Question about insurance premium deduction after employee no longer qualifies. State is North Carolina.

[carolineb]

Our company, A. Company, provides a health insurance option for employees that regularly work 32 hours per week. During the past 18 months, there was a buyout and merger of several companies with the same health insurance option, making all employees of the various companies employees of the A. company.

An employee of Company E. and an employee of Company P. chose not to continue as regular 32 hour per week employees but to work only as needed (2 shifts per month required minimum), which, according to policy, indicates they no longer qualify for insurance benefits.

A. Company is still deducting and billing these employees for health insurance. A. Company states they cannot release the employee from such billing unless the employee can prove he, she has other qualifying health insurance or resigns from A. Company.

Is this legally correct practice?

 

[Zigner]

1: What US state?
2: Who are you in this matter?

 

[quincy]

North Carolina. In the title.

 

[carolineb]

1: What US state?
2: Who are you in this matter?

I am one of the Clinical Supervisors and Educators. This matter has been referred up the hierarchy to the VP of Operations (by one of the employees and by our location's Executive Director). The employees are quite upset; and, quite frankly, I am distressed at the prospect of losing two excellent nurses.

 

[Zigner]

North Carolina. In the title.

Yep - sneaks by us all from time to time

 

[PayrollHRGuy]

What is the logic Company A is saying they must have that information? The employees no longer qualify for the coverage.

 

[carolineb]

two, not to.

What is the logic Company A is saying they must have that information? The employees no longer qualify for the coverage.

Their logic is that the employee can not cease coverage except during the annual benefit offering period.

 

[cbg]

They are correct. The employees would need to provide proof of other coverage in order to drop coverage outside of the annual Open Enrollment period.

Since the ACA, it's quite possible that they still qualify by law.

 

[carolineb]

They are correct. The employees would need to provide proof of other coverage in order to drop coverage outside of the annual Open Enrollment period.

Since the ACA, it's quite possible that they still qualify by law.

Even if they no longer qualify for insurance with any employer and the individual mandate has ended?

 

[carolineb]

They are correct. The employees would need to provide proof of other coverage in order to drop coverage outside of the annual Open Enrollment period.

Since the ACA, it's quite possible that they still qualify by law.

I think I understand it, now. If I understood what I read in the ACA, 120 days a year is qualifying. These employees may only work 48 days in a year BUT at the time of open enrollment, each of them worked 120 days a year or more. I'm thinking it's like if you earn $100,000 a year and buy a top of the line Lexus with payments of $600 a month, you still owe $600 a month for the length of the contract. Decreasing your earnings does not relieve you of the contract or the payment amount.

 

[cbg]

It's slightly more complex than that but yes, that's essentially it. It's not, do they qualify today, but, Did they qualify at the time the employer was tallying for OE purposes. I don't do the tallying myself (although I do work in Employer Benefits) so I've forgotten if the time that's done is the same for everyone or if it varies depending on when OE is, but I work for a university. My department only offers benefits to employees; there's another department altogether that manages student insurance. Our plans exclude students, but we've had to offer insurance to a handful of students who might be on work study or an internship and work enough hours in the relevant time to qualify under the ACA.

 

[carolineb]

It's slightly more complex than that but yes, that's essentially it. It's not, do they qualify today, but, Did they qualify at the time the employer was tallying for OE purposes. I don't do the tallying myself (although I do work in Employer Benefits) so I've forgotten if the time that's done is the same for everyone or if it varies depending on when OE is, but I work for a university. My department only offers benefits to employees; there's another department altogether that manages student insurance. Our plans exclude students, but we've had to offer insurance to a handful of students who might be on work study or an internship and work enough hours in the relevant time to qualify under the ACA.

Thank you for your time and input.