Phrases Made Easy: “Cost Sharing Reductions”

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Welcome back to another edition of “Phrases Made Easy.” This series at our blog aims to help make all of those long, drawn-out insurance phrases easier to understand. One thing we notice when talking about health insurance (and health benefits in general) is that the concepts can be “wordy” and boring. We emphasize fixing that here!

Today we’ve selected the phrase “Cost Sharing Reductions.” The primary reason we’ve selected this phrase, is because it can be a very important concept for certain people in the new Covered California state health insurance exchange. Like many other phrases in our “Phrases Made Easy” series, this one sounds difficult, but it’s really not that bad at all.

If you are shopping in the health insurance exchange, you may start to see the phrase Cost Sharing Reduction (or CSR). Here is what a Cost Sharing Reduction is:

Cost sharing reduction plans are offered through Covered California for consumers whose income is between 133% to 250% of the federal poverty level (FPL). These plans offer lower cost-sharing to reduce your clients’ out-of-pocket costs when accessing medical care. These plans are available only through Covered California.

Quite simply: Cost Sharing Reductions reduce your out-of-pocket expenses. If you purchase what is called an “Enhanced Silver Level Plan” through Covered California, and are eligible for Cost Sharing Reductions, you will get help with your co-payments, deductibles, and other out-of-pocket medical expenses.

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Question: What is the criteria for Cost Sharing Reduction eligibility?

Answer: There are two criteria:

  1. You need to purchase an “Enhanced Silver Level Plan” on the Covered California state health insurance exchange.
  2. Your yearly income must be between 100% and 250% of FPL (or approximately $11,490 per year & $28,725 per year for individuals).

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Here are the three tiers of Silver Level Plans that include Cost Sharing Reductions (or CSRs) in the new state health insurance exchange in California. A standard Silver Level Plan without Cost Sharing Reductions has 70% actuarial value:

  • Enhanced Silver 94: 100% FPL to 150% FPL (94% enhanced actuarial value)
  • Enhanced Silver 87: 150% FPL to 200% FPL (87% enhanced actuarial value)
  • Enhanced Silver 73: 200% FPL to 250% FPL (73% enhanced actuarial value)

Essentially, these are additional benefits that help people who make less, reduce their out of pocket costs. If you have additional questions about “Cost Sharing Reductions” (or CSRs), and how they may apply to you, please contact Policy Advantage Insurance Services. We are “Covered California Certified” and can help you with your questions when navigating the exchange.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: https://policyadvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

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Benefits Chalk Talk: 10 Essential Health Benefits

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Welcome back to another edition of “Benefits Chalk Talk.” In this series at our blog, we provide you with valuable, up-to-date, relevant information about health benefits planning so that you can put the things in place that make the most sense for yourself or your company. At Policy Advantage Insurance Services, we feel that informed consumers can make a really big difference in our industry.

The topic today is about the “10 essential health benefits” that must be included in all insurance plans starting on January 1st, 2014. The Affordable Care Act (or ACA/Obamacare), required that certain new “essential benefits” be included in all health insurance plans.

Additionally, you may have heard recently in the news that many people across the country are going to be unable to continue their current health insurance plans. The “10 Essential Health Benefits” provision is one of the reasons why. Many of today’s plans on the individual market do not conform to these minimum standards set forth in the law.

As such, any plans that were not “grandfathered in” (ie: in place before March 23rd, 2010, with certain exceptions) can no longer be offered. As a result, people in these plans will need to find a new one starting on January 1st. In many cases, because of the additional added benefits, premiums will also be more expensive.

