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Date: September 16, 2016

Bulletin Number: 1506

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Subject Updating Employee Health Insurance Eligibility in PayServ

Purpose To provide agencies with procedures for updating employee health insurance eligibility records in the payroll system.

Affected Employees

All employees.
Effective Date(s)

September 14, 2016.
Background As stated in Payroll Bulletin #1492 New Employer Federal Reporting Guidelines for the Affordable Care Act and NYS New Hire Reporting, the Office of the State Comptroller (OSC) must capture and report if an employee is eligible for health insurance coverage and the date the employee is eligible for that coverage.

On September 14, 2016, OSC will initially populate the “Eligible for Health Insurance” and “Date Eligible for Health Insurance” fields with information provided by the Department of Civil Service.

Two groups of employees will be populated as “Yes” for the “Eligible for Health Insurance” field:

  • All employees currently enrolled in the New York State Health Insurance Program (NYSHIP) or the Opt-out Program; and
  • Employees not enrolled in NYSHIP who are paid on the ANN, CAL, CYF, or 21P payroll basis and whose FTE percentage is 50 percent or higher.

For employees whose “Eligible for Health Insurance Coverage” was pre-populated as “Yes” the “Date Eligible for Health Insurance Coverage” will be pre-populated with the later of January 1, 2015 or the following date:

  • Enrollment date for employees enrolled in NYSHIP or the Opt-out Program; or
  • 42 or 56 days after the date of first eligibility (depending on bargaining unit) for employees not enrolled in NYSHIP, but are paid on the ANN, CAL, CYF, or 21P payroll basis with a FTE percentage of 50 percent or higher.

January 1, 2015 is the placeholder date being used for employees who were first eligible or continuously enrolled in NYSHIP prior to this date. This information is being used to ensure compliance with the “employer mandate” provisions of the federal Patient Protection and Affordable Care Act (PPACA) which took effect January 1, 2015. As a result, actual dates of eligibility for these individuals do not need be provided.

Employees who do not meet either of the two above criteria will be pre-populated with “No” in the “Eligible for Health Insurance Coverage” field and the “Date Eligible for Health Insurance Coverage” will not be populated.

It is imperative that agencies review this information for all of their existing employees and make corrections as needed. The State is required to submit this information to the Internal Revenue Service to prove compliance with certain provisions of the federal Patient Protection and Affordable Care Act. Reporting inaccurate or incomplete information could result in major financial penalties to the State of New York. As a result, prompt agency attention to this exercise is required.
 
OSC has also created a new query to allow agencies to evaluate the eligibility status of their employees so that updates can be made if necessary.

OSC Actions- New Locked Query OSC has created a new Locked Query entitled LQ_076_NEW_HIRE_ACA_INS_ELIG

Once the payroll representative enters in the Department ID at the prompt, this query will display the following for each employee in the department, regardless of current payroll status:

  1. Department
  2. Name
  3. Empl ID
  4. Empl Record
  5. Date of Birth
  6. Payroll Status
  7. Eligibility Config Field 1(Eligible for Health Insurance Coverage)
  8. Eligibility Config Field 2 (Date Eligible for Health Insurance Coverage)
Agency Actions   Agencies should use Locked Query # LQ_076_NEW_HIRE_ACA_INS_ELIG
to confirm the health insurance eligibility status of their employees.

A new reason code, ACA, has been created for agencies to use to update an employee's health insurance eligibility in the payroll system. If an existing employee's health insurance eligibility status needs to be changed after the initial load by the Department of Civil Service, updates to the two newly created fields can be submitted through the Job Actions Request page using Data Change/ACA. Requests must be made using the highest effective dated row. The two fields are:
  • Eligible for Health Insurance Coverage and
  • Date Eligible for Health Insurance Coverage

For employees not enrolled in NYSHIP but who are paid on the ANN, CAL, CYF, or 21P payroll basis with an FTE percentage of 50 percent or higher, the Department of Civil Service is making a reasonable assumption of health insurance eligibility.  In addition, the Department of Civil Service is only providing health insurance eligibility information for certain State employees. As a result, it is each agency’s responsibility to review this information and provide corrections if changes need to be made.

Agency payroll officers must coordinate with their agency’s Health Benefit Administrator (HBA) to ensure accurate information is provided in these fields. The Department of Civil Service will also be issuing a memo to all State agency HBAs outlining these requirements.

The “Eligible for Health Insurance Coverage” field must be correctly set to “Yes” or “No” for all existing employees.

For employees who were first eligible or continuously enrolled in NYSHIP prior to January 1, 2015, the “Eligible for Health Insurance Coverage” field must be “Yes” and the “Date Eligible for Health Insurance Coverage” should be populated with January 1, 2015.

For employees eligible for health insurance coverage after January 1, 2015, the “Date Eligible for Health Insurance Coverage” must reflect the employee’s first date of eligibility for health insurance benefits. Refer to the following table to compute the date eligible for health insurance benefits.

Group

Waiting Period

Date Eligible

Council 82
CSEA
DC-37
PIA
UCS
UUP*
GSEU**
All Others

42 days
42 days
42 days
42 days
42 days
42 days
n/a
56 days

43rd day
43rd day
43rd day
43rd day
43rd day
43rd day
1st day
57th day

*The 42-day waiting period for otherwise eligible newly hired academic employees will begin on the actual day of professional eligibility, but not earlier than August 15.

**GSEU employees are eligible for health insurance coverage on their appointment date.

For example, if a CSEA employee is hired in a benefits eligible position on September 14, 2016, the “Date Eligible for Health Insurance Benefits” is October 26, 2016 - the 43rd day after their first date of hire.

For employees placed on a leave of absence during which they are ineligible for an employer contribution towards their health insurance, the “Date Eligible for Health Insurance Benefits” should be set to the 1st day of the 2nd payroll period following their return.

The NYSHIP General Information Book contains information related to employee health insurance eligibility requirements.
Agencies must review this report and provide any needed updates no later than October 31, 2016.

Questions Questions regarding this bulletin may be emailed to the Payroll Earnings mailbox.