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Employee Eligibility Requirements for the Affordable Care Act (ACA)

Policy
Purpose: 

To outline employee eligibility for health insurance under the State Employee Health Plan pursuant to the provisions of the Affordable Care Act (ACA).

Applies to: 

All employees who are not benefits-eligible and whose appointments do not qualify them to participate in the State Employee health plan.

Campus: 
Lawrence
Edwards
Parsons
Juniper Gardens
Yoder
Topeka
Policy Statement: 

Pursuant to the provisions of the ACA, the University must offer health insurance to all employees who work an average of 30 or more hours per week over a measurement period. The State of Kansas Health Care Commission has the authority to establish the eligibility criteria for participation in the State Employee Health Plan.

Adjunct faculty (as herein defined for ACA purposes) and student employees who work an average of 30 hours or more weekly (1,560 hours/year) over a 12-month period will be ACA-eligible for the State Employee Health Plan. All other employees who are not benefits-eligible (as herein defined, i.e. in a temporary position or in a regular position with less than 48% FTE) who work an average of 20 hours or more weekly (1,000 hours) over a measurement period will be ACA-eligible for the State Employee Health Plan.

ACA Measurement Period

The standard measurement period for ongoing employees, as determined by the State Employee Health Plan, runs from mid-October to mid-October. New hires have their own 12-month individual measurement periods, in addition to the 12 month standard measurement period, and must have hours tracked individually during both periods until they are blended into the standard measurement period.

During the measurement period, the number of hours reported for all active appointments with the University and appointments with any other State agency for which the employee provides employment information will count toward determining ACA-eligibility. If determined to be ACA-eligible, the employee will be offered the opportunity to participate in the State Employee Health Plan and can elect coverage to be effective during the stability period as defined herein

Reporting of Hours Worked to Determine ACA Eligibility

For ACA eligibility purposes, all hours worked must be counted for all active appointments with the University and appointments with any other State agency within the past 12 month period. Human Resource Management determines what work hours count toward ACA eligibility, incorporating the application of rules regarding breaks in service.

All employees, including student employees, who are not benefits-eligible as herein defined will either be required to report hours worked weekly or will have hours identified, as described below, to determine ACA-eligibility during each measurement period. The rate of pay for employees appointed to salaried positions is not affected by any hours reported pursuant to this policy to determine ACA-eligibility.

Hours worked during travel for part-time salaried employees, paid leave time provided under the provisions of workers’ compensation, and, paid leave hours for employees eligible for such, are counted as qualifying toward ACA-eligibility. Employees will be required to report hours worked for concurrent or previous jobs with any State of Kansas agency within the past 12 month period, since those hours count toward ACA-eligibility.

Failure by employees to accurately report actual hours worked or falsification of hours worked for ACA purposes will be reviewed to determine if there may be grounds for disciplinary action, up to and including termination of employment.

Hourly Employees:

By the end of each work week, hourly employees must report the number of actual hours worked each day on all active appointments using the appropriate time reporting code in the HR/Pay system.

Work Study Student Employees:

The hours worked on positions funded by Work-Study do not count toward eligibility for health insurance coverage under ACA. Students working exclusively in Work-Study funded positions are able to work up to 30 hours per week while classes are in session. Work-Study funded employees should be appointed to positions established specifically for that purpose.

Non-Benefits Eligible Lecturers and Part-time Faculty:

Lecturers and part-time teaching faculty who are not benefits-eligible are considered as “adjunct” faculty and are not required to track and report time. The standard hours of the appointment, as determined by gross pay divided by pay rate, will be used to credit hours of service to determine ACA eligibility.

Other Part-time Salaried Staff Who Are Not Benefits-eligible:

Salaried part-time faculty and staff who are not benefits-eligible must report all hours worked on an hour-for-hour basis at the end of each work week using the “ACA” time reporting code in the HR/Pay system for purposes of determining ACA eligibility.

Graduate Teaching Assistants (GTAs):

GTAs will be considered as “adjunct” faculty and are not required to track and report time. The Standard Hours of the appointment, as determined by gross pay divided by pay rate, will be used to determine ACA eligibility.

Graduate Research Assistants (GRAs):

Research performed by GRAs must directly contribute to the research requirements for the graduate degree being sought and must further the student’s field of study to attain the degree. The Standard Hours of the appointment, as determined by gross pay divided by pay rate, will be used to determine ACA eligibility.

Graduate Assistants (GAs) and Other Salaried Student Employees (Not a GRA or GTA):

By the end of each work week GAs, except as excluded below, and other salaried graduate student employees must report the number of actual hours worked on an hour-for-hour basis each day on all active appointments using the “ACA” time reporting code in the HR/Pay system.

Student Employees Who Serve in Residence Halls:

Graduate students who serve as “Residential Graduate Assistants” and are required to live in student housing facilities will be deemed eligible under the ACA for health insurance through the State Employee Health Plan and are not required to report hours worked. Undergraduate students who serve as “Residential Undergraduate Assistants” and are required to live in student housing facilities will be required to report hours worked, including all hours during which they are on call, on an hour-for-hour basis, to determine ACA-eligibility.

