The first thing you need to do when setting up a new plan is provide essential information about the plan and its requirements. This is done on the Plan Description tab:
- Plan Name: Provide the name of the specific plan being outlined in this sheet. For example, “Salary Plan” or “Hourly Plan”.
- Begin Date: Enter the date this plan was first offered during the reported calendar year (ex. During 2018).
- End Date: Enter the date this plan was last offered during the reported calendar year (ex. During 2018).
- Meets Minimum Value: (Yes or No) The plan offering meets the Bronze (entry-level) plan requirements, as established under the Affordable Care Act.
- Waiting Period: Enter the number of months or days new hires or transitioning employees must wait to become eligible for health insurance benefits.
- Coverage Effective Date: Specify whether coverage is effective immediately following the waiting period or on the first of the month following the waiting period. Select “Other” if the plan begins on another set date during the month.
- Spouse Coverage Offered: Select whether or not spouses are eligible for coverage under this plan. Note: Select “conditional” if your spousal coverage is subject to conditions (such as only making your plan available to spouses who are not eligible for another group health plan or Medicare).
- Meets Affordability: The plan’s Single only coverage offering does not exceed 9.56% of the employee’s income.
- Affordability Safe Harbor: Select the basis (Rate of Pay, FPL or W-2) used to determine that the offering does not exceed 9.69% of the employee’s income.
- Dependent Coverage Offered: Select whether or not dependents are eligible for coverage under this plan.
- Funding: Select whether this plan is Fully Insured or Self-Funded.
- Plan Start Month: Enter the plan’s annual renewal month.
- Coverage Termination Date: Select whether the coverage offering for this plan terminates immediately after employment ends or at the end of the month.
Important Note about Plan Changes
You must provide plan information covering the entirety of the reporting year (January 1 – December 31). If plan information changes during the year:
- If any of the plan attributes on the Plan Description tab changed during that calendar year, you need to create a new plan. Start the new plan at the date at which the attribute(s) changed.
- If all the attributes on the Plan Description tab remained constant for the calendar year, but the plan cost changed (maybe at renewal), you do not need to create a new plan. Instead, enter the plan cost change on the Plan Cost tab (discussed here).
Next Step: Plan Management 6 - Plan Mapping