Many of our clients have fully insured small (2-50) group health plans. Eligibility for those plans is contingent on working 30 hours or more/week.
Anne has an employee who has taken on caregiver duties for a very ill family member. In recent weeks, her hours have wavered just above and below the 30 hour threshold. Anne wanted to know how to handle this.
Carefully!
Insurance carriers can do payroll audits. If they find a covered employee whose hours are consistently below full time status, they can disenroll that person, potentially denying claims already paid. While the employer has some flexibility, full time status must be carefully monitored.
Then there’s the issue of bending the rules for one employee but not another. We all know how that can turn out.
Best to cover this topic in an Employee Handbook that clearly states your edibility requirements.
That makes ‘enforcement’ the responsibility of the employee, not you.
