NDPERS has provided information regarding the Affordable Care Act (ACA) to assist employers with their eligibility and reporting requirements. Employers should seek legal guidance on employer specific questions to ensure compliance with the ACA.
To ensure compliance with the Affordable Care Act (ACA) and to monitor your ongoing eligibility in the grandfathered plan, you must notify NDPERS 90 days prior to implementing any changes in your employer contribution rate.
Based on the ACA, your organization can lose eligibility to participate in the NDPERS grandfathered plan:
a. If the organization reduces the employer contribution rate by more than 5% of the contribution rate that was in effect on March 23, 2010.
b. If, at least, 1 individual is not continuously covered on the employer plan since March 23, 2010.
Transitioning Out of the NDPERS Health Insurance
If it is determined that a reduction of the employer contribution or a lapse in coverage will result in the plan losing its grandfathered status, the options for the political sub-division will vary.
Large Employer (Minimum 51 employees)
If the employer is a large employer as defined by the ACA as 51 or more employees, NDPERS will automatically transfer your group to the non-grandfathered plan. Your monthly health premiums will be adjusted accordingly. If this occurs, written notification will be provided to the employer.
Small Employer (50 or less employees)
If the employer is not a large employer as defined by the ACA as 51 or more employees, then your group is considered a small employer group. Your organization will lose eligibility to participate in the NDPERS group health insurance. As the employer, you will receive written notification stating the last date of coverage for your group. You will need to explore coverage options with carriers in North Dakota or can visit the Insurance Marketplace for ACA compliant coverage.
Participation Guidelines for Political Subdivisions
Political subdivisions electing to participate in the NDPERS group health insurance (Plan), must meet the minimum participation and contribution requirements established on May, 1 2004.*
Each November, the NDPERS health insurance carrier verifies that each participating political subdivision continues to be eligible to participate of the Plan and may contact your organization for additional information.
Any organization participating in the Plan, must ensure that a certain number of eligible employees participate in the Plan based upon the size of the eligible employee population.
Minimum Employer Contribution
Effective May 1, 2004, organizations enrolling in the Plan on or after this date, must contribute at least 50% of the single health insurance monthly premium for each participating employee.
*Any organizations participating in the Plan prior to May 1, 2004, are not subject to these requirements. However, if an organization was compliant on May 1, 2004, it must maintain compliance. This means, the organization cannot change the employer contribution toward health insurance premiums to be less than 50% of the single monthly rate.
These requirements prevent adverse selection impacting the Plan, which could increase the premiums for participants.
- ACA Decision Chart
- Federal Register
- Outline of Regulation with Page Numbers
- Fact Sheet
- ACA Questions
- Notice of Coverage Options
- Acknowledgement of or Decline Offer of Health Insurance Coverage (SFN 60711)
- Benefit Enrollment Report - Employer Self Service (ESS).
- OMB Memorandum