(828) 438-6000 webmaster@wpcc.edu

Procedure

03.02.130.e Health Insurance

 

 

 

 

The College participates in the statewide group health insurance plan, which covers hospital and medical expenses and is available to employees at no additional cost.  Family and dependent coverage as well as higher levels of coverage is available at the employee’s expense.  Information for the State Health Plan options can be located here:  https://shp.nctreasurer.com/Pages/default.aspx

Full-time employees with less than a twelve (12) month appointments are treated as regular employees and their individual employee health insurance continues through the summer months of June, July and August following completion of their nine (9) month appointments.   For nine (9) month instructional personnel who choose to be paid as earned, any summer benefit premiums will be deducted from their pay in the months of March and April and escrow payments will be set up to cover the full summer months (June and July).

In the event that nine (9) month instructional personnel terminate their employment with the College and do not return to work at the beginning of the new academic year (i.e., typically, August 15th), the employee may be required to pay the employer’s portion of the summer benefit premiums.

Affordable Health Act Insurance Eligibility
Under the Affordable Care Act (ACA), beginning on January 1, 2015, North Carolina agencies must offer health insurance coverage for employees who qualify under the ACA guidelines which include employees who average 30 hours per week or 130 hours per month based on the agency’s guidelines or procedures. If the employer fails to make offers of insurance, the employer faces financial penalties. In North Carolina all employees who qualify for an offer of insurance under the ACA definition are entitled to insurance coverage (bronze level plan under the State Health Plan). The bronze plan was developed to provide minimum essential coverage and that minimizes the employer contribution in an administratively feasible manner.

 

 

 

Definitions:
Service hours:
Service hours: Each hour for which an employee is credited for the performance of services. For instructor positions, service hours include classroom instruction time, class preparation, course development, and other duties as assigned or required by the college.

  •  The College has also elected to utilize the “bright line” or safe harbor approach which allows the College to determine average hours over a measurement period to determine eligibility.
[__/su_spoiler]
Workload formula:
Workload formula: Workload (loading) formula recognizes service contributions of all instructional positions and helps ensure equity in workload assignments. In the North Carolina Community College System, the formula for workload is a local college decision.

  •  The College has elected to use a 2.25 multiplier for contact hours taught by adjunct instructors for the majority of curriculum courses and some very rare continuing education courses.
  • For all other positions service hours would be a direct 1 to 1 match based on the time sheet, lab or clinical hours, and/or stipend contract for hours worked.
[__/su_spoiler]
Break in Service:
Break in Service: A period of time for which an employee does not work. This could be semester breaks or other times the College is closed. [__/su_spoiler]
Standard/Initial Measurement Period:
Standard/Initial Measurement Period: The period of time for which an employee’s hours are recorded and measured to determine average hours worked.

  •  The College will utilize a 6 month measurement period.
  • For new hires, the employee will be evaluated from the first day of the month following the date of hire through six months.  There will be some overlap at the six month period to allow the employee to become part of the regular cycle for the following measurement period.

 

[__/su_spoiler]
Administrative Period:
Administrative Period: The time after the Standard/Initial Measurement Period that it takes to determine eligibility and enroll an eligible employee in the health plan.

  • The college will utilize a 2 month administrative period. During the first month employees’ hours are analyzed to determine eligibility, then in the second month employees are enrolled if they choose the bronze plan.
  • For new hires, administrative period will be 2 months after the initial measurement period has ended.
[__/su_spoiler]
Stability Period:
Stability Period: The period of time after the Administrative Period for which health benefits are provided to eligible employees.

