Who may be excluded under PPACA

[Guest BenefitsAnnie]

Hi,

I know that we must count our interns and fellows in terms of determing large employer status. What's unclear to me is whether we are required under PPACA to offer them coverage. Interns typically work 3 months but that may be extended in some cases. Fellows typically work 6 months. Both types of employees work 40 hours per week while on board. Currently, they are considered ineligible for our benefits.

May we continue to exclude them under PPACA? If we do continue to exclude them and they receive a subsidy on the exchange, are we liable for the 3k penalty? Or, does the penalty not apply since they were not eligible for our plans to begin with?

Thanks!

[GBurns]

I suggest that you seek legal counsel. Your current ineligibility standards might even be questionable.

[Guest BenefitsAnnie]

Hi,

Our plan documents are written to exclude those not expected to work at least 6 months (interns) and those not considered full or part-time employees (fellows), so I don't see a problem -- at present -- with excluding these two groups from coverage. In my experience, this is a a fairly standard plan exclusion as far as health plans go. My concern is about our ability to continue to exclude these two groups when the employer penalties become effective.

[GMK]

^I'm not fully versed in the matter, but I think your concern is legit.

This may provide some useful answers:

http://www.sevenhillsservice.com/ftpgetfile.php?id=133

[Guest BenefitsAnnie]

Thanks, GMK! Your link was very helpful. It appears that, yes, we can exclude both interns and fellows based on the 95% rule -- an employer must offer coverage to 95% of its full-time employees. We can also exclude interns based on the fact that they typically don't work over 3 months. Something we will have to stay cognizant of, however, is that if the Fellows, who do work over 3 months, purchase on the Exchange and receive a subsidy, we may be liable for the penalty of 3k for that employee.