Employer Shared Responsibility
Health Care Reform – Impact on Hourly Workforce
Employer Shared Responsibility is a component of the Patient Protection and Affordable Care Act (ACA) that requires employers to offer affordable and Minimum Essential Health Care Coverage (MEC) to all team members that average 30+ hours of service per week over the course of a specified period of time.
The health plans Toys“R”Us offers are considered affordable and provides Minimum Essential Health Care Coverage (MEC) as defined by ACA. This means you will generally not be eligible for a government subsidy if you decide to waive company coverage and enroll in a plan on the health insurance marketplace. If you do receive a subsidy while eligible for our plans, you may be required to pay it back to the government.
Service hours include actual hours worked and non-working hours such as vacation, holidays and sick time. If you take an unpaid FMLA, unpaid jury duty or unpaid military leave of absence, the period of time you are on a leave will be excluded from the Standard Measurement Period – (see Measurement Periods below).
For ongoing (current) team members:
- Full-time status for hourly team members (part-time hourly and full-time hourly) will be measured using the “look-back” Standard Measurement Period method. The Standard Measurement Period is May 1st of the current plan year to April 30th of the following plan year. For example, the Standard Measurement period for the 2016-2017 plan year is May 1, 2016 - April 30, 2017.
- During the Standard Measurement Period, hourly team member’s hours will be measured to determine if they average 30+ hours of service per week. If so, these team members will be offered coverage during the Administrative Period and treated as full-time for the subsequent Standard Stability Period, regardless of the number of hours actually worked during this period of time.
- If an hourly team member is deemed not eligible during the Standard Measurement Period, they will not be offered coverage during the Administrative Period and will not be eligible for coverage for the entire Stability Period. They will be re-measured during the next Standard Measurement Period*.
For newly hired team members and team members coded as full-time hourly in Workday:
- Management team members (including Level IV 3+ and M90) - will be eligible for benefits after 30 days of service. Hours worked will be hard-coded to 40 hours per week during the Initial Measurement Period. If status does not change during the year, management team members remain eligible for the subsequent Stability Period.
- Part-time or seasonal team members - will not be offered coverage upon hire. Service hours will be tracked starting the first of the month following date of hire during the Initial Measurement Period. If deemed eligible after end of the Initial Measurement Period, coverage will be offered during the Administrative Period and the team member will remain eligible through the Stability Period. Hours will be re-measured during the Standard Measurement Period. If a team member is deemed ineligible, their status will remain ineligible during the next Standard Stability Period and hours will be re-measured during the Standard Measurement Period.
Status change during the plan year:
If status changes from:
You will be eligible for benefits:
PT hourly/Seasonal to FT hourly or Management
Upon completion of 30 days of service
Remain eligible for the entire Stability Period.
FT hourly or Management to PT hourly/Seasonal
BENEFITS DO NOT DROP
Remain eligible for the entire Stability Period. Hours will be re-measured during the Standard Measurement Period. However, if you'd like to drop coverage, you must do so within 30 days of your PT/Seasonal status change.
How Your Coverage Is Impacted If You are Rehired:
- If you are rehired within 31 days from separation, you will immediately be put back in the coverage (or no coverage, if previously declined) elected prior to your termination of employment.
- If your break in service is more than 31 days but less than 13 weeks, you can make a new election (or newly enroll in coverage if you previously declined coverage). However, any supplemental life insurance benefits previously approved will require you to submit Evidence of Insurability before coverage is reinstated.
The effective date of your coverage will be your rehire date.
You don't have to re-satisfy the dependent documentation requirements if previously submitted. New dependents will need to be verified.
If you enroll in the same plan you had before your termination, your deductible and Out-Of-Pocket (OOP) maximum prior to termination is re-instated upon your return. If your enroll in a different plan, your deductible and OOP will be reset.
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