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Part 3: Health Insurance Set-Up

Part 3: Health Insurance Set-Up

The health insurance collection section will configure standard measurement, initial measurement,
spouse and dependent information, and employee contribution information.

Health Plan Renewal Date

The health plan renewal date, pictured below, is usually the same day that your health plan would
renew.

  • The date is entered in a month/day format, or the date may be found on the calendar drop-down.

Open Enrollment Information

The Affordable Care Act allows employers to have up to a 3 months to enroll employees once they
become eligible for coverage.

On the open enrollment page you will choose how many months your company allows before
becoming eligible for coverage by inputting the number of months or scrolling up or down, shown
below.

Type of Insurance

A fully-insured health plan is the more traditional way to structure an employer-sponsored health plan.
With a fully-insured health plan: The company pays a premium to the insurance carrier. The premium
rates are fixed for a year, based on the number of employees enrolled in the plan each month. With a
self-insured (self-funded) health plan, employers (usually larger) operate their own health plan as
opposed to purchasing a fully-insured plan from an insurance carrier.

Safe Harbors

In order to determine whether affordable coverage is offered to employees, the IRS provides three
“safe harbor” methods that can be used to estimate an employee’s income using information that
employers have. If an employer can satisfy the affordability test using any of these three safe harbor
methods, the offer of coverage will be considered affordable under the employer mandate.

If you are unsure of which safe harbor to use, choose “Unsure” from the drop down menu. The
system will automatically choose which safe harbor makes the most sense for your
organization based on your answers to various questions.

Benefit Codes

Many payroll systems will use codes to identify specific benefits provided to employees. The code
entered should match the code used for payroll transactions for the least cost health insurance benefit
provided to employees for self-only (no dependents) coverage. If you do not have a separate code used
exclusively for employee self-only coverage, enter the code used for employee self-only coverage. For
example, some employers will have a HEALTH code that is used irrespective of the type of coverage
selected by the employee.

If you are using a code which is currently being used for your organization, make sure they are
identical.

Benefit Description

Enter an easy-to-read description for your least cost plan health insurance benefit code.

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