Q: Do I need to enter dependents for employees in HR?
A: Dependent information is only needed if you have a self-funded insurance plan and an employee opts for spouse or dependent coverage. It is not necessary to enter dependents if you have a fully insured plan.
If you are enrolling employees in coverage by submitting a file to the insurance company, then dependent information must be entered so it can be included in the electronic enrollment file generated by the program. When you create the enrollment file, if you have selected spouse and/or dependent coverage on the benefit record but no dependents have been set up on the employee’s account, it will generate a message on the Exception Report. That problem should be corrected before submitting the enrollment file.
If paper forms are submitted to the insurance company to enroll employees, then you do not necessarily need to enter the dependents in the HR program immediately. At the end of the year, however, the system will include the dependent information on Part III of the 1095-C form. Dependents must be entered on employee accounts for this to happen.
If your insurance company provides a file after the end of the year listing which employees and their dependents that were enrolled in coverage, then this information can be imported into the system to complete the Part III information. If an import option does not exist for your insurance company’s coverage file format, contact Datatech to see if we can add support to import these files.
Dental Plan Option
Q: We have a dental plan that is offered as an option with our medical plan. What is the best way to set this up?
A: Create two different medical plans, one for employees that choose to have the dental plan option and one for employees that opt out. Each plan can have it’s own deduction amounts and costs set up.
Q: We enrolled an employee in coverage for January 2015 based on their hours in December 2014. But the employee didn’t end up working at all in 2015, and no 1095-C was generated. Why wasn’t a 1095-C created for this employee?
A: If the employee didn’t work at all in 2015, then no 1095-C is necessary. Only employees that are full time in one or more months will receive a 1095-C. The 1095-C is not required.
1095-C Look-Back Period Question
Q: We use a 12 month look-back period and have an employee that completed their measurement period in November 2015. The employee has full time hours during the look-back period, but the program is not printing a 1095-C for the employee.
A: This is correct, because the employee is in a Limited Non-Assessment Period for the entire calendar year. (See the definition for Full-time employee in the 1095-C instructions.) During the months of January to November, the employee is in the initial measurement period. During the month of December, the employee is in the admin period. You can place the mouse pointer over each line 16 for the year and see that the 2D code was eligible to be reported for each of these months.
The employee’s status as a full time employee applies during the stability period associated with the measurement period. In this case, the stability period is from 1/1/16 to 12/31/16. That means that if the employee continues working in 2016, the employee will receive a 1095-C for 2016 due to that full time status.
ALE Group Member Status
Q: We have an employee that was employed and had insurance in one company from 1/1/15-10/31/15. He came back in another company and insurance coverage started 12/1/15. What would be the correct ALE Member Status in each company?
A: The ALE Member Status setting on the ACA tab of the employee setup is designed to make sure that the program knows two things: 1) that an employee is employed by other members of the ALE Group and 2) which company the employee’s hours should be reported under for insurance enrollment purposes. This setting is used by the ACA Hour Eligibility Report to determine whether or not to include an employee on the report, and whether it needs to check for hours worked in other ALE members if the employee is included on the report.
In this example, the employee worked for one company and was enrolled in coverage through that company. When the employee starts working for another company in the ALE group, no changes should be made to the ALE Member Status in either company, provided that:
1) In the first company that the employee worked for, the ALE Member Status should be set to “Employed by another ALE member”. This tells the HR program that for purposes of the ACA Hour Eligibility Report, the employee should be reported on that company’s report.
2) In the second company that the employee starts working for, the ALE Member Status should be set to “Do not report under this ALE member”. This tells the program that the employee should not be included on the ACA Eligibility Report that is run for the second company.
If you have both companies set to “Employed by another ALE member”, then the employee will be included on the ACA Hour Report when it printed for each company.
If you have both companies set to “Do not report under this ALE member” then the employee will not be included on the ACA Hour Report when it is printed for either company. (And consequently, you risk the employee not being enrolled in coverage whent they should be.)
To summarize: the “correct” setting is to always make sure that the ACA Member Status is set to “Employed by another ALE member” in only one company in the ALE group, and “Do not report under this ALE member” in all other companies in the ALE group.
We are planning a new report to audit the ALE Member Status setting across all companies in the ALE Group to assist you in making sure this is the case for all employees that are employed by multiple companies.