I work for a very large health care company with several thousand employees. I was hired as a pay-per-visit-employee. I have always worked in excess of 30 hours per week however, I am not eligible for the company’s health insurance benefits because I am only a pay per visit employee. Can they avoid the ACA mandate of offering me health care coverage just because of my job classification?


An employer can't refuse coverage to a full-time employee, regardless of job classification, however they can credit hours in such a way that it may not qualify you. For instance an adjunct teacher may only be credited with a fraction of hours, furthermore employers can use year long look-back periods to show you aren't full-time. That being said, it seems like they are on some shaky ground here. The best bet would be to ask them to clarify what rule they are referring to to show they don't need to offer you health insurance due to job classification. Feel free to run it by us when you have that.

Here is some additional information:

"Seasonal employees, contractors, volunteers, educational employees, services provided by student work-study programs, adjunct faculty, and business owners either don’t count toward the total or count toward the total differently. For those who do count toward the total, employers should use a reasonable method of crediting hours of service that is consistent with section 4980H of the IRS tax code."

Generally there is just a fine line between being a "contractor" and an employer using "contractor" status to avoid payroll taxes and providing benefits. Nothing you stated above specifically says you must be one or the other. Check out this article from the Department of Labor. We will collect more facts on this to help better educate people moving forward. Feel free to post more findings below.

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daniel scheible on

Answer Rating:

i am a full time employee. my company has blue cross blue shield but refuses to sign me up. i have heard every excuse imaginable. my medical bills are in the thousands and i have been eligable for 17 months now. im also being penalized by the IRS. i’m confused about my rights.

ObamaCareFacts.com on

For 2015 a large employer only has to insure 75% of full-time employees, starting in 2016 it’s 95%. If you work for a large employer who doesn’t offer coverage you can get coverage with cost assistance through the health insurance marketplace. You may need to have your employer fill out an employer coverage tool https://www.healthcare.gov/downloads/employer-coverage-tool.pdf . Although typically this is used to show an employer offers coverage that isn’t affordable, not that they simply aren’t expanding coverage to you.

The kicker here is that you were supposed to be getting coverage through the private market (including the marketplace) since 17 months ago. Your employer should have made this more clear to you, but they didn’t technically break any laws by not doing this. What you should do is check with your employer if you will be offered coverage before January 1st. If not make sure to enroll in a plan by December 15th of this year to have coverage that starts as early as January 1st of the next year. You’ll owe the fee for this year but can get on the right track starting next year.

You can also go for the long shot and try to explain to the marketplace the situation and see if you qualify for special enrollment.


Rudy myers on

I am employed by a company that offers medical, dental, and vision. However, people were having trouble logging on during open enrollment so they extended the open enrollment by a few days. I was never able to login and I’ve contacted my company at least a half a dozen times and told them that I was never able to sign up for benefits. I still can’t get anyone to help me. What should I do? It’s been a few months now.

Melvin on

My employer refuses to give me my heath insurance for 2016 cause they claim I didn’t meet the deadline when I did. What can be done

Christopher on

I asked my boss for insurance he said no, but I don’t think he’s paying the penalty. How do I repot him to pay the penalty or force him to give me insurance

Erik on

I work in Illinois and my company is out of Indiana. I work over 40 hours a week and my company doesn’t offer any form of health care . I’m in need of a affordable option. Now that I got a family

Shawn M Thaxter on

My new employer offers medical benefits after you have been employed for a year. Can I get insurance through Obamacare in the meantime.

ObamaCareFacts.com on

Yes. The rule for not getting marketplace coverage when you have employer coverage is based on having access to employer coverage. So until you can actually enroll in an employer plan, you can use the marketplace and will qualify for cost assistance based on income.

Denise on

I am a full time employee for large company. For 10 years. I went out on leave and was on disability for 1 year they held my position and kept me in the system. I came back to work in may and was told i wouldnt qet benefits until jan 2021 i didnt work enough hours. They calculated the time i was off on disability Now they say i dont get them for this whole year because again i dudnt work enough hours I have been told to contact corporate which I’ve done and I have written at least 10 emails with no response whatsoever I’ve been trying to get a written policy or written statement as to why I do not get benefits and I have received nothing