Here is an overview of the “10 Essential Health Benefits (source: www.healthcare.gov):

  1. Ambulatory Patient Services: “Outpatient care” – the kind you get without being admitted to a hospital
  2. Emergency Care: Trips to the emergency room
  3. Hospitalization: Treatment in the hospital for inpatient care
  4. Maternity & Newborn Care: Care before and after your baby is born
  5. Mental Health Services: Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
  6. Prescription Drugs: Your prescription drugs
  7. Rehabilitative & Habilitative Services: Services and devices to help you recover if you are injured or have a disability or chronic condition. This includes physical and occupational therapy, speech language pathology, psychiatric rehabilitation, and more
  8. Laboratory Services: Your lab tests
  9. Preventive & Wellness Services: Preventive services including counseling, screening, and vaccines to keep you healthy and care for managing a chronic disease
  10. Pediatric Care: Pediatric services – this includes dental care and vision care for kids

The above listed are the “10 Essential Health Benefits” that must be included in all insurance plans starting on January 1st, 2014. Keep in mind that there may be minor benefits differences between states, but for the most part, all of the above must be included in new insurance policies.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: https://policyadvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

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Covered California: “Certified Insurance Agent”

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Today’s blog post is about Covered California’s “Certified Insurance Agents.” As you know, the new state health insurance marketplaces recently opened up for enrollment on October 1st, 2013. The marketplace in California is called Covered California.

With the opening of these marketplaces, a number of new ways to enroll in an individual health insurance plan emerged. One of those ways is finding the help of one of Covered California’s “Certified Insurance Agents.”

The “Certified Insurance Agent” training program allows licensed insurance agents in the state of California to assist the public in enrolling in the new state marketplace programs. Effectively, a “Certified Insurance Agent” becomes a guide for you. They can help you navigate the nation’s largest new insurance marketplace. Here is the official Covered California Certified Insurance Agent marketing badge. You will see it begin to appear on insurance brokerage websites, business cards, letterhead, etc:

CCCertified

If an agent in California is a “Certified Insurance Agent,” they have accomplished the following:

  • Obtained an insurance license to do business in California.
  • Are in good standing with the California Department of Insurance.
  • Have been through an in-person 8 hour Covered California training seminar.
  • Have completed 4 hours of Covered California self-study.
  • Have passed the “Covered California Certification Exam” with a score of 80% or better.
  • Registered and completed the agreement with Covered California to be a “Certified Insurance Agent.”

After completing each of the above requirements, a Covered California “Certified Insurance Agent” is then able to help the public navigate one of two programs at the exchange:

  1. The individual health insurance marketplace.
  2. SHOP (Small Business Health Options Program), for small business.

A Covered California “Certified Insurance Agent” can be a valuable asset for you in navigating the current healthcare reform conditions. They can also help you navigate the new insurance marketplace website, apply for coverage, and provide suggestions about which programs may fit best. Policy Advantage Insurance Services is a Certified Insurance Agent for Covered California. Please contact us with your questions today.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: https://policyadvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

YouTube: http://www.youtube.com/PolicyAdvantage

Pinterest: http://www.pinterest.com/PolicyAdvantage

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Benefits Chalk Talk: Metallic Levels of Coverage

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Welcome back to another edition of “Benefits Chalk Talk.” In this series at our blog, we provide you with valuable, up-to-date, relevant information about health benefits planning so that you can put the things in place that make the most sense for yourself or your company. At Policy Advantage Insurance Services, we feel that informed consumers can make a really big difference in our industry.

Today we’re going to tell you a little bit more about the new “Metallic Levels of Coverage” and how they work with regard to healthcare reform and individual health insurance policies. You’re going to want to familiarize yourself with these distinctive types of coverage, because you’ll begin to see them quite often.

These “Metallic Levels of Coverage” will be used both inside and outside of the new state health insurance exchanges. Their primary purpose is to explain (in simple terms) the amount of coverage that health insurance plans provide. The amount of coverage is based on actuarial value. Actuarial value is the percentage of health costs that would be covered by the health plan for an average population. Here are the four standardized “metallic levels of coverage”:

MetallicLevels

  • Bronze = 60% Insurance Company Pays, 40% Policyholder Pays
  • Silver = 70% Insurance Company Pays, 30% Policyholder Pays
  • Gold = 80% Insurance Company Pays, 20% Policyholder Pays
  • Platinum = 90% Insurance Company Pays, 10% Policyholder Pays

Insurance companies must offer the minimum “Bronze Level” plan as their lowest level of coverage starting on January 1st, 2014. This will be consistent with plans both inside and outside of the exchange. A couple of important additional items to understand:

