Hour Eligibility Report

Running the Hour Eligibility Report

Reporte de Elegibilidad

The Hour Eligibility Report should be run at the end of each measurement period to determine the full-time or part-time status of your employees.  Employees that are determined to be full-time are eligible for an offer of coverage. 

For employers using a monthly measurement period, you must run the report on a monthly basis for the prior months’ payroll.

This report can be used for employers using a look-back measurement period. However, we recommend using the ACA Lookback Eligibility Report instead.  That report is better geared towards the look-back method.

Go to ACA > Hour Eligibility Report.

To qualify for insurance coverage, normally employees must have 130 hours of service in a calendar month (or average 30 hours per week when using the pay period option).  These are the limits specific in the Affordable Care Act and will be the default hour limits used by this report. 

In the past, some employers have offered coverage to employees based on a lower hour requirement.  If you want to offer coverage to employees that worked fewer than 130 hours in the calendar month (or 30 hours/week), go to the Tools > HR Setup option and you can adjust the hour requirement. 

Ending Date

Enter the ending date of the measurement period that you want to run the report for.

Eligibility Date

The Eligibility Date will be determined automatically by the program.

Category

If you have different ACA categories defined, you can select a category to print with this entry and only employees assigned to this category will be included on the report.

For example, if you have employees working in multiple states and a separate category is defined for each state, you can use this selection to print the employees for one state at a time.

Update Hours/Status

Select this box to update the hours of service on the measurement period records, update the employees’ status as full or part-time, and create a new measurement record for the following month for that employee. These updates can be found in the Employee’s File under the ACA tab.

Create/Update Benefit Records

Select this box to create an insurance eligibility record for each employee that has newly qualified for coverage or extend the enrollment date on existing enrollment records for employees that are already covered.

Print Employees With Zero Hours

Normally the report does not include employees that haven’t worked during the month.  Select this box if you want to include any employees that have a measurement record for the month that you are printing but who may not have worked.

In some cases, an employee may have worked in the prior month but not in the month that the report is being printed for.  In this situation, the employee would have had a measurement record created by the report run for the prior month, but no hours in the current month.

Require Pre-Enrollment Record for Newly Eligible Employees

The default behavior of the report is to enroll any eligible full-time employees in coverage unless the employee has an active decline record entered on the Health Benefits tab page on the employee setup window.  Selecting this box will change that behavior.

When this box is selected, employees will not get enrolled in coverage unless you have set up a pre-enrollment record on their account with their plan and coverage selections.  This gives you a way of overriding the default automatic enrollment behavior of the report.

Include Hours From Unprinted Checks in Batch

Select this box if the current batch of checks waiting to be printed includes hours from the month that you are printing the report for and you need to determine eligibility before printing those checks.

Check for missing categories/monthly measurement records

Normally you should leave this box selected.  When selected, the program will make a list of all employees that worked during the calendar month.  It will make sure that each employee is assigned to a category.  Any employees not assigned to a category will be assigned to the default category. 

It will also make sure that every employee has a measurement record for the month that you are printing the report for.  Normally a measurement record will have already been created if the employee worked in the prior month and you printed the Hour Eligibility Report for the prior month with the Update Hours/Status box selected.  New employees normally have a measurement record created when their account is first set up.

To make sure that no employees slip through the cracks, this box should be selected.

Print part time employees that declined in separate section

Select this option to separate the part-time employees who have a decline record from the part-time employees that are not eligible. If you do not select this option, all part time employees will show in the Part Time, Not Eligible section of the report.

Export Employees Due Offer

This option will export to Excel only the offers that are due.

Export Report

The whole report will be exported to excel.

Sections on the ACA Hour Eligibility Report

The ACA Hour Eligibility Report groups employees into different sections, depending on their status.  It is important to understand what each section indicates and how to interpret the information presented for each employee.

Every section does not necessarily appear on every report.  For example, if you haven’t hired any new employees recently, you might not have any employees that are newly eligible for coverage.

Terminated, Not Eligible

These are employees that may have hours worked in the current measurement period but who also have a date terminated indicating that they are no longer working.

Part Time Employees, Not Eligible

Part-time employees (generally under 130 hours) are not eligible for coverage.

