Qualifying for Benefits

Rockie

We have a minimum number of hours (30) an employee must work to qualify as full time for the purpose of health insurance benefits. Do any of you have a minimum number of weeks an employee must be actively at work to qualify for benefits? Our carrier has informed us that it's in our contract that this is 48 weeks out of the year. This leaves 4 weeks for vacation time, etc. We have many people who get 5-6 weeks of vacation/year.

Have any of you run into this issue and how do you handle it?

Thanks

stilldazed

We have an issue that is similar but not exactly. Our insurance contracts are written with the criteria that a minimum of 30 hours/wk is required for FT status. However, our policies require a minimum of 36. We do have workers who slip below the 36 (with and without time off). We do not change their status to PT until they have been warned that their hours are low, that they are at risk of losing benefits, that we are concerned they may be having FMLA qualifying absences, etc. We have never, to my knowledge, had an insurance company question our designation of FT vs. PT status or ask for confirmation that our staff are working at least 30 hours/wk. We try to manage the workhr issue as a disciplinary issue and let the FT/PT status designation follow.

Pattie

We have always had the language written for number of hours per week -- in our case 35/wk, which is FT for us. It's never had language stating so many weeks per year. The majority of our EE's are long term and have 5-6 weeks vacation as well.

Perhaps you need to look at re-writing your contract to remove the number of weeks per year.

jmcaa

Look in the definition section of your health plan book and see what constitutes actively at work. Our PTO does not count against an employee's hours worked.

davids

Maybe I am not understanding this. If an employee takes a 6 week vacation, does that employee lose coverage? What if the employee is out sick for 12 weeks? Would your insurance company claim the employee lost coverage after the fourth week? I don't recall ever hearing of a threshold number of weeks that the employee had to work to maintain coverage.