  1. There is also a plan level called “Catastrophic Coverage.” This catastrophic plan is available only to people under 30 years of age. This plan is a high deductible health plan intended for those who are not utilizing services (younger people), in order to keep premiums lower.
  2. The “Platinum Level” (90%/10%) plan is not available in certain state health insurance exchanges. Be sure to check to see if you’ll be able to participate in a Platinum Level plan in the state where you reside.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: https://policyadvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

YouTube: http://www.youtube.com/PolicyAdvantage

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Health Insurance Marketplaces: Enrollment Begins October 1st

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On October 1st, 2013, the new health insurance marketplaces will open for enrollment across the country for the first time. These new marketplaces (or exchanges) were a major component of the Affordable Care Act (also known as Healthcare Reform, Obamacare, etc). The main objective of these exchanges is to extend coverage to those who cannot afford (or cannot obtain) health insurance. 

If you’ve been following along, in past blog posts we’ve described some of the characteristics of these new exchanges. We’ve discussed the general nature of these marketplaces (specifically the California state marketplace called “Covered California“). We’ve also talked a little bit about eligibility (ie: Federal Poverty Level), and the individual tax penalties involved if someone decides not to purchase health insurance.

That all being mentioned, we won’t go back into those types of topics in this blog post. Instead, this post is intended to be more of a “checklist” for you, so you can decide if you’re prepared for the new exchanges to open up.

These are the kinds of questions you should be asking yourself before the new marketplaces open in October:

Do I currently have health insurance? 

  • If the answer is no, it’s most likely for a few different reasons: A) It’s not affordable. You just flat-out can’t pay the expensive premiums. B) It’s not easily accessible. You want health insurance, but you can’t get it. You could be self-employed, between jobs, unemployed, or you may have a preexisting condition. C) You really don’t care. You can afford some kind of health insurance plan (and you have access to one), but you don’t want to spend your money on health insurance premiums. If these examples sound like you, you’ll want to take a very close look at the new health insurance exchanges.  

If the answer is “yes I do have health insurance,” you want to ask: Where am I currently getting my health insurance?

  • This is an important question. You’ll want to know if you’re buying your own plan, or if you’re getting it through an employer. Regardless of which one it is, you may want to take a look at the health insurance marketplaces because your premiums might be cheaper if you are eligible to receive premium subsidies (which will be many, many people… so make sure to take a look). However, if your employer currently has affordable health insurance coverage in place for you at work, or if your spouse has access to an employer plan, you may not be eligible for subsidies in the exchange.

Does it make more sense for me to buy a health insurance plan…?… or pay a tax penalty.

  • By January 1st, 2014 it’s got to be one or the other. You’ve either got to buy a minimum essential coverage health insurance plan, or you’ve got to pay a tax penalty. You’ll want to decide which one will make more sense in your situation (in certain cases, it may make more sense to pay the tax penalty, especially the first year).

Are the health insurance plans inside of the marketplaces the same as the ones outside of them?

  • The answer to this is yes. The plans inside the exchange will be the same as those outside of it (both are plans from private companies like Kaiser, Health Net, Anthem, etc).

Should I shop in a health insurance exchange?

  • You can always purchase an individual health insurance plan outside of a state health insurance marketplace (and starting on January 1st, 2014 you can’t be denied coverage for preexisting conditions inside or outside of an exchange). This means you don’t have to shop for your plan inside the exchange. However, the big advantage to shopping in the exchanges: you may qualify for substantial subsides that will reduce your monthly premium by quite a bit. The disadvantages: there is some additional administration (tax forms, etc). Also, certain plans and physician networks may not be available through the exchange (ie: not all insurance companies offer plans in the exchanges).

How (and where) can I apply for a plan in the exchange?

  • Eventually, the easiest way to take care of this will be online. You’ll be able to jump online and shop & compare insurance rates right at the state marketplace website. We say “eventually,” because states are still getting online accessibility prepared. Until then, you can apply in person, over the phone, or with a trained “assister/navigator” (these are people that are certified by the state’s Department of Insurance to help you enroll. IE: a Certified Insurance Agent). We can help you, please contact us.