Part Time Employees, Declined Coverage

Part-time employees that have an active decline record will print in this section.  These employees are not enrolled in coverage.

Full Time Employees, Declined Coverage

Full-time employees that have an active decline record will print in this section.  These employees are not enrolled in coverage.

Full Time Employees, Decline Expired

Full time employees that have an active decline record with a decline date over a year old will print in this section.

Full-time employees that have not had an offer of coverage made within the last year should receive at least one offer of coverage each plan year.  If you have an open enrollment period each year, make sure to offer coverage to all full-time employees at that time. 

Due to the seasonal nature of agricultural employment, it is possible that an employee might not be working during an open enrollment period. Or they may be working but they only have part time status because they are working fewer hours at that time of the year.  In addition, if the employee has any gaps in service, he might return to work within the 13-week time period that is allowed for employers to treat a returning employee as a new employee.  This means that an employee might not automatically receive an offer of coverage for the first month that he has full time hours because he is treated as a continuing employee.

Full Time Employees, Haven’t Met Qualifying Hours

If you have a qualifying number of hours that must be worked before employees are eligible to be enrolled in your medical plan, any employees that have full time status but haven’t reached the qualifying hour threshold will appear in this section.

Review this section to see if employees that haven’t met the required number of hours have been working for more than three months.  If they have, you may need to offer them coverage.  Otherwise, you may not be able to report a safe harbor code on the 1095-C for one or more months.

Full Time Employees, Missing Pre-Enrollment Record

This section will list any employees that do not have a pre-enrollment record when you have checked the Require Pre-Enrollment Record for Newly Eligible Employees box.  Review your records for these employees to make sure that all of the employees have received an offer of coverage. 

Employees may appear in this section if they have not returned their paperwork, or if you have not entered a pre-enrollment record on their file.

Second Month Eligibility

If your medical plan is setup to require two full time months for employees to be eligible for coverage, this report will list full time employees that have completed only the first month of full time work and employees that have completed their second month of full time work.

Returning Employees, Previously Enrolled

This section will list employees that have a gap in employment of less than 91 days (13 weeks), were previously a full-time employee and enrolled in coverage, and who should be enrolled in coverage starting the first of the following month.

Keep in mind that continuing employees may not have full time hours in the month in which they return to work, but they may still need to be enrolled in coverage as of the first of the following month to comply with ACA regulations.  (See 54-4980H-3 (c)(4)(iv) Treatment of continuing employee.)

Full Time Employees, Newly Eligible

Employees who have not been enrolled in coverage yet and have full time hours will appear in this section.

If you have a waiting period defined on your medical plan, the Description/Plan column may have a date next to the plan description.  This is the employee’s starting enrollment date based on the waiting period. If two dates appear next to the plan description, this could indicate that the employee already has an enrollment record (the first date) that is not the same as the starting date based on the waiting period.

If no date appears next to the plan name, then the employee will be enrolled in coverage as of the eligibility date.

(The waiting period on your medical plan may be determined either based on a set number of months since the employee was hired, or as a number of months after the full-time hours are first recorded.  This information is entered on the Eligibility tab page of the medical plan setup window.)

Full Time Employees, Previously Enrolled, Eligible Again

When employees may have their status changed to part-time for one or more months, their coverage may be dropped.  When they have full-time status once again, the coverage may be re-instated.  Those employees will print in this section.

Employees will appear in this report if: (1) they were previously enrolled in coverage; (2) they did not have a break in service of more than 91 days and/or had one or more months where hours worked qualified them for part time status; (3) they are full-time for the current month will appear in this section.

Part Time Employees, Continued Enrollment

If you have selected the Keep Enrolled When Part Time box on the benefit record, and a full-time employee is enrolled in coverage and their hours drop to part-time status, the employees’ coverage will be continued.  Employees in that situation will print in this section.

Full Time Employees, Continuing Enrollment

Employees that have full-time status and were enrolled in the previous month will appear in this section.  The ending date for these employees’ benefit records will be extended another month.

Other Employees

Employees whose status cannot be established by the program will print in this section.  If you have employees in this section, review their hours and coverage/benefit information.  Contact Datatech Support if you need assistance figuring out what to do with these employees.