Employee
An individual who is 18 years or older during any part of a calendar quarter, employed full-time or part-time and reported by the employer for purposes of unemployment compensation. If an employee is under the age of 18 during any part of a calendar quarter, he or she should not be included in the calculation for uncovered employees on the HC-1.
Employee - Part-Time
An employee who works for an employer for fewer than thirty hours a week or fewer than 390 hours in a calendar quarter.
- A “week” means a calendar week of Sunday through Saturday. A week of “work” is a calendar week in which the employee in fact worked. This means a week in which an employee is on the payroll but does not actually work is not a week that counts as one of the 20 or fewer weeks allowed by seasonal employees. Likewise, the calendar week is used to determine whether an employee works for 30 weeks or fewer.
- A person is a part-time employee if they qualify using either of the definitions provided for part-time. Because “or” is used by the law, an employee is not required to meet both definitions to be considered part-time.
Employee - Seasonal
An employee who (1) works for an employer for 20 weeks or fewer in a calendar year and (2) works in a job scheduled to last 20 weeks or fewer. Note: Certain part-time and seasonal employees may be excluded from the calculation for the assessment. To exclude an employee from the assessment, both of the following conditions must be met:
- The employer must offer health care coverage to all its regular full-time employees. If coverage is not offered to regular full-time employees, the hours worked by part-time and seasonal employees are subject to the assessment and must be included in the calculation on the HC-1.
- Any part-time or seasonal employee must be covered by some other insurance other than Medicaid. If the person lacks insurance coverage or uses Medicaid, his or her hours are subject to the assessment and must be included in the calculation on the HC-1.
Employer
A person who is required to furnish unemployment insurance coverage by chapter 17 of title 21 of Vermont Statutes.
Please note: The definitions of “employer” and “employee” track with the law relating to unemployment insurance, not withholding requirements. This means some workers will have wages withheld but not be included in the HCFCA calculation and some workers will not be required to have wages withheld but nevertheless be considered an employee for the HCFCA. Most workers will be “employees” for both the withholding and HCFCA requirements.
Health Care Coverage
Any private or public plan that includes both hospital and physician services.
- Although nearly all plans count, there are situations where employees covered by Medicaid or a plan from the Vermont Health Benefit Exchange are considered “uncovered” for purposes of paying the assessment. See “Uncovered Employees” to learn of those situations.
- The HCFCA requires an employer to pay for part of a plan but does not specify how much it must pay. Thus, any amount paid by the employer is acceptable for an employee to be considered covered.
- A Health Savings Account (“HSA”) is not by itself a plan. However, the IRS requires an HSA to be offered with a health plan. An employee is considered covered if the HSA associated plan includes both hospital and physician services and the employer contributes in the HSA.
- A cafeteria plan or flex spending account is not a plan that includes both hospital and physician services. Therefore, an employee is not covered if offered a cafeteria plan or FSA but no coverage paid in part by the employer.