Although these are not all of the questions you should be asking yourself, they are a very good start. They should help you begin to understand and make decisions about participating in a state health insurance marketplace.

Remember: on January 1st, 2014, you need to have a health insurance plan in place, or pay a tax penalty. The state health insurance marketplaces will be a big source of insurance for those who are currently uninsured. Make sure to take a good look at them, especially if you don’t currently have health insurance.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: https://policyadvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

YouTube: http://www.youtube.com/PolicyAdvantage

Pinterest: http://www.pinterest.com/PolicyAdvantage

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Insurance Alphabet: Letter F

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F is for:

“Full Time Equivalent Employee”

Full Time Equivalent Employees (FTE): are employees who do not work full-time (defined as 30 or more hours per week) in your business or organization, but do count towards the full-time equivalent employee count. In other words, YES… part-time employees do count towards your overall employee grand total.

“Full Time Equivalent Employees” is extremely important because it is the sole factor in healthcare reform that determines which employers are mandated to provide health insurance coverage, and which employers are not mandated to provide health insurance coverage. Starting on January 1st, 2015, employers with 50 or more “full time equivalent employees” must provide adequate health insurance coverage to their employees, or face a tax penalty.

For additional detailed information about Full Time Equivalent Employees, please read this blog post.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: https://policyadvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

YouTube: http://www.youtube.com/PolicyAdvantage

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Department of Labor: Insurance Exchange Notice to Employees

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Today’s blog post is about the insurance exchange notices that need to go out to employees of nearly all employer groups in the United States. The Department of Labor is calling this correspondence the “model notice.” It contains information about the upcoming health insurance marketplaces.

There are provisions in the healthcare reform bill that were designed to expand coverage and access beginning in 2014. Some of these provisions included the establishment of what are called state health insurance exchanges (or marketplaces). With these exchanges, premium tax-credits may assist qualified individuals or families in the payment of their health insurance premiums. As such, employers need to distribute notices to their employees about the coverage options available through the new marketplaces.

On January 1st, 2014 individuals and employees of small businesses will have access to a new individual private competitive health insurance market – the Health Insurance Marketplace. This marketplace will provide a “one stop shop” to find and compare private health insurance options. Open enrollment for the new health insurance exchanges begins on October 1st, 2013.

Section 1512 of the Affordable Care Act creates a new Fair Labor Standards Act (FLSA) section 18B requiring a notice to employees of coverage options available through the Marketplace. You can find copies of the approved “model notices” here:

  1. Department of Labor “model notice” for employers that are currently offering health insurance coverage.
  2. Department of Labor “model notice” for employers that are not currently offering health insurance coverage.

Which employers must provide notice?

The FLSA section 18B requirement to provide a notice to employees of coverage options applies to employers to which the FLSA applies. In general, the FLSA applies to employers that employ one or more employees who are engaged in, or produce goods for, interstate commerce. For most firms, a test of not less than $500,000 in annual dollar volume of business applies. The FLSA also specifically covers the following entities: hospitals; institutions primarily engaged in the care of the sick, the aged, mentally ill, or disabled who reside on the premises; schools for children who are mentally or physically disabled or gifted; preschools, elementary and secondary schools, and institutions of higher education; and federal, state and local government agencies.

Which employees do I provide notice to?

Employers must provide a notice of coverage options to each employee, regardless of plan enrollment status (if applicable) or of part-time or full-time status. Employers are not required to provide a separate notice to dependents or other individuals who are or may become eligible for coverage under the plan but who are not employees.

When does the notice need to go out to employees?

With respect to employees who are current employees before October 1, 2013, employers are required to provide the notice no later than October 1, 2013. The notice is required to be provided automatically, free of charge. Employers are required to provide the notice to each new employee at the time of hiring beginning October 1, 2013. For 2014, the Department of Labor will consider a notice to be provided at the time of hiring, if the notice is provided within 14 days of an employee’s start date.

