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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

How Does Covered California Determine Group Size?

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Question: The Small Business Fact Sheet on the coveredca.com website states that the SHOP exchange is for businesses with 50 or fewer full-time equivalent employees. On the CoveredCA agent webinar #2, Michael Lujan says that the FTE calculation is only used to determine whether or not a group is subject to the pay or play mandate and that the SHOP is open to any business with 50 or fewer full time employees, not FTE employees. Which is correct? I’ve sent two emails to folks at CoveredCA but have yet to receive a response.

Answer: The FTE method of calculating employees should be used in both cases that you mentioned according to the ACA: (1) to determine group size in the exchange and (2) to calculate the play or pay penalty if any. I don’t doubt that Mr. Lujan may have mistakenly said otherwise with all he had going on. But the exchange itself is inconsistent in their published information on this issue.


Sarah, the exchange is inconsistent on this matter. Quoting yesterday’s SHOP announcement fact sheet - “Small-business