Breaks in Service:

Employees of educational organizations, who work on an academic year basis, may not be negatively impacted by breaks in service lasting at least four consecutive weeks, but less than 27 weeks.  Human Resource Management will credit employees with hours of service during such break periods at a rate equal to the average hours worked per day during the three months leading up to the break in service.  The rules governing employment break periods for educational organizations apply only to employees treated as continuing employees; if an employee experiences a break in service longer than 26 weeks, or if the employee’s break in service is longer than their previous, continuous employment, the employee will be treated as a new hire for ACA purposes, rather than a continuing employee.  Educational organizations are not required to credit employees with more than 501 hours of service for any and all break periods in a calendar year.        

Supervisory Approval or Monitoring of Hours Worked to Determine ACA Eligibility

Hourly Employees:

Supervisors approve hours worked by hourly employees based on the normal procedures for the HR/Pay system. Those hours will be used to determine ACA- eligibility.

Lecturers, Salaried Staff and Other Part-time Faculty That Are Not Benefits-Eligible and Salaried Student Employees:

Supervisors will be provided information to monitor the numbers of hours worked for purposes of determining ACA-eligibility. It is the responsibility of the supervisor to make adjustments to an employee’s work schedule, if appropriate, prior to hours being worked in order to comply with the University policy on appointment percent/FTE. Any resulting financial obligations will be incurred by the unit(s) with any and all current, employing appointments.

Exclusions or Special Circumstances: 

Employees are required to report prior service within the past 12 months with any State of Kansas organization in order to determine ACA-eligibility.

Exceptions to the appointment limits for graduate student employees in the summer or when classes are not in session may be authorized by the appropriate dean(s) or vice provost(s), thereby accepting any ensuing fiscal responsibility of those exceptions.

Consequences: 

Failure by employees to accurately report actual hours worked or falsification of hours worked for ACA purposes will be reviewed to determine if there may be grounds for disciplinary action, up to and including termination of employment.

Any resulting financial obligations will be incurred by the unit(s) with any and all current, employing appointment(s).

Contact: 

Department of Human Resource Management
109 Carruth O’Leary Hall
1246 West Campus Road
Lawrence, Kansas 66045
785-864-4946
hrdept@ku.edu

Approved by: 
Provost and Executive Vice Chancellor
Approved on: 
Thursday, July 24, 2014
Effective on: 
Thursday, July 24, 2014
Review Cycle: 
Annual (As Needed)
Definitions: 

ACA-Eligible: Employees who meet the criteria established by the Affordable Care Act and the State of Kansas Health Care Commission are to be offered group health insurance through the State Employee Health Plan.

Adjunct: Employees will be deemed “adjunct” for ACA-eligibility purposes if they hold lecturer, GTA, or other faculty appointments that are not benefits-eligible.

Benefits-Eligible: Employees with appointments in regular positions with 48% or greater FTE who are eligible for the entire benefits package, including health insurance, mandatory retirement, death and disability, etc.

Non-Benefits Eligible: Employees with appointments in temporary positions or appointments to regular positions with less than 48% FTE.

Measurement Period: For ongoing employees, the standard measurement period runs from mid-October to mid-October. New hires also have a 12-month individual measurement period and must be tracked in both periods until they are blended into the standard measurement period. Each measurement period has its own separate 12-month stability period.  The stability periods, much like the measurement periods, overlap.

Stability Period: This is a 12 month period in which an ACA eligible employee who elects the State Employee Health Plan will have coverage while actively employed. For ongoing employees, the stability period will generally be the following calendar year.

Keywords: 
ACA, ACA eligible, Affordable Care Act, appointment levels, appointment limits, appointments, Child Labor Law, Fair Labor Standards Act, faculty, FLSA, FTE, full-time equivalent, GA, Graduate Assistant, GRA, Graduate Research Assistant, Graduate Teaching Assistant, GTA, health insurance, hourly employee, hours approval, hours reporting, hours worked, HR/Pay System, lecturers, less than 48% appointments, maximum appointment levels, non-GTA Graduate Salaried Students, part-time salaried faculty, part-time salaried staff, stability period, staff, State of Kansas Employee Health Plan, State of Kansas Open Enrollment, student assistant, Student Assistant Complex Director, student employee student employment, student employment eligibility, student employment limits, student hourly, student intern, Student Resident Assistant
Review, Approval & Change History: 

02/03/2017: Updated DLR

06.21.2016: Updated DLR

10/30/2015: provided more details regarding standard and individual measurement periods; provided federal work study-related hour limitations; removed information on adjunct calculations for instructors of record and added information on the standard hour calculation; described educational organization break rules and fringe-related liabilities for units employing ACA Eligible employees.

01/20/2015: Policy formatting cleanup (e.g., bolding, spacing).

07/24/2014: This policy was drafted by Human Resources. The draft was circulated to deans, vice provosts, and vice chancellors for comment. After revising the policies in light of comments received, the policies were discussed with graduate students and faculty researchers. Finally, the drafts were reviewed and endorsed by the Director of Human Resources, the Associate Vice Provost for Human Resources Management, General Counsel, and the Vice Provost for Administration & Finance prior to final approval from the Provost.

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