Again, you can find copies of the approved “model notices” here. There are two of them. One is for employers that are currently offering health insurance coverage, and one is for employers that are not currently providing health insurance coverage:

  1. Department of Labor “model notice” for employers that are currently offering health insurance coverage.
  2. Department of Labor “model notice” for employers that are not currently offering health insurance coverage.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: https://policyadvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

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Phrases Made Easy: “Minimum Essential Coverage”

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Welcome back to another edition of “Phrases Made Easy.” This series at our blog aims to help make all of those long, drawn-out insurance phrases easier to understand. One thing we notice when talking about health insurance (and health benefits in general) is that the concepts can be “wordy” and boring. We emphasize fixing that here!

Our biggest goal is to help you tune in, understand, and put this knowledge to work for yourself or your company. We’re firm believers that informed consumers can make a really, really big difference in our industry.

The phrase that we’re talking about today is minimum essential coverage. This one sounds difficult, but it’s really not too bad. We’ve selected this phrase for one primary reason:

  1. Under the healthcare reform law (Obamacare, ACA)… minimum essential coverage is: the type of health insurance coverage that is required to be held by most Americans (per the individual mandate), in order to avoid individual tax penalties. 

In other words… you need to find a place where you can find minimum essential coverage (or pay a tax penalty). It doesn’t matter how rich you are or poor you are, where you live, or what kind of job you have… the law states that nearly every single American citizen will need to find minimum essential coverage by January 1st, 2014. It’s just that simple.

There are a number of different places where you can find minimum essential coverage. Here are the majority of options available for most people:

  • Coverage under an “eligible employer-sponsored plan,” which the proposed Treasury rule defines generally to mean coverage under a group health plan, whether insured or self-insured, including coverage under a federal or non-federal governmental plan (keeping it simple: coverage through your employer).
  • Coverage under an employer-sponsored retiree health plan.
  • Coverage under certain government programs, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and TRICARE.
  • Coverage in the individual insurance market, including a plan offered by an Exchange** (if you’re in California, you’ll want to look at Covered California).
  • Other coverage recognized by HHS, including self-funded student health coverage and coverage under Medicare Advantage plans.

**Very important new concept to understand

Please note that coverage listed as “excepted benefits” (as defined by HIPAA) will not qualify as minimum essential coverage. IE: dental benefits, vision benefits, and FSAs will not qualify on their own.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: https://policyadvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

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Delayed: Employer Mandate (+50 FTE)

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Today’s blog post is about a change/delay in the healthcare reform law (Obamacare, ACA, the Affordable Care Act, or whatever you would like to call it). Last week, the White House announced that the “employer mandate” (ie: employers with 50 or more full time equivalent employees having to provide coverage) would be delayed until 2015.

The reason that this happened, is because many businesses had informed the Obama administration that they were greatly unprepared for this change to be implemented (citing administrative burdens, difficulties with technology, additional expenses, etc). As a result, the White House rolled-out a decision that the “employer mandate” would be delayed until 2015.

What does this mean?

  • Employers with +50 Full Time Equivalent Employees: You will not have to provide minimum essential coverage to employees by January 1st, 2014. This decision allows you to postpone your decision making (ie: pay or play) until January 1st, 2015 (one full year). If you are not currently providing health insurance coverage, you may have faced additional tax penalties. With this decision, you will have additional time to make your decisions about employee health benefits.
  • Employers with Less Than +50 Full Time Equivalent Employees: This recent determination has not changed your health benefits planning in any way. If you are currently providing health insurance to your employees, you can continue to do-so. If you are not currently providing health insurance to your employees, keep in mind that (as of now) the individual mandate is still in place, and your employees will need to find a way to find affordable health coverage (or face a tax penalty).

The Fallout:

  • Democrat/Liberal Interpretation: many employers with +50 FTE across the county are already currently offering health insurance coverage. Because the overwhelming majority of employers with 50 or more FTE are already offering health insurance, this is not much of a change, and will not affect the broad scope of healthcare reform overall. This is simply a means to allow those employers with 50 or more FTE to continue to make their necessary adjustments, with an extra year of time.
  • Republican/Conservative Interpretation: this is the beginning of many of the major “issues” for the healthcare reform bill (Obamacare). Many will argue that there is much potential for this bill to begin to “unravel,” and that the “train wreck” is yet to arrive. Additionally, be prepared to anticipate major changes as this bill is implemented (ie: will the individual mandate still hold up?).
  • Policy Advantage Insurance Services Interpretation: This decision gives employers with +50 FTE’s more time to make their decisions about whether-or-not to offer health insurance coverage. The healthcare reform bill was large and far-reaching legislation, and changes were anticipated. Be prepared for additional delays and changes along the way. There is no-doubt that this bill will continue to take shape as implementation moves forward. We will continue to stay up-to-date with changes… stay tuned, and keep informed.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: https://policyadvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

