Patient Protection and
Affordable Care Act
(PPACA)
Information for UND Departments and Employees
Presented By:
Pat Hanson, Director, Human Resources
November 2014
Topics to be Covered
Affordable Care Act (ACA) Overview
 ACA Definitions
 Cost/Penalties
 ACA Timeline
 Calculation of Eligibility
 Next Steps
 Going Forward
 Questions

Affordable Care Act Provisions
Guaranteed Issue/Individual Mandate
 Benefit and Cost Sharing Standards
 Public Exchange Availability
 Consumer Subsidies based on income
 Employer “Mandate” (Shared
Responsibility)

Guaranteed Issue

The law requires insurance companies to
provide what is called "guaranteed-issue"
coverage, meaning that insurers can not
deny coverage based on past illnesses or
current health conditions.
Individual Mandate

Beginning January 1, 2014, the Affordable Care Act (ACA)
requires individuals, who are not exempt, to either maintain
minimum essential health insurance coverage for themselves
and any nonexempt family members or be assessed a tax
penalty:
◦ 2014 – $95 per uninsured person or 1 percent of household
income over the filing threshold (whichever is greater)
◦ 2015 – $325 per uninsured person or 2 percent of household
income over the filing threshold (whichever is greater)
◦ 2016 – and beyond, $695 per uninsured person or 2.5 percent
of household income over the filing threshold (whichever is
greater)
◦ 2017 – going forward, the penalties will be increased by the
cost-of-living adjustment
Benefit and Cost Sharing Standards
Standardized essential health benefits
must be provided by all plans (exception
for grandfathered health plans-NDPERS)
 Standardized cost sharing of health
benefit costs between insured and the
insurance company

◦ Services must be covered at specific cost
sharing rates – Certain preventive care
services must be covered in full
Public Exchange Availability
The Affordable Care Act (ACA) introduces a
new option for small business employers and
individuals to access health insurance, Health
Insurance Marketplaces, also called
Exchanges.
 The next open enrollment period for plans
offered through the Individual Marketplaces
starts Nov. 15, 2014, and ends Feb. 15, 2015.
 To qualify for subsidies, the individual may
not be eligible for affordable health care
through their employer

Employer “Mandate”
(Shared Responsibility)

All employers with 50 or more full-time
equivalent (FTE) employees must provide
adequate, affordable health insurance to
substantially all FTE employees or pay a
penalty per full-time employee per year.
Coverage must be offered to the
employee and dependents (Not spouse).
State of North Dakota –
One Employer For ACA Purposes
Determination has been made that State
Agencies and NDUS are ONE employer
for calculation of hours worked and
penalties
 When calculating which employees have
worked an average of 30 hours or more
per week, employment at all State
Agencies and NDUS institutions must be
included.

Definition of FTE Employee
Full-Time Employee – Benefited (working in a
regularly funded position, 20 hours or more per
week and at least 20 weeks per year)
 Variable Hour Employee* – Non-benefited
employee anticipated to average 30 or more
hours per week (130+ hours per month/1560+
hours per year) upon hire or during the
measurement period
 Seasonal Employee* – Employed during same
season each year, that is more than six months in
duration and works more than 1560 hours per
year
*Includes non-work-study student employees

Current Cost of Health Insurance
Coverage Per Temporary FTE


Employee: $1,108.00 per year ($46.19/pp)
Employer: $4,564.88 per year (~$190/pp)
Cost is for a single premium only. Employee may
purchase dependent coverage at their own expense
(Does not cover spouse) – Add’l Cost - $6,107.28.
 Policy is the same NDPERS policy offered to
benefited employees.
 If employee qualifies for coverage during the
measurement period, they will remain eligible for the
next plan year, as long as they remain employed,
regardless of the number of hours worked.

Potential Employer Penalties

Must offer coverage to 70% of FTE
employees in 2015 and 95% in 2016

Not offering coverage to 70/95% eligible
employees AND at least one eligible
employee receives a tax credit/subsidy
◦ $2,000.00 per FTE employee

Offers coverage to 70/95% eligible
employees AND at least one eligible
employee receives a tax credit/subsidy
◦ $3,000.00 per FTE employee who qualified for a
subsidy
Initial ACA Timeline for NDUS

Measurement Period: 11/1/2013-10/30/14
◦ Hours of non-benefited employees (including
non-workstudy students) will be tracked to
determine if they will be offered ACA Health
insurance effective January 1, 2015
Administrative/Open Enrollment Period:
11/1/2014-12/31/2014
 Plan Year (Stability Period):
1/1/2015 – 12/31/2015

Measurement Period

November 1 – October 31

Eligible employees must have worked an average of 30+
hours per week/130+ per month/1560+ per year)
All hours worked by a current temporary
employee will be counted-even hours worked as
a benefited employee
 Hours worked prior to a six month break (or a
break that exceeds previous time worked) will
not be included in annual total
 Weeks during breaks of 4 weeks to 6 months will
not be included in the calculation of average
hours worked

Calculating Hours Worked

Non-benefited Instructors
◦ Hours worked per week will be calculated using 2.67
hours per each hour of teaching or classroom time
(includes class preparation time, classroom time, grading
papers and additional required meeting & office hours)
◦ Contracts should include all classes taught and hours
worked
◦ Hours worked per week will be calculated on a semester
or contract basis. FTE/Standard Hours will be updated in
HRMS to match the results of that calculation
◦ All Additional Pays MUST have hours worked filled in, if it
is payment for additional hours worked
◦ Look Back Period: Additional Pays without hours listed,
will need to have hours calculated.
Calculating Hours (cont’d)

Non-benefitted Coaches
◦ Part-time coaches for recognized sports will be
automatically eligible for ACA coverage
◦ Other part-time coaches may be eligible
depending on average number of hours worked.

Graduate Students
◦ Restricted to working a maximum of 20 hours
per week-Ineligible for ACA
◦ Supervisors must be reminded of this restriction
◦ Offered Graduate Health Insurance
Calculating Hours (cont’d)

Resident Assistants
◦ ACA eligibility dependent on actual number
of hours worked

Student Employees (Non-Workstudy)
◦ ACA eligibility dependent on actual number
of hours worked

Workstudy Employees
◦ Not eligible for ACA
Next Steps





Human Resources is currently calculating hours
worked by non-benefitted employees during look
back period.
Employees eligible for ACA Health Insurance will be
notified in writing and offered health insurance
Eligible employees must waive or accept coverage in
writing by December 5, 2014
Effective December 15, 2014, ACA eligible employees
will pay their semi-monthly premium through payroll
deduction and employer share will be paid through
employer deduction-charged to salary funding source
ACA coverage will remain in effect for 12 months, as
long as they are still employed.
Going Forward
Always include hours on Additional pays
Be aware of number of hours worked by
temporary employees – any employees hired to
work more than an average of 30 hours per week
will be eligible for ACA coverage upon
employment
 Be aware of current employment by applicants when hiring, ask if they have been, or are
currently working, for another State Agency or
NDUS institution
 Last department hiring will be charged ER share
 Departments CANNOT encourage/ask ACA
eligible employees to waive coverage


Annual Offer of Coverage
Look back period for 2016 started
November 1, 2014
 Determination of ACA eligibility for all
variable hour temporary employees will
occur upon hire, 12 months after hire and
then at the end of each Measurement
period
 Offers/Waivers must be completed on an
annual basis

Questions?