Group health

Group Benefits Renewal Readiness 16 of 16 checks apply here

• More employees are recorded as full-time than are recorded in total.

  This is arithmetic on your own two entries: the count averaging at least 30 hours of service per week exceeds the total headcount. The federal definition counts an employee as full-time at an average of at least 30 hours of service per week, with 130 hours in a calendar month treated as the monthly equivalent, so the full-time count is a subset of the whole and cannot be larger than it.

  inconsistency cfr-26-54-4980h-1-lii

• The preceding-year average you recorded reaches the threshold the applicable large employer definition uses.

  The regulation defines an applicable large employer as one that employed an average of at least 50 full-time employees, including full-time equivalent employees, on business days during the preceding calendar year. The figure you recorded for the preceding year is at or above that number. Whether the definition is met for your business is a determination under the statute and its regulations, and it turns on a calculation this module does not perform.

  question cfr-26-54-4980h-1-lii

• The full-time test is measured in hours of service, and hours are not being recorded for everyone.

  The definition is expressed in hours: an average of at least 30 hours of service per week, or 130 hours in a calendar month as the monthly equivalent. A manager estimate or an untracked population cannot be measured against an hours threshold after the fact, and the preceding-calendar-year test the applicable large employer definition uses looks backwards.

  documentation cfr-26-54-4980h-1-lii

• Employees whose hours vary around the threshold are recorded, and hours are not being tracked by system.

  You recorded employees whose hours vary enough that their side of the threshold is unclear, and a tracking method other than a timekeeping system. The threshold itself is an average of at least 30 hours of service per week, with 130 hours in a calendar month as the monthly equivalent. An average cannot be computed from an estimate, so the population most likely to matter is the one least likely to be measurable.

  gap cfr-26-54-4980h-1-lii

• A plan is offered and no affordability safe harbour is recorded as the basis for the employee contribution.

  The regulation provides three safe harbors and expresses all of them against the same 9.5 percent threshold: the Form W-2 safe harbor, measured against 9.5 percent of the employee's Form W-2 wages from the employer for the calendar year; the rate of pay safe harbor, measured for an hourly employee against 9.5 percent of 130 hours multiplied by the hourly rate of pay; and the federal poverty line safe harbor, measured against 9.5 percent of a monthly amount determined as the federal poverty line for a single individual for the applicable year, divided by 12. Which one the contribution is set against is a decision, and it is the kind of decision that should exist on paper before a renewal rather than after.

  documentation cfr-26-54-4980h-5-lii

• A wage-based affordability safe harbour is recorded alongside tipped or variable wages.

  You recorded that the contribution is set against Form W-2 wages or against rate of pay, and that a meaningful number of employees receive tips or variable wages. The Form W-2 safe harbor is measured against 9.5 percent of that employee's Form W-2 wages for the calendar year, and the rate of pay safe harbor against 9.5 percent of 130 hours multiplied by the hourly rate of pay. Both are wage figures, so both move when pay varies. The federal poverty line safe harbor in the same paragraph is not a wage figure.

  question cfr-26-54-4980h-5-lii

• A plan is offered, but not to everyone recorded as averaging 30 or more hours.

  You recorded that the plan is not offered to everyone averaging at least 30 hours of service per week. That threshold is the one the definition uses, expressed as an average of at least 30 hours per week or 130 hours in a calendar month. Whether an offer is required, to whom, and what follows if it is not made are determinations under section 4980H and its regulations, none of which is made here.

  question cfr-26-54-4980h-1-lii

• The employer is also the plan administrator, so the continuation-coverage notice period the regulation states is the 44-day one.

  Where the employer is also the plan administrator, the regulation provides that the administrator shall furnish to each qualified beneficiary a notice not later than 44 days after either the date coverage is lost or the date the qualifying event occurred, depending on the plan provisions. That is a single stated period rather than the employer's 30 days to notify the administrator followed by a fresh 14 days. Which of the two start dates applies is answered by the plan document, not by the regulation.

  timing cfr-29-2590-606-4-lii cfr-29-2590-606-2-lii

• A third party administers the plan, so the employer's own notice runs to the administrator rather than to the beneficiary.

  For most plans the employer must furnish the notice to the plan administrator not later than 30 days after the date on which the qualifying event occurred, and for plans under which continuation coverage commences on the date of loss of coverage, not later than 30 days after the date a qualified beneficiary loses coverage due to the qualifying event. The administrator's own period then runs separately, not later than 14 days after receipt of the notice of qualifying event.

  timing cfr-29-2590-606-2-lii cfr-29-2590-606-4-lii

• A qualifying event date is recorded and it is not known who the plan administrator is.

  The period that applies depends on the answer. Where the employer is also the plan administrator the regulation states a 44-day period; where it is not, the employer owes a notice to the administrator within 30 days and the administrator owes one to each qualified beneficiary within 14 days of receipt. Until the role is established, none of the three periods can be calendared.

  gap cfr-29-2590-606-4-lii cfr-29-2590-606-2-lii

• The plan's notice procedures are not written down, and the regulation defers to the plan document in several places.

  The 44-day period for an employer that is also the plan administrator runs from either the date coverage is lost or the date the qualifying event occurred, depending on the plan provisions. A multiemployer plan may provide for a longer notice period than otherwise required, as specified in the plan documents. Where the regulation defers to the document, the document is the operative text, and an unwritten procedure cannot be the document.

  documentation cfr-29-2590-606-4-lii cfr-29-2590-606-2-lii

• This is recorded as a multiemployer plan, and the regulation allows a longer notice period for that plan type.

  Multiemployer plans may provide for a longer notice period than the periods otherwise required, as specified in the plan documents. So the 30-day figure is a floor for this plan type rather than the answer, and the document governs.

  question cfr-29-2590-606-2-lii

• No plan renewal or anniversary date is recorded.

  Several of the decisions this module records are made once per plan year: which affordability safe harbour the contribution is set against, expressed in the regulation against a 9.5 percent threshold for the applicable calendar year, and the preceding-calendar-year measurement the applicable large employer definition uses. Without the date, none of them has a deadline attached.

  documentation cfr-26-54-4980h-5-lii cfr-26-54-4980h-1-lii

• The recorded renewal date falls within the next sixty days.

  The affordability safe harbour basis is expressed for the applicable calendar year, and the full-time measurement the definitions section describes is an average over time rather than a snapshot. Both are easier to settle before a plan year is set than after it has started.

  timing cfr-26-54-4980h-5-lii cfr-26-54-4980h-1-lii

• No plan is offered, and the preceding-year average recorded reaches the applicable large employer threshold.

  The definition describes an applicable large employer as one that employed an average of at least 50 full-time employees, including full-time equivalent employees, on business days during the preceding calendar year. You recorded a figure at or above 50 for the preceding year and no plan offered. Whether section 4980H imposes anything on your business, and what, is a determination under the statute and regulations that is not made here.

  question cfr-26-54-4980h-1-lii

• Employees perform work in more than one state.

  The sections read for this module are federal ones: the definitions of full-time employee and applicable large employer, the affordability safe harbors, and the continuation-coverage notice periods. States impose their own continuation and insurance requirements on top of the federal ones, and none of those was read here.

  question cfr-26-54-4980h-1-lii cfr-26-54-4980h-5-lii cfr-29-2590-606-2-lii