Employer Shared Responsibility Worksheet Are you a large employer? You need to know if you are a large or small employer under the Employer Shared Responsibility Requirement, so that you can make the appropriate changes to your health insurance coverage. This worksheet will help you determine the size of your business. Simply follow the steps below using your employee figures from last calendar year. If you have seasonal employees, include them if they were employed for more than 120 days of the year. Find your full-time equivalent (FTE) total for the year Find your full-time employee total for the year For each month, enter the number of employees who worked at least 30 hours a week or at least 130 hours a calendar month, on average. For each month, enter the number of hours worked by employees that worked less than 30 hours a week or less than 130 hours a calendar month, on average. Then, add these together to find your full-time total. Then, total these hours and divide by 120 to find your FTE total. Number of full-time Month employees Number of full-time Month employees Hours worked by part-time Month employees Hours worked by part-time Month employees January July January July February August February August March September March September April October April October May November May November June December June December ÷ Total yearly hours for part-time employees Full-time total Calculate your employee total 120 = FTE total Find your yearly total by adding your full-time employee and FTE totals. Then, divide by 12 to get your employee total. This is the number you will use to determine if the Employer Shared Responsibility Requirement applies to your business in 2015. + Full-time total = FTE total ÷ 12 Yearly total = Employee total If your employee total is Less than 100 The Shared Responsibility Requirement does not apply to your business in 2015. Keep in mind, you will need to recalculate again in 2015, when the definition of large group employers changes to 50 or more. 100 or more You are subject to the Shared Responsibility Requirement in 2015. Make sure you understand how this impacts your group coverage in 2015. Blue Cross of Northeastern Pennsylvania is a Qualified Health Plan issuer in the Federally Facilitated Marketplace. Blue Cross of Northeastern Pennsylvania administers health care plans offered by Blue Cross of Northeastern Pennsylvania, Highmark Blue Shield, First Priority Health® and First Priority Life Insurance Company®. IND362-EMP-WS 5/14 © Blue Cross of Northeastern Pennsylvania. 2014