In SummaryThe Question is: How Do You Classify a Returning Employee?

The ACA rules for calculating Full Time status make it difficult for staffing companies to determine how to treat employees that are off or in-between assignments.

If an employee is considered full time when they go off-assignment, do you consider them full time when they return or subject them to another “look-back” (initial measurement period) or new waiting period?

The Answer is: It Depends.

Break in Service Rules:If the break in service is longer than 13 weeks, the employee can be subjected to either new waiting or measurement periods BUT they can also be applied IF the break is longer than 4 weeks (not exceeding 13 weeks) AND the break in service was longer than the period of employment (this is known as the “Rule of Parity”).

For Example:John works for you on-assignment for 5 weeks. If John has no new assignments until you rehire him 8 weeks later, he can be treated as a new hire and subjected to a new measurement period or waiting period for benefits.

Is there ahire date or1st paycheck

date onfile?

Enrollmentform has been

received byPAI & entered

into EnrollmentSystem

Y

YN

N

Enrollment record is

complete; enrollee added

to claims processing

system and ID cards are

mailed out

Enrollee is reported toclient on SF

weekly report. ACA coverage begins on 1st of

the month following the receipt of thefirst premium

Has the employee stopped working?

Has the employee returned within 13 weeks?

Coverage is terminated in

the enrollment system

Employer / Client reports return date to PAI’s MSR to

request reinstatement of ACA coverage

Enrollment form is held

in the enrollment

system awaiting the 1st paycheck date

Is 1st

paycheckreceviedwithin 6months?

The form expires (a new enrollment form must be

submitted once the employee starts working)

Coverage remains terminated

Y Y Y

N

Is there ahire date or1st paycheck

date onfile?

Enrollment form has been received by PAIand entered into Enrollment System

Y

YN

N

Enrollment record is

complete; enrollee added

to claims processing

system and ID cards are

mailed out

Enrollee is reported toclient on SF

weekly report. ACA coverage begins on 1st of

the month following the receipt of thefirst premium

Has the employee stopped working?

Has the employee returned within 13 weeks?

Coverage is terminated in

the enrollment system

Employer / Client reports return date to PAI’s MSR to

request reinstatement of ACA coverage

Enrollment form is held

in the enrollment

system awaiting the 1st paycheck date

Is 1st

paycheckreceviedwithin 6months?

The form expires (a new enrollment form must be

submitted once the employee starts working)

Coverage remains terminated

Y Y

Y

N

UNDERSTANDING THE 13-WEEK BREAK-IN-SERVICE RULE

The simplest way to understand the Break

in Service rule is: if an eligible full time

employee has a break in service, they are

returning to work within 13 weeks, and they

meet the Rule of Parity, they should be

treated as eligible again immediately upon

their return to an assignment. Coverage

can be reinstated with a simple notification

to PAI whose process will automatically

terminate coverage on employees with a

break in service longer than 13 weeks. If the

employee returns to work before that period

and wishes to re enroll, notify PAI and they

will reinstate the employee’s coverage.

THE ACA ENROLLMENT PROCESS