Parameters/Insurance Plans INS > INSURANCE PARMETERS > INSURANCE PLANS Actuary Plan - Select an Actuary Plan as established in the ACTUARY INSURANCE PLANS DIRECTORY. The Actuary Plan Type must be Medical for all Medical Plans and Waivers. Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 8

13 Insurance Parameters/Insurance Types INS > INSURANCE PARAMETERS > INSURANCE TYPES Offer of Coverage- Select the Offer of Coverage for each Insurance Plan/Type for ACA reporting. Identify the Effective Date for each Offer of Coverage including Waivers. (For example- 7/1/14 and 7/1/15) 1A - "Qualifying Offer" made to full-time employee - Coverage was minimum value and affordable using the Federal Poverty Level safe harbor, and minimum essential coverage was offered to spouse and dependents 1B - minimum value coverage to employee only 1C - minimum value coverage offered to employee and minimum essential coverage offered to dependent (but not spouse) 1D - minimum value coverage offered to employee and minimum essential coverage offered to spouse (but not dependent) 1E - minimum value coverage offered to employee and minimum essential coverage offered to spouse and dependent. 1F - Non-minimum value coverage offered to employee and dependents. 1G - Offer of coverage to employee who was not PT for any month during year 1H - No offer of coverage 1I - "Qualified Offer Transition Relief" code can be used for employees not received an offer of coverage if employee made "qualified offer" to 95% of FT employees in 2015 NOTE: A new field "Employee Monthly Cost of Single Coverage" must be populated prior to processing ACA reporting if the Offer of Coverage is 1B, 1C, 1D or 1E. Enter the Cost of the Lowest Plan Single Coverage. More information will be provided. Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 9

14 Setup Waiver of Coverage INS > INSURANCE PARAMETERS > INSURANCE PLANS ADD a separate Insurance Plan for Waived Coverage for tracking purposes only. This Plan will not be included in Monthly Insurance Processing. The Actuary Plan Type must be Medical for ACA reporting. INS > INSURANCE PARAMETERS > INSURANCE TYPES ADD Insurance Types as needed. Offer of Coverage- Select the Offer of Coverage for each Insurance Plan/Type for ACA reporting. Identify the Effective Date for each Offer of Coverage including Waivers. NOTE: A new field "Employee Monthly Cost of Single Coverage" must be populated prior to processing ACA reporting if the Offer of Coverage is 1B, 1C, 1D or 1E. Enter the Cost of the Lowest Plan Single Coverage. More information will be provided. Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 10

15 INS >EMPLOYEE INSURANCE INFORMATION ADD Employee Insurance record for each Plan/Type/Effective Date combination to which the employee waived coverage. MAINTAIN EMPLOYEE INSURANCE INFORMATION INS >EMPLOYEE INSURANCE INFORMATION Start Dates - Required. Enter the date this Insurance Plan/Type goes into effect for the employee. End Dates - Enter the date this Insurance Plan/Type is no longer in effect for the employee (a date when the employee is no longer eligible for this insurance coverage or when he/she leaves employment). NOTE: Remember to also End Date the Dependent records when the employee is ending insurance coverage or when a Dependent is dropped from coverage. Also, maintain insurance Start Date and End Dates when employees change Insurance Plans or Types. Do not cross months. End Date records at the end of month, for example 06/30/15 and enter a Start Date for the beginning of the next month 07/01/2015. Only one Medical Plan should be valid per month. Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 11

16 TRACKING DEPENDENTS INS >EMPLOYEE INSURANCE INFORMATION/DEPENDENTS TAB ADD a record for each Dependent covered under the employee. The Start Date and End Date will be used to determine the months of coverage. Dependent - Required. Enter the dependent's full name (up to 25 characters). Gender - Required. Entry is 'F' for female, by default. Change to 'M' for male as necessary. Relationship - Select a code (as established in the RELATIONSHIP DIRECTORY) to identify the relationship of the dependent to the employee. The relationship description displays. Birth Date - Enter the dependent's date of birth. The dependent age in years and months displays. Required if Soc Sec No is blank. Student - Select the checkbox to indicate this dependent is a full-time student. This is not used for ACA reporting. Soc Sec No - Enter the dependent's nine-digit Social Security number (no hyphens). Required if Birth Date is blank. Requested for ACA reporting. NOTE - Employer should make an effort to report each dependents social security number. Insurance Coverage - Select the Plan (Medical, Dental, Vision, Life) that the Dependent has coverage. A mass update option has been added to populate existing Dependent information records. INS > MASS UPDATE DEPENDENT COVERAGE. Start Date - Enter the date the Dependent is added for coverage. End Date - (previously called Inactive Date) Enter the date the Dependent stops insurance coverage. NOTE: Remember to also End Date the Dependent records when the employee is ending insurance coverage or when a Dependent is dropped from coverage. Notes - Enter as much additional information as necessary pertaining to this dependent's coverage. Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 12

17 Mass Update Dependent Coverage INS > MASS UPDATE DEPENDENT COVERAGE Use this option to mass update the Dependent Coverage types Medical, Dental, Vision and Life on the EMPLOYEE INSURANCE/DEPENDENTS TAB. Plan/Type: - Select an Insurance Plan/Type to update the dependents attached to the Employee Insurance Plan/Type selection. Get Records - click button to display records in the grid from the Plan/Type selection. The grid includes Employee Name, Plan/Type, Dependent Name, and Coverage Types. Dependent Coverage - select the coverage type Medical, Dental, Vision and Life to mass update the coverage type in the grid. Any coverage types already populated on the Dependent tab will appear with checkmarks. Remove the checkmark from any records that are incorrect. Post - click to update the coverage type on the Dependent Tab. Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 13

18 Dependent Report INS >INSURANCE REPORTS> EMPLOYEE DEPENDENT COVERAGE Date Range - Enter a date range to include Dependents on the report based on Dependent Start/End Date. Active Dependents Only - select to include only active dependents based on the Date Range entered in the selection criteria. SSN/ID Selection - Select the employee identifier to display on the report, employee ID (I), Social Security number (S), or neither (blank). Revised: 07/17/ Central Susquehanna Intermediate Unit, USA Page 14