  •   The college will utilize a 6 month stability period.
  • For new hires, the stability period will be 6 months after the administrative period and continue through the next regularly scheduled stability period (the stability period could be between 7 – 11 months).
[__/su_spoiler]
Seasonal Employee:
Seasonal Employee: An employee who is employed on a temporary basis for a defined season, such as registration. [__/su_spoiler]
Independent Contract Employee:
Independent Contract Employee: An individual who is contracted to perform a service for the college for which there is no employer/employee relationship; the college has the right to control or direct only the result of the work and not what will be done and how it will be done. These individuals would not be ACA eligible under the College’s guidelines. [__/su_spoiler]
Temporary Agency Employee:
Temporary Agency Employee: An employee assigned to work at the college through a staffing firm. These individuals would not be ACA eligible under the College’s guidelines. [__/su_spoiler]
[_/su_spoiler]
Employment Structure and Health Plan Coverage Eligibility:
Full-Time Employee:
Full-Time Employee: An employee who works at least 30 hours per week and is employed at will or on an appointment basis (9-month for Faculty).  Health Insurance Coverage is offered at time of employment. [__/su_spoiler]
Faculty:
Faculty: [__/su_spoiler]
Staff:
Staff: [__/su_spoiler]
Part-Time Employee:
Part-Time Employee:

  •  An employee who works between 20-29 service hours per week. Health insurance is not offered. Between 20-29 hours per week, employees may participate in the health plan by paying the entire cost of coverage. If under 20 hours per week, employee cannot participate in the plan.
[__/su_spoiler]
Adjunct:
Adjunct: employed with a course-based contract per academic term with no expectation of recurring employment outside of the contracted hours [__/su_spoiler]
Staff:
Staff: employed at will for the duties needed. [__/su_spoiler]
Full-Time Temporary Employee:
Full-Time Temporary Employee:  An employee who works at least 30 hours per week or 130 hours per month for a period of time, not to exceed 12 months, with no expectation of recurring employment. Health insurance is offered within 30 days after it is determined the employee will be working at least 30 hours per week or 130 hours per month. [__/su_spoiler]
Part-Time ACA Eligible Employee:
Part-Time ACA Eligible Employee: An employee who works more than 30 hours per week for a measurement period. Health insurance will be offered during an administrative period for the duration of the stability period as described by the College.  The employee would have to meet the eligibility requirements during future measurement periods to continue health insurance coverage. Employee must maintain employment throughout the stability period. [__/su_spoiler]
Employment Category/Appointment Type Eligibility Trigger Eligibility Point
A Full-Time Employee Hire Time of Hire
B Part-time Employee Hire Eligible at hire but must pay full cost of coverage if working between 20-29 hours
C Full-time Temporary Employed to work more than 30 hours per week or 130 hours per month Within 30 days of eligibility
D Part-time ACA Eligible Employee After measurement period where employee averaged more than 30 hours per week. Subsequent Stability Period assuming continued employment
* Temporary Agency Staff May be eligible for coverage through the temporary agency
** Independent Contractor No coverage eligibility
[_/su_spoiler]
Measurement Period:

The measurement period for the college will be a six (6) month time period that will encompass at least one complete academic curriculum term.

The measurement period for any new hire will begin on the first day of the following month after employment (unless they begin on the first business day of the month). After the first six months they will be on the regular schedule of all part time employees. There will be a period of overlap of the initial measurement period and the regular measurement period.

Administrative Period:

The administrative period for the college will be the two (2) month period following the measurement period for all employees.

Stability Period:

The stability period for the college will be the six (6) month time period immediately following the administrative period.

The stability period for any new hire will begin the month after the administrative period has ended and continue to the next regularly scheduled stability period. Therefore, an employee may be eligible for ACA benefits between 6 and 11 months based upon the hire date due to the overlap of the measurement period for new hires.              

If an employee leaves the college’s employment or is terminated the ACA coverage would be terminated immediately. Otherwise the employee would continue to have coverage until such time as the next measurement period declares the employee ineligible for ACA coverage.

Measurement Period Administrative Period Stability Period
A January-June July and August September – February
B July-December January and February March-August
Define Established Breaks in Service:

A break in service is a period of time for which an employee does not work due to college breaks or breaks within the semesters. These breaks may include, but not limited to, semester breaks, summer break, spring break, and Christmas breaks. These breaks are not included in the calculation of hours for ACA eligibility.

If a time period of 26 weeks (two semesters) or greater occurs then the employee would be considered a re-hire.

