Plan Groups, part of the ACA Coverage Tracker within Dynamics Payroll Inspector (DPI), allow you to segment employees based on coverage eligibility and assignment rules. Creating Plan Groups ensures each employee is assessed correctly for health insurance coverage under the Affordable Care Act (ACA).
Accessing Plan Group settings
You can create a Plan Group by navigating to the settings screen for the ACA Coverage Tracker in Dynamics Payroll Inspector. Scroll to the bottom of the settings page to find the Plan Groups section.
Creating a new Plan Group
Select Add New Plan Group and provide a name that reflects the group of employees it applies to (ex: 'Hourly Coverage Plan' or 'Seasonal Staff Coverage'). This helps distinguish groups based on employee type, benefits, or eligibility.
Defining Plan Group Deduction Codes
Select the desired Deduction Code(s) on the left and use the arrow to move it to the right. Codes can only be associated to one plan group; if a code is greyed out, it has already been added to a plan. Once you have moved the Deduction Codes to the right, use the drop down for each code to determine the coverage level.
Note: If an employee is associated to a Benefit Code only, rather than a Deduction Code, the Benefit code’s information will be used and the employee premium is assumed to be $0.00. In this case, make sure that the Master Deduction Code is the same as the Benefit Code.
Self-Insured, Conditional Offer, or MEC and MV
After defining the plan group deduction codes and coverage levels, you will need to identify whether this group is self-insured, if it is a conditional offer of spousal coverage, and if the group meets the requirements for MEC and MV.
Plan Groups – Self-Insured Health Coverage
An employer that offers health coverage through a Self-Insured health plan must report information about each employee (full-time and non-full-time) who is enrolled in such coverage.
Employers/ALE Members that offer health coverage through an employer-sponsored self-insured health plan must complete Form 1095-C, Parts I, II, and III, for any employee who enrolls in the health coverage, whether or not the employee is considered full-time for any month of the calendar year.
Enrollment information must be reported within Part III for Covered Individuals on Form 1095-C, for ANY employee who is enrolled in coverage and any spouse or dependent(s) of the employee.
Plan Groups – Conditional Offer of Spousal Coverage
A Conditional Offer is an offer of coverage that is subject to one or more reasonable, objective conditions Example: an offer to cover an employee’s spouse only if the spouse is not eligible for coverage under Medicare or a group plan sponsored by another employer.
By indicating Yes, the new Line 14 codes 1J or 1K, will be used to report a conditional offer to spouse as an offer of coverage, regardless of whether the spouse meets the reasonable, objective condition.
A conditional offer generally would impact a spouse’s eligibility for the premium tax credit under section 36B only if all conditions to the offer are satisfied. To help employees who have received a conditional offer determine their eligibility for the premium tax credit, the ALE Member should be prepared to provide, upon request, a list of any and all conditions applicable to the spousal offer of coverage.
Plan Groups – MEC and MV
Minimum Essential Coverage (MEC)
Minimum Essential Coverage is a requirement of the Affordable Care Act, and all plans setup within the Dynamics Payroll Inspector must comply with this requirement. Therefore, the checkbox for Minimum Essential Coverage cannot be unchecked.
Minimum Value (MV)
A plan provides Minimum Value if the plan pays at least 60% of the costs of benefits for a standard population and provides substantial coverage of inpatient hospitalization services and physician services. An offer that fails to provide substantial coverage should be reported on Form 1095-C as not providing minimum value.
Offer effective dates and cost
This is an optional step; Dynamics Payroll Inspector will attempt to use the current cost for an HR Benefit code or Deduction code from the respective setup cards in GP.
As the employee-only costs for a group of coverage codes change, the costs can be updated with this step. The amount entered in this step will override any amount that comes from GP for any employees on these plans in the set up date range. These costs will not sync back to GP.
Defining eligibility criteria
A group of employees can be defined using Employment Type, Employee Class, Position, and/or Work Location. Employees in the defined group are assumed to have been offered coverage for this group of plans.
This setting is beneficial if the company does not have full offer details and/or deduction/benefit codes properly assigned to employees in GP. Employees may be included in multiple Plan Groups since they may be offered several different groups of plans to choose from.
Choosing to manually include an employee a Plan Group will not override any other Plan Group that they may be included in due to benefit/deduction code assignments in GP. Assigning these manual offers will not sync back to GP; they are only used for generating accurate 1095-C reporting in the Payroll Inspector.
Managing and editing Plan Groups
Once saved, your group will appear in the Plan Groups list. You can return to this screen at any time to modify group names, eligibility criteria, or associated codes. Changes take effect during the next tracker scan.