Time for some preventive care?

Published 8:47 am Tuesday, August 12, 2014


Carter County’s school system’s employee health insurance policies will be getting a facelift, but this operation won’t be elective surgery.
Members of the Carter County Board of Education discussed health care reform and its effects on the school system’s employee benefits plans during a workshop meeting Monday, and learned they will need to make changes.
At the workshop, members of the board heard a presentation by Mike Ingram of 5 Points Benefits, an employee benefits brokerage based in Franklin that handles the benefits plans of many school systems in the state, including Carter County’s. Ingram discussed with the board some of the details of health care reform that will have an impact on the school system’s benefits plan and how it is offered to employees.
Two of the biggest challenges facing the school system’s current benefits plan are identifying employees who must be offered benefits and what federal law defines as discriminatory practices in the way employee plans are administered.
Under the Affordable Care Act, employers who offer health insurance as an employee benefit must offer that insurance to all full-time employees, which is defined as those employees who work an average of 30 or more hours per week or 130 or more hours per month.
Ingram said some employees of the system – such as coaches, bus drivers and substitute teachers – are frequently considered part-time employees, and as such are not eligible for benefits. However, he said, circumstances can lead to those employees reaching the 30-hour mark and they would have to be offered benefits by the school system. He described those employees as “variable hour employees.”
According to Ingram, there is a provision in the Affordable Care Act which would allow the county to adopt a “Safe Harbor Rule” when dealing with variable hour employees. Ingram said the system could track the employee’s hours over a 12-month period and average them out. If the employee has an average of 30 or more hours per week during the monitoring period. that employee would then become eligible for benefits for 12 months.
The school system would continue tracking the employee’s hours each year to determining benefit eligibility for the next year.
Ingram also described provisions of the Affordable Care Act that bar discrimination by employers when offering a health insurance benefit to employees. He said employers must provide equal insurance benefits to all employees.
“The top 25 percent wage earners cannot have better benefits than the bottom 75 percent,” Ingram said, adding this applied to waiting times, policies and subsidies.
Currently, the Carter County school system offers different health insurance benefits to different classifications of employees. For those employees classified as “professionals” the system not only pays a subsidy on the cost of insurance for the employee, but offers a subsidy for the cost of family medical insurance as well. Employees classified as “para-professionals” receive the subsidy for their own insurance but not for family coverage plans.
Ingram said the board will need to evaluate how it handles these benefits, what it offers to employees and come into compliance with provisions of the Affordable Care Act. To do otherwise, he added, could result in penalties and fines from the federal government.

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