Workload:

Curriculum Course Workload Ratio Calculator

Lecture Hours 1 hour = 2.25 Workload
Lab Hours 1 hour = 2.25 Workload
Clinical/Practical Hours 1 hour = 1.0 Workload

Continuing Education/Basic Skills Course Workload

Instructional Contact Hour (no outside work required) 1 hour = 1.0 Workload
Instructional Contact Hour (outside work required) 1 hour = 2.25 Workload
Instructional Contact Hour (paid outside work) 1 hour = 1.0 Workload

Non-Instructional PT Employee Workloads Ratio Calculator

Contact Hours 1 hour = 1.0 Workload

Ratio Calculator (Defined under PT Employee pay rate sheet) – Example:

Employee A works in curriculum, GED, and the Academic Success Center – that employee’s hours are calculated below

English 111 (3 Contact Hours) 6.75 Workload
English 112 (3 Contact Hours) 6.75 Workload
GED Course (7 Hours per week) 7 Workload
Tutoring Center (5 Hours per week) 5 Workload
Total Workload counting toward the 29 hour per week maximum 21 Workload
  • The Programs Coordinator located in the Academic Affairs office is managing the multiplier documentation.
  • Adjunct instructors complete a self-identifying form each semester informing the Academic Affairs office of the courses they will teach and if they will be working in any other area of the College.
  • The Payroll office is tracking all staff and instructors who are paid through a time sheet or stipend contract in which the hours are counted one to one.
  • Between the Academic Affairs office and the Payroll office a worksheet is kept on all part time employees during the measurement period to determine the average number of hours to credit the employee and verify eligibility for ACA requirements.
  • The office of Human Resources then reviews and determines if any employee is eligible under ACA for health insurance coverage. They will then make contact with the employee during the appropriate administrative period.
Opting Out Procedures:

Any employee may voluntarily choose to not accept coverage in the health plan.  Employees should annually complete a form that acknowledges that they were offered coverage and chose not to accept the coverage.  Opting out of coverage shall not be used as a reason to allow an employee to work additional hours.  Once an employee opts out for the plan year, they cannot enroll again until the next annual enrollment.

Any employee may opt-out of the bronze plan as offered by the State but still be eligible to participate on the State exchange for insurance coverage; however, in so doing, the employee may forfeit any applicable federal subsidies available to apply to private insurance purchase through the State exchange.

Bronze Plan:

The High Deductible Health Plan (HDHP) summary of benefits is highlighted below. As a reminder, the HDHP will also be Health Savings Account (HSA) eligible, which will allow employees to make tax-exempt contributions to an account that can be used to pay eligible medical expenses.

MedCost will serve as the Plan’s third party administrator (TPA) for claims and related services for this plan and employees enrolled in this plan will be utilizing the MedCost network of providers.

The services below will also be offered to employees in the HDHP

  • Teladoc 24/7: access to consultations over the phone or online (where available) with board certified physicians for common conditions such as allergies, infections, etc. The out-of-pocket cost to the member for this service will be $40.00.
  • HealtheReports: online provider search, cost and quality tool
  • Personal Care Management: customized health education and one-on-one nurse mentoring to encourage self-empowerment and self-management. Includes transitional care management.
  • Personal Health Suite: online suite of health and wellness tools and information, including Health and Productivity Assessment, Healthy Living Programs, personal health portal and health trackers

Monthly Premium Rates for HDHP

High Deductible Health Plan (HDHP)

Medical Benefits
Benefit Design Individual Coverage Family Coverage
Individual Deductible $5,000 $10,000
Out-of-Pocket Maximum $6,450 $12,900
Coinsurance Covered at 50%
Non-network benefits will be paid at 40%.The non-network deductible and out-of-pocket maximum will be 2 times the in-network amounts.
Pharmacy Benefits
ACA Preventive Pharmacy Covered at 100%
The pharmacy benefit will be managed by Express Scripts and use their National Preferred Formulary (drug list) and include their broad retail pharmacy network.

 

Coverage Tier Total Premium Employer Share Employee Share
Employee Only $210.00 $117.62 $92.38
Employee and Child(ren) $379.87 $117.62 $262.16
Employee and Child(ren) $379.87 $117.62 $262.16
Employee and Spouse $586.56 $117.62 $468.94
Employee and Family $680.56 $117.62 $562.94