Plan Management

Plan Management



Reviewing Health Insurance Plans 

Once you’ve reviewed your Company & Division Management information, the next step is to review your Medical Plan information via the Plan Management module, which can be accessed from the Home screen: 


 
If you are already in the Company & Division Management module, you can also access the Plan Management module by clicking the Plan Management button in the upper right corner: 


 

      


What is a Plan? 

For the purpose of ACA Reporting, a “PLAN” refers to the employee-only, lowest cost coverage available to a given employee classification. Many companies offer plans with multiple tiers, but IRS reporting requirements are only concerned with the employee-only, lowest-cost option offered to eligible employees. 

If a plan has different contributions and premiums depending on the employee classification (for example, Hourly and Salaried employees receive the same plan, but with different costs; or your lowest-cost options vary by state), you should create a separate plan for each of the lowest-cost eligibility classifications. 

Reviewing  a Plan  

You can review the plan(s) for your organization, by clicking on the parent organization name on the left. Your plan(s) will appear below: 

 

Click the plan you want to review.

Plan Description 

 This tab includes essential information about the plan and its requirements:


 

  1. Plan Name: The name of the plan being reported . For example, “Salary Plan” or “Hourly Plan”. 
  1. Begin Date: The date this plan was first offered 
  1. End Date: The date this plan was last offered during the reported calendar year. 
  1. Meets Minimum Value: (Yes or No) An employer-sponsored plan provides minimum value if it covers at least 60 percent of the total allowed cost of benefits that are expected to be incurred under the plan Click here for additional information on Minimum Value.
  1. Spouse Coverage Offered: (Yes / No or Conditional) Are spouses eligible for coverage under this plan?
  1. “Conditional” is the term used if your spousal coverage is subject to conditions (such as only allowing spouses who are not eligible for coverage elsewhere to enroll). 
  1. Meets Affordability: (Yes or No) The employee-only contribution rate passes one of the affordability safe harbors: -Form W-2 wages, an employee’s rate of pay, or the federal poverty line (FPL), 
  1. Affordability Safe Harbor: The basis  (Rate of Pay, FPL or W-2) used to determine that the employee-only contribution  passes the affordability test.  Click here for more information on Affordability Safe-Harbors. 
  1. Dependent Coverage Offered: (Yes or No) Are dependents eligible for coverage under this plan?
  1. Funding: Is the plan Fully Insured or Self-Insured? 
  1. Level funded plans are reported as Self Insured.
  1. Plan Start Month: The plan’s annual renewal month. 
  1. Coverage Termination Date: Does coverage offered for this plan terminate immediately or at the end of the month of the termination? 

Important Notes about Plan Changes 

ACA Track must have plans that cover  the entirety of the reporting year (January 1 – December 31) therefore:

  1. If any of the plan attributes on the Plan Description tab changed during that calendar year, that requires a new plan to be set-up. 
  1. If all the attributes on the Plan Description tab remained constant for the calendar year, but the plan cost changed (maybe at renewal), a new plan is not necessary. Instead, we will capture  plan cost change on the Plan Cost tab

Plan Mapping

Once you have reviewed your plan details, please review the mapping codes.


  1.  Plan ID(s): This section should include all variations  of the plan ID used in your employee data that refers to this particular plan. It is important that all variations are added; otherwise, your employee data will have data upload errors.  For example, if you have one low cost PPO plan, but the plan ID's are PPO1 and PPO2, both of those plan ID's should be mapped to this plan.
  1. This field is required. Even if you only use one Plan ID in your data and it matches the Plan Name exactly, it still needs to be listed here. 
  1. You cannot map the same Plan ID to more than one plan. 
  1.  Plan Assignment: This section shows which plans are offered to which company/divisions.  Divisions not eligible for this plan are on the left and division eligible for this plan are on the right. Notify your ACA Reporting Specialist if adjustments are needed. 

Plan Cost 

This section will reflect the monthly cost of the plan for employee only coverage, for the designated plan periods.  For the purpose of ACA reporting, you report the lowest-cost employee-only coverage. The cost of buy-up plans is not reported.

 

Group Shape To Image

  1. Start Date: This is the first date this pricing was offered to employees, during this reporting year. 
  1. End Date: This is the last date that this pricing was offered to employees, during this reporting year.  
  1. Monthly Employee Required Contribution: This is the monthly contribution amount for the lowest-cost, employee-only coverage available under this plan. 
  1. Monthly Employee COBRA Rate: This is the cost of COBRA for employee-only coverage minus the 2% administration fee.  
  1. Monthly Opt-Out Credit: This is the monthly dollar amount the employee receives from the employer if they opt out of the company health plan. This amount will be used to determine affordability on Line 15 of the 1095-C.  

**See Opt-out (Waiver) Credits communication for additional details on opt-out 

You must provide Plan Cost data for the entire year: 

  1. If the plan renewed on January 1 and the lowest employee-only coverage pricing did not change during the year, you only need one line of cost data.  
  1. If your plan renews at another date with a different price (or the price of the lowest employee-only coverage changed for any other reason during the year), you need to add additional lines to ensure the entire year is covered: 


 






Review start and end dates for accuracy; the system will reject any overlapping dates. 

Calculating Monthly Employee Required Contribution

When calculating your Monthly Employee Required Contribution, use the lowest-cost, employee-only plan. Remember that this is a MONTHLY contribution amount, not the amount contributed for each pay period. Use one of these methods to determine the Monthly Employee Required Contribution: 
  1. Method 1: If you know the ANNUAL Employee Required Contribution, divide this amount by 12. 
  1. Method 2: Multiply the Employee Required Contribution for each pay period by the number of pay periods each year, and then divide that number by 12. For example, if employees are paid weekly, multiply their weekly contribution by 52 and divide that by 12. 

Calculating Monthly Employee COBRA Rate 

When calculating your plan's Monthly Employee COBRA Rate, use the lowest-cost, employee-only plan and deduct the administrative fees (only if included, typically 2%). 

Employee-Based Premiums (Cost Varies) 

Alert
**This section only applies if your company uses variable contribution rates. 

For some health insurance plans, the lowest cost employee-only contribution will vary. Some employers have age-banded or location-based (zip code) contributions and premiums.
If the contribution varies by specific employee classification (such as salary vs hourly), there should be a unique plan created for each subgroup. 
 
However, if the contribution varies at the individual employee level (including differing costs based on age or location), there should be a single plan created and the “Cost Varies by Employee” option selected on the Plan Cost tab. When you do this, rather than entering a set price for the plan, you will provide the individual lowest cost single-only contribution and premium rates on the Employee Datasheet template.

To use employee-based premiums, the “Cost Varies by Employee” box should be checked and the “Monthly Employee Required Contribution” and “Monthly Employee COBRA Rate” fields should be blank for any plan cost entries listed on this tab: 



Completing Plan Entry 

If you have any questions after reviewing your Company Plan information, please do not hesitate to reach out to your ACA Track Reporting Specialist.

 




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