FAQ's

What is a qualifying event?

A qualifying event is an event that allows an employee to enroll in your group health plan or make changes to it outside of the annual open enrollment period. Examples of this would be the birth or adoption of a child, marriage, death, loss of coverage due to divorce, spouse's loss of coverage, increasing hours from part-time to full–time, etc.

Can an employee decide to enroll after open enrollment has ended?

An employee should not be allowed to enroll in your group health plan at any time other than your annual open enrollment unless it's a qualifying event.

Can I allow a new hire to enroll into our health plan even though he won't actually be eligible for another 60 days?

You should not allow employees to enroll outside of the open enrollment period other than for a qualifying event. If you make one exception you have now set precedence and therefore must allow all new hires, etc. to enroll at the same time.

Can our part–timers enroll into our group health plan, but pay 100% of the coverage?

Part–timers are not eligible for your group health plan. They may seek coverage through the Mass Health Connector if they are not eligible for coverage elsewhere.

Are pre–existing health conditions covered from day one of health care coverage?

Massachusetts is a Guarantee Issue state. Pre–existing health conditions are therefore covered from day one of enrollment.

Can an employee cover step–children on the group health plan?

If the step–children are dependents and the employee wishes to enroll them into his/her family coverage they may do so.

Can an employee cover their boyfriend/girlfriend on our group health plan if they are living together?

The carriers will allow for domestic partner coverage, but the employer decides whether to allow for this or not. Once offered to an employee the employer has set precedence and must therefore offer this coverage to all employees in this situation.

Do I have to offer health coverage to an employee's domestic partner?

Under Massachusetts law you are not required to offer domestic partner/common–law coverage or to the children of the significant other if they are not the employees legal dependants.

What is the minimum amount an employer can contribute towards an employees group health care costs?

The carriers will require 50% employer contributions towards the group health care plan. The Mass Health Care Reform requirements are 33%.

What is a Full-Time Equivalent (FTE)?

A FTE is not the same as a full–time employee. A FTE is equal to 2000 payroll hours per year. For example if you have 5 part–time staff members each working 8 hours per week they will add up to 1 FTE (or 40 hours). You do not have to offer them health benefits, but their hours will count towards your Employer Mandate Requirements.

What if my employees won't enroll into our health plan, but I know they don't have coverage elsewhere?

Any employee not enrolling in your health benefits should sign a HIRD (Health Insurance Responsibility Disclosure) form. This form must be kept on file by the employer for 3 years. This is an affidavit signed by the employee attesting to the fact that you the employer have offered them insurance, offered pre-tax deductions, offered to contribute towards their premium, but they do not wish to enroll.

I have 50 employees. Do I have to meet both parts of the Fair Share Test?

No. Your requirements are to meet 25% participation OR 33% contributions.

We have over 50 employees, but we don't have 25% participation. What does that mean for us?

The new 2009 regulations require employers to meet both parts of the Fair Share Test. If you do not have 25% participation you will be assessed $295. This fine will be assessed to you when you file your DUA filing online quarterly starting in Jan. 2009. Assessments are also due quarterly starting in '09.