Participating Employers in an AHP Program are required to complete the Annual Rate and Census Reconciliation form when enrolling and prior to Renewal. This provides confirmation that the participating Employers still qualifies under the Benefit Plan Underwriting Regulations.
The Annual Rate and Census Reconciliation form can be generated by both the HR Manager and the Broker via Manage Documents. HR Managers should review and complete the Annual Rate and Census Reconciliation form as well as load the completed form to the Document Center.
How to download as the Broker
On the Client Dashboard, open the orange context menu for the Client in question and select Manage Documents.
On the Manage Documents page, select Download Census Reconciliation Form. The form generates in an Excel file and the you can provide this to the HR Manager to complete.
How to download as the HR Manager
From the HR Dashboard, the HR Manager selects Manage Documents.
Here, the HR Manager selects Download Census Reconciliation Form button. The form generates in an Excel file for the HR Manager to complete. Once completed, the HR Manager will upload the completed Annual Rate and Census Reconciliation form to the Document Center.
Sample of the Annual Rate and Census Reconciliation form
In order to complete, follow the instructions listed below:
- Verify all amounts highlighted in Blue
- Enter in all information highlighted in Yellow
- Grey fields are calculated fields and should not be changed
- Total Employees on Wage and Tax Statement. It is estimated that the Wage and Tax for December 31 will be available for the Plan Year submission. The most recent Wage and Tax Statement can be used if that statement is not available. See A refers to the Employer's most recent Quarterly Wage and Tax Statement.
- Employees On or (Off) as of Census Date. It is understood this will be the net change in employed individuals compared to the date of the census being reconciled. This number can be negative in the event Employees have left in the interim time period. This question must be answered; otherwise, the census will not save to the group’s Document Center. If the answer is zero, 0 must entered; the field cannot be blank.
- Employees Not Working 30 Hours (or FT Hours) a Week.
- Total Full Time Eligible Employees (Line 4 = Lines 1 + 2 - 3)
- Less Those Employees with Qualified Waivers. Employees with qualified waivers for other coverage are deducted at this time.
- Plus Continuants (Not on Wage and Tax). Continuants not on the Wage and Tax Statement are identified and added back in this step.
- Net Eligible Employees. Line 7 = Lines 4 - 5 + 6
- Net Eligible Employees per Census dated. Provide the date of the census being reconciled. The month and the year must be numeric. In the Excel file, right click on the cell for the month, go to Format Cells and in the box that pops up click on the General tab and then click OK. After that, you can enter in a number for the month. You would also do this for the year.
- Number of FTEs in past calendar year for over 50% of work days. Divide the number of hours worked for those part-time Employees under the FTE Hour limit and add to full-time Employees for 20 or more weeks in preceding calendar year. This is the number that must be over 20 to be in the COBRA program; otherwise, State Continuation would apply.
- Max # of Full- and Part-Time Employees employed at one time in past 20 weeks. This calculation looks at the number of Employees for determining if Medicare can be primary. This represents the highest number of Employees reported during a single pay period in the time frame. To qualify as Medicare primary a group must have fewer than 20 Employees on this line and complete additional registration paperwork.
- Participation Rate, must be over 75%. This is calculated line 8 divided by line 7.
- Continuation Program in Effect. If line 9 is over 19 for over 50% of the work days in the preceding year, the group qualifies for COBRA treatment, otherwise, it's State Continuation.
- Medicare Primary. If line 10 is under 20 and the Participating Employer has Employees over 65 and otherwise eligible, they may be able to apply for the Medicare Primary exemption.
A. Average Employee Rate (Rate Sheet). This is the rate being charged by the Plan for each additional enrolled Employee. If there is more than one medical plan, the average Employee rate is based off the plan with the lowest Employee-only rate.
B. Average Enrolling Employee Contribution Rate. This is the amount Employees are required to contribute to Employee-only coverage. Provide only the amounts Employees must contribute to Employee-only coverage and not the contribution cost for family or other tiers of coverage.
C. Contribution Percentage. This should not exceed 75% for Employee-only coverage. This is the percentage of the cost of coverage that is bourne by Employees.
D. Single or Family.