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Health Benefits Implications of Reduction of Hours, Furloughs, and Layoffs Created by Coronavirus Pandemic

As businesses continue evaluating staffing needs in response to the COVID-19 disruptions, one of the potential unintended consequence of reducing working hours or furloughing employees is the impact on health benefits.
A woman researches info on unemployment after being laid off during the coronavirus pandemic.

Many businesses had to make tough decisions when it came to retaining their employees during the COVID-19 pandemic. Some might continue to face challenges while bringing people back to work. Evaluating staffing needs and navigating problems created by a lack of employees have kept some businesses from being fully operational, resulting in a reduction of employee hours or furloughing/laying-off employees. 

A potential unintended consequence of reducing working hours or furloughing employees:

  • Individuals may no longer be eligible to stay on their employer’s health plan
  • If they are permitted to stay on the plan, the cost may be higher

Employee health plan eligibility

The plan document for health coverage often includes average hours of service or active employee status eligibility requirements to determine coverage offered and employee cost. In certain circumstances, employees may remain on their employer health plan through COBRA, but it is most likely cost-prohibitive given employees would have to pay the entire premium while working fewer or no hours.        

Businesses who want to help their employees stay on their health plan at the same rate are encouraged to contact their carriers, understand eligibility requirements, and if necessary, request flexibility.

In addition, states have a public interest in helping individuals stay on their employer’s health plans. Several states – Alabama, Massachusetts, New Jersey (for large employers with 51 or more employees), Washington, and Wisconsin – issued bulletins during the height of the pandemic specifically requesting that insurers be flexible with eligibility requirements. A few states – Maine, New Hampshire, New Jersey (for small employers) and Ohio – made this a directive. The IRS clarified that employers who qualify for the retention credit may utilize the health plan expenses as qualified wages even if there are no or reduced hours/wages. This may lessen some of the financial burden on employers who qualify for this credit if they choose or are required to continue health benefits.

Potential financial impact on applicable large employer

Applicable Large Employers (ALEs) may face potential financial consequences under the Affordable Care Act’s Employer Shared Responsibility (ESR) provisions, if some employees currently working reduced hours or furloughed employees are no longer eligible for a health plan.

What happens when ALEs reduce hours?

In general, ALEs must offer adequate and affordable health insurance coverage to full-time employees (and their dependents) or risk the IRS potentially assessing a penalty under Internal Revenue Code Section 4980H if a full-time employee receives a premium tax credit. Potential assessments can be significant. These aspects were always in place, but the COVID-19 pandemic placed a spotlight on what can happen in such situations.

An employee’s full-time status is often determined under the Look-Back Method during a timeframe known as the stability period.  Keep in mind, that it does not matter if the employee is not actually working full-time hours after having hours reduced or being furloughed. The look-back period generally has already occurred and the employee’s status as full-time is locked in. Even though an ALE’s offer of COBRA coverage can be considered an offer of coverage for ESR purposes, the ALE may be subject to a Section 4980H penalty because it is less likely that the offer will meet affordability requirements. 

Employees returning to work after being furloughed or laid-off

As businesses consider rehiring laid-off employees or returning furloughed employees to their previously held positions they should factor in whether they would benefit from financial incentives offered by the federal government to retain employees (e.g., the Employee Retention Credit offered in the CARES Act). 

ALEs should be aware of the special rules that apply in determining if employees are considered continuing employees (rehired for ESR purposes) or new hires after a break in service. In general, a break in service is a period where an employee has no credited hours of service. ALEs risk a 4980H assessment if they do not offer adequate and affordable coverage immediately to rehired employees who were full-time prior to the break in service and if the employer is in the same stability period.

In contrast, ALEs generally have more time to offer coverage to those considered newly hired employees who are full-time under ESR provisions. For example, ALEs don’t have to offer coverage to new hires reasonably expected to be full-time at the start date; they have until the first day of the fourth full month before they are at risk for a 4980H assessment.

How ALEs determine New Hire or Rehire for 4980H?

An individual is considered a new hire if one resumes providing services to an ALE after not being credited with an hour of service for at least 13 consecutive weeks (26 consecutive weeks if the employer is an educational organization). An individual who resumes providing service after a lesser period is a rehired employee for ESR purposes.

Alternatively, if an employer wishes to consider the employee a new hire for the purpose of ESR sooner than the 13 weeks (26 for educational organization), they may use the rule of parity. Under this rule, an individual may be treated as a new hire even if the break in service is for a lesser period and if certain conditions are satisfied. Under the Rule of Parity, an ALE may treat an employee as a new hire if:

  • The break in service was four (4) consecutive weeks or more
  • The break in service period exceeds the number of weeks of employment with the ALE immediately preceding the break in service

ALEs wanting to rehire furloughed or laid-off employees should factor these rehire rules in their planning to avoid the risk of incurring a Section 4980H assessment.

What's next?

Navigating business challenges created by the coronavirus requires employers to make determinations on how they wish to support their employee’s healthcare needs, which the global pandemic placed a heightened importance on. This may entail evaluating what flexibility their geographies and carriers either afford or require, when it comes to expanding the employee population that can avail themselves of affordable employer-sponsored health coverage.

In this evaluation, ALEs must factor in the dynamic of whether these employees could subject them to a risk of a costly 4980H assessment. This is a delicate needle to thread; balancing the financial cost of health coverage for employers that may have already taken a significant financial hit from the crisis with the health coverage needs of their employee population (both active and inactive), while adding in the state and federal rules that add a layer of complexity to this decision. 

Paychex understands the layers of complexity created by the COVID-19 pandemic. As you return individuals to work, know that we can help. We have the expertise with ESR to help assist with filing the necessary forms on deadline, the know-how to evaluate your penalty risk for coverage offers under ESR requirements, and much more.

laurie savage headshot
Laurie Savage is Senior Compliance professional, leading robust legislative research efforts analyzing intricate policy, including the Affordable Care Act (ACA), paid leave, tax reform and recently, legislation responding to the COVID-19 pandemic.
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* This content is for educational purposes only, is not intended to provide specific legal advice, and should not be used as a substitute for the legal advice of a qualified attorney or other professional. The information may not reflect the most current legal developments, may be changed without notice and is not guaranteed to be complete, correct, or up-to-date.

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