4250-R Determining Employee Qualification for Health Insurance Coverage

  • DEFINITIONS:

    Ongoing Employee: An employee who has been employed by the employer for at least one full standard measurement period.

    New Employees: An employee who has been employed by the employer for less than one complete standard measurement period. Also, a variable hour employee who is considered "newly hired" because the employee failed to be employed for at least of one hour of service for more than 26 consecutive weeks (excluding special leave and employment breaks of up to 501 hours).

    CAMPBELL COUNTY SCHOOL DISTRICT EMPLOYEE CLASSIFICATION FOR ONGOING AND NEW EMPLOYEES:

    1. Permanent Full Time – Employees who work 30 or more hours per week during their work year. The scheduled work year must be more than 120 days in length.

    o New employees reasonably expected to work full-time will be offered coverage on the first date of the month following employment.

    2. Permanent Part Time – Employee averaging less than 30 hours per week during their work year. The scheduled work year must be more than 120 days in length.

    3.  Seasonal/ Temporary –The term seasonal employee means an employee who is hired into a position for which the customary annual employment is six months or less.

    o Not all employees working less than 6 months may be included in the seasonal employee category, as employment must also customarily occur at the same time each year.

    o May include coaches, who are not otherwise employees of the district, and temporary groundskeepers.

    o Can never include substitute workers.

    4. Variable – Based on the facts and circumstances at the employee’s start date, the district cannot determine that the employee is reasonably expected to work, on average, at least 30 hours per week. This category may also include a new employee expected to work initially at least 30 hours per week and is reasonably expected to work 30 hours per week for a period of "limited duration". Because of the anticipated "limited duration" of the 30-hour work week, it cannot be determined that the employee is reasonably expected to work, on average, 30 hours per week over the initial measurement period.

    o Includes substitute teachers, substitute nurses, substitute bus drivers and other substitute workers.

    MEASUREMENT PERIODS:

    Ongoing Employees - The periods defined below pertain to Ongoing Variable Employees:

    Standard Measurement Period:

    November 1 through October 31 of each year (12 calendar months).

    This is a period to examine whether an employee averaged 130 hours per month (30 hours per week) or 1,560 hours per year to qualify them for insurance coverage.

    Standard Administrative Period:

    November and December of each year (2 calendar months).

    This period is used to compile reports to verify employee eligibility from the measurement period and offer eligible employees coverage.

    Standard Stability Period:

    January 1 through December of each year (12 calendar months).

    If an employee is determined to work at least 30 hours per week during the Measurement Period, they qualify for insurance for the entire subsequent Stability Period (provided the employee remains employed regardless of the average number of hours of service the employee works)

    Newly Hired Variable Hour Employees - The periods defined below pertain to New Employees:

    Initial Measurement Period:

    Beginning on the first day of the calendar month immediately following the employee’s start date through the last day of the calendar month following the employee’s one-year employment anniversary.

    This is a period to examine whether an employee averaged 130 hours per month (30 hours per week) to qualify them for insurance coverage.

    The initial measurement period for new variable hour employees is 12 calendar months.

    Initial Administrative Period:

    One month period beginning the first day after the New Variable Employee’s measurement period.

    This period is used to compile reports to verify employee eligibility from the measurement period.

    Initial Stability Period:

    Twelve month period beginning the first day of the calendar month following the administrative period.

    If an employee is determined to work at least 30 hours per week during the Measurement Period, they qualify for insurance for the entire Stability Period.

    If determined full-time (average of 30 hours of service during the measurement period), employee must be offered coverage with sufficient time for employee to elect coverage effective the first day of the calendar month following the administrative period. The stability period must equal 12 calendar months.

    Employee’s hours of service are measured again at the end of the ongoing measurement period. Coverage is offered (or extended) as applicable.

    Special Unpaid Leave and Employment Break Periods

    When applying the look-back measurement method to an ongoing employee, an educational organization employer determines the employee's average hours of service for a measurement period by:

    •  Computing the average hours of service after excluding any special unpaid leave and any employment break period during that measurement period, and
    •  By using that average as the average for the entire measurement period.

    Alternatively, for purposes of determining the employee's average hours of service for the measurement period, the employer may choose to treat the employee as credited with hours of service for any periods of special unpaid leave and any employment break period1 during that measurement period at a rate equal to the average weekly rate at which the employee was credited with hours of service during the weeks in the measurement period that are not part of a period of special unpaid leave or an employment break period.

    No more than 501 hours of service during employment break periods in a calendar year are required to be excluded (under the first method) or credited (under the alternative method) by an educational organization, provided that this 501-hour limit does not apply to hours of service required to be excluded or credited in respect of special unpaid leave.

    ADOPTION DATE:  October 14, 2014

    LEGAL REFERENCE(S):

    CROSS REFERENCE(S): 4250

    ADMINISTRATIVE REGULATION: