Health Plan and full time benefits

[Guest Ginny Rigsbee]

I am trying to find out what we can do about an employee that continues to fail to meet what we require to receive full time benefits. This is not quite as cut and dry as it sounds...this employee had a major health problem...she is back at work and is not quite getting 30 hours per week. We have discussed this with her on several occasions and she always agrees to try "and do better". She was also doing this prior to her illness. We pay part of our employees premiums and they pay the rest....she currently pays extra if she is short the 30 hours....A-I am not sure if this is legal. And B-it doesn't seem fair that she gets vacation, and the other benefits that the people who do get 30 hours plus receive. While we don't want to take her insurance away, we have to come to some sort of agreement that is fair to employee/employer. My other concern is if the insurance company decided to audit my payroll records and they find out she is not getting the required hours in....what happens then?

Any help anyone can provide would be great...mroberts and papogi have helped in the past.

[mroberts]

What's her prognosis? Is this ever going to get better? What else does she say when she mentions she'll try and do better?Since she is not quite working full-time, I'm wondering if she's receiving partial disability benefits since a major health problem is the cause?

Are you subject to FMLA and how long has this employee been falling below 30 hours? If she's taking intermittent FMLA, she could still be under the 12 total weeks allotment. Additionally, if you run your FMLA on a calendar year basis, she just got another 12 weeks starting last week.

Lastly, how many hours below 30 is she working? 20? 25? Most carriers would not have a problem making an exception if she's working more than 20 hours per week since she's probably still considered a full-time employee. Just be careful since you're setting a precedent.

[Guest Ginny Rigsbee]

mroberts...thanks for your response. We do not fall under FMLA...we are under 50 employees. She is not still collecting any disability, as she has completely recovered. This was an aneurysm....I talked to you about this individual sometime ago. The illness is not even the reason she doesn't get her hours in...although she is a great employee, she seems to always have issues (appointments, cramps, sick family, etc.). When we have our chats about doing better, she does for awhile and then we are back to square one. I know exactly what you mean by precedent because another individual who is working the same hours is going to expect the same treatment....and could come back to sue us if they are not receiving it. I think I will offer her 2 choices...she must get the time in or go part time and go on COBRA. My other fear is what if she decides to report that we made her pay more of a health premium than other employees even though she agreed to it you know?

[mroberts]

You could always go back to your carrier and change the eligibility definition to all full-time employees working 20 or 25 hours if you wanted to. It depends on how badly you want to keep this employee. Since you have indicated that she is a great employee, it might be worth amending your plan document. Otherwise, I concur with you - if she can't work the 30 hours per week, keep her on as a part-time employee and offer her COBRA.

[Jbentz]

Due to the precedent nature of this, i would ensure that you use a consistent measure and that it is listed in the plan document. Does it mention an average of 30 hours per week per quarter? Semi-annually? If in only states "30 hours per week", I would put your measure in the plan document; this will keep you from having to yo-yo her back and forth weekly. If you look for averages every 3 to 6 months, then you have a measure to keep you from discriminating either way and it can be used for all employees.

[KIP KRAUS]

What is the exact definition of working 30 or more hours per week in your group contract? If it reads something like “regularly scheduled to work 30 or more hours per week” it could be argued that even though she doesn’t get the full 30 hours per week due to sickness, appointments, etc. she is still scheduled to work at least 30 hours per week. Any employee could fall short of the 30 hours per week due to unforeseen circumstances and their cover doesn’t end. If the situation doesn’t improve you may have to threaten her with termination. Sometimes this can shock an employee into reality.

As to charging her more for her portion of the premiums I’d stay clear of this one unless you establish this in writing so that it applies to any employee similarly situated.

The issue of vacation and other benefits not related to medical coverage is a separate issue and can usually be determined by the company differently than eligibility for insured benefits.