19.2.1 Initial Enrollment
The County will determine ACA eligibility by virtue of the extra-help employees’ appointed FTE (Full-Time Equivalent) upon hire or actual hours worked within a measurement period.
Category A (Appointed FTE)
Extra-help employees who work a Full Time Equivalent (FTE) of 0.75 or more (as defined by the Patient Protection and Affordable Care Act (ACA) of 2010 will be offered coverage effective the first of the following month after hire. Employees who remain in this Category will be included in the County’s Standard Measurement Period (October of current year to October of next year) and will be part of the annual open enrollment process.
Extra-Help employees in classifications designated as “relief” and “seasonal” are not eligible for coverage under this category.
Category B (Actual Hours Worked)
For the purposes of the Patient Protection and Affordable Care Act (ACA) of 2010 the following types of employee classification will be will be placed in an initial measurement period (IMP) of twelve (12) months from hire date to determine if actual hours worked during this time is an average of thirty (30) hours or more per week:
- Part-time employee: the County reasonably expects employee to be employed on average less than thirty (30) hours of service per week during the initial measurement period, based on all facts and circumstances on employee’s start date.
- Seasonal employee: customary annual employment for the position is six (6) months or less, and that period begins each calendar year in approximately the same part of the year.
- Variable hour employee: based on the facts and circumstances on your start date, the County cannot determine whether the employee is reasonably expected to be employed on average of at least thirty (30) hours of service per week during the initial measurement period because the hours will be variable or otherwise uncertain.
Eligibility of extra-help employees in classifications designated as “relief” and “seasonal” will be determined under this category.
Employees who qualify for the Kaiser HDHP or Kaiser HMO Plan under Category B will be offered coverage at the end of their individual IMP. There is a thirty (30) day administrative period and coverage will start the first of the following month after the administrative period. Coverage is effective for twelve (12) months (Stability Period).
Ongoing Eligibility
If individuals drop off payroll, they continue to pay the employee part of the premium. If employees fail to pay the premium they will be terminated from coverage and offered COBRA. Health coverage will be terminated for covered extra-help employees who:
- Terminate employment (benefits terminate at the end of the month of termination).
- Fail to pay their portion of cost
19.2.2 Cost Share
The County’s share of the premium will be equal to eighty-five percent (85%) of the cost for employee only coverage. The Employee cost will be any remaining cost of the premium for the coverage tier selected.
Effective January 1, 2020, Extra help employees who meet the eligibility criteria as described under Category A or B may elect to enroll in the Kaiser HDHP or the Kaiser HMO plan for employee only coverage. The County will pay eighty-five percent (85%) of the total premium for employee-only coverage for employees enrolled in the Kaiser HDHP or the Kaiser HMO plan (employees pay 15% of the total premium).
Extra help employees (excluding limited term) who meet the eligibility criteria as described under Category A or B may enroll dependents in the Kaiser HDHP or the Kaiser HMO plan for dependent coverage. The County will contribute eighty-five percent (85%) of the total premium for employee-only coverage and the employees will pay the difference.