Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 001 - GENERAL; HEALTH BENEFITS ELIGIBILITY AND ENROLLMENT › Chapter 006 - PART SIX: SMALL EMPLOYER HEALTH-BENEFITS PROGRAM › Section 13 001 006 - PART SIX: SMALL EMPLOYER HEALTH-BENEFITS PROGRAM

Current through June, 2024
Section 31.00
				Definitions
(01/15/2017, GCR 16-099)
As used only in Part Six, the following terms have the
				  following meanings:
Annual employee open enrollment period [1 ]
A period in which a qualified employee enrolling in a
				  qualified health plan through Vermont Health Connect (VHC) may:
(a) Create an account;
(b) Select QHPs, and if offered by the
				employer, stand-alone dental coverage for himself/ herself, and dependents, if
				the qualified employer offers coverage to dependents;
(c) Complete the employee eligibility and
				enrollment application;
(d) Receive
				assistance from VHC in completing the application;
(e) Estimate whether the coverage offered by
				the employer meets applicable federal affordability standards, by
(1) exiting the employee application;
				and
(2) submitting an application
				for individual eligibility determination for affordability assistance to
				purchase coverage as a qualified individual;
(f) Designate an authorized representative
				according to Section 5.02.
The annual employee open enrollment period shall precede the
				  end of the employer's current plan year and shall follow the annual employer
				  election period.
Annual employer election period [2 ]
The employer election period comes before both the employee
				  open enrollment period and the completion of the employer's current plan year.
				  During the employer election period, the qualified employer may change its
				  participation in VHC for the next plan year, and elect the following:
(a) The employees to whom it will offer
				coverage;
(b) Whether to offer
				coverage to the qualified employee's dependents, and the coverage tiers to
				offer, i.e., single, two-person, adult plus dependent, or family;
(c) Whether to offer stand-alone dental
				coverage;
(d) Whether the
				individual owners, partners, retirees, or others will participate in a plan
				offered to employees;
(e) During
				the election period employers will be able to go on the VHC website and use the
				available tools for assistance in deciding whether to offer their employees
				group health coverage.
(f) The
				method by which the qualified employer makes QHPs available to qualified
				employees (see: employer choice, section 34.00 ); and
(g) The amount of its contribution towards
				the premium cost of each coverage tier for each class of participant.
Dependent
Any individual who is or may become eligible for coverage
				  under the terms of a group health plan because of a relationship to a
				  participant. [3 ]
Employee [4 ]
Any individual employed by an employer. An employee does not
				  include an individual and his or her spouse with respect to a trade or
				  business, whether incorporated or unincorporated, which is wholly owned by the
				  individual or by the individual and his or her spouse, and does not include a
				  partner in a partnership and his or her spouse.
Employer [5 ]
(a)
				The term "employer" means any person acting directly as an employer, or
				indirectly in the interest of an employer, in relation to an employee benefit
				plan.
(b) Such term includes
				employers with one or more employees, and
(c) All persons treated as a single employer
				such as a controlled group of corporations; partnerships, proprietorships,
				etc., which are under common control; affiliated service groups; and other
				arrangements such as separate organizations and employee leasing arrangements.
				[6 ]
Full-time employee [7 ]
(a) An employee who is employed on average at
				least 30 hours of service per week, for effective plan years beginning on or
				after January 1, 2014.
(b) For
				purposes of the definition of small employer, full-time employee does not
				include seasonal workers.
(c) For
				purposes of the definition of qualified employer, full-time employee does not
				include seasonal employees.
Qualified employee [8 ]
An employee made eligible to enroll in coverage through VHC
				  through an offer of coverage from a qualified employer.
Qualified employer [9 ]
A qualified employer is a small employer that:
(a) Has its principal place of business in
				Vermont, and elects to provide coverage for all fulltime employees of such
				employer through VHC, regardless of where an employee resides; or
(b) Elects to provide coverage through VHC
				for all of its full-time employees who are principally employed in Vermont, and
				if not principally employed in Vermont, to each full-time employee through the
				small business health options program (SHOP) serving that employee's primary
				worksite.
Seasonal employee [10 ]
The term seasonal employee means an employee who is hired
				  into a position for which the customary annual employment is six months or less
				  and the employee does not have any hour of service for the employer for a
				  period of at least 13 consecutive weeks before resuming employment
Customary means that by the nature of the position an
				  employee in this position typically works for a period of six months or less,
				  and that period should begin each calendar year in approximately the same part
				  of the year, such as summer or winter.11
In certain unusual instances, the employee can still be
				  considered a seasonal employee even if the seasonal employment is extended in a
				  particular year beyond its customary duration (regardless of whether the
				  customary duration is six months or is less than six months). For example, if
				  ski instructors at a resort have a customary period of annual employment of six
				  months, but are asked in a particular year to work an additional month because
				  of an unusually long or heavy snow season, they would still be considered
				  seasonal employees.12
Employers may but are not required to provide seasonal
				  employees with coverage for purposes of being a qualified employer.
Seasonal worker [13 ]
An employee who performs labor or services on a seasonal
				  basis, including ordinarily, when the employment pertains to or is of the kind
				  exclusively performed at certain seasons or periods of the year and which, from
				  its nature, may not be continuous or carried on throughout the year. A worker
				  who moves from one seasonal activity to another, while employed in agriculture
				  or performing agricultural labor, is employed on a seasonal basis even though
				  she may continue to be employed during a major portion of the year. Seasonal
				  workers include retail workers employed exclusively during holiday
				  seasons.
Seasonal workers are not counted when determining whether an
				  employer is a small employer.
Small employer [14 ]
(a) For plan years beginning on or after
				January 1, 2014 through December 31, 2015, an entity which employed an average
				of at least 1 but not more than 50 full-time employees on working days during
				the preceding calendar year and who employs at least one employee on the first
				day of the plan year.
(b) Beginning
				on January 1, 2016, an entity which employed an average of at least 1 but not
				more than 100 employees on working days during the preceding calendar year and
				which employs at least 1 employee on the first day of the plan year. The number
				of employees shall be calculated using the method set forth in section
				4980H(c)(2) of the Internal Revenue Code; in general, by:
(1) Counting each full-time employee as one
				employee;
(2) Adding the number of
				hours worked by part-time employees in a month and dividing by 120;
				and
(3) Excluding seasonal workers
				if the employer's workforce exceeds 50 full-time employees for 120 days or
				fewer during the calendar year.