YouTube: http://www.youtube.com/PolicyAdvantage

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Phrases Made Easy: “Full Time Equivalent Employees”

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Welcome back to another edition of “Phrases Made Easy.” This series at our blog aims to help make all of those long, drawn-out insurance phrases easier to understand. One thing we notice when talking about health insurance (and health benefits in general) is that the concepts can be “wordy” and boring. We emphasize fixing that here! Our biggest goal is to help you tune in, understand, and put this knowledge to work for yourself or your company. We’re firm believers that informed consumers can make a really-really big difference in our industry.

Here we go: today’s phrase is “Full Time Equivalent Employees.” *Note: this is a SUPER important concept for employers with regard to healthcare reform. That’s the overwhelming reason we picked this phrase today. You’ll want to understand this one in 2013 (ie: BEFORE 2014 gets here). So highlight it, share it, pass it along, circle it in red, underline it, etc. Do what you need to do to make sure that you “get it”… and help others get it too.

Phew… after that, you’re wondering: “WHY is this one so important?” That’s the best question we’ve heard all day. Here’s why:

  • “Full Time Equivalent Employees” is extremely important because it is the sole factor in healthcare reform that determines which employers are mandated to provide health insurance coverage, and which employers are not mandated to provide health insurance coverage. 

As a business owner, this is one that can cost you money if you don’t get it right (ie: tax penalties that can be fairly sizable). We won’t get into details here, but we’re talking thousands of dollars (and in larger cases, even hundreds of thousands of dollars). You want to make sure that you get this one right so that you’re: A) avoiding tax penalties, and B) planning correctly and efficiently. That’s why there’s more of a sense of urgency in this post.

Question: What are “Full Time Equivalent Employees?”

Answer: Full Time Equivalent Employees (FTE) are employees that do not work full-time (defined as 30 or more hours per week) in your business or organization, but do count towards the full-time equivalent employee count. In other words, YES… part-time employees do count towards your overall employee grand total.

Question: Why is this so important when it comes to healthcare reform?

Answer: As mentioned above, the “Full Time Equivalent Employee” count is what matters when deciding which employers are mandated to provide health insurance coverage to their employees. Furthermore, employers with 50 or more “full time equivalent employees” must provide adequate health insurance coverage to their employees.

Question: OK got it. So how do I calculate how my part-time employees count towards this “full time equivalent employee” total? 

Answer: The following is an example of how this is calculated. For sake of simplicity, this example uses part-time employees that work year round (seasonal employees working 120 days per year or less do not count towards the employee count). Here you go:

————————————————————————————————————

ABC Corp has 42 full-time employees (each working +30 hours per week)

ABC Corp also has 18 part-time employees (these 18 employees work 15 hours per week)

To calculate part-time workers’ full-time equivalent status, you add up all of the part time employees’ monthly hours, and divide by 120. So in this example:

  • 18 part-time employees x 15 hours per week = 270 total part-time hours per week in the company.
  • Then, 270 part-time hours x 4 weeks in the month = 1080 part-time hours per month in the company.
  • So, 1080/120 = 9

In this example, this company has 9 additional “full-time equivalent employees” through their part timers. Add 9 to your full-time employees (42+9), and you have 51 FTE employees. So although they only have 42 full time employees, they have 51 “full-time equivalent employees” based on their part-timers’ hours, and would be required to provide coverage.

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The moral of the story: part-time employees DO count towards your employee grand total, when you apply the phrase “Full Time Equivalent Employees.” If you have further questions about this concept please contact us any time. It’s extremely important for businesses that are at (or near) 50 “Full Time Equivalent Employees” status to understand it. Please share this blog post with companies you think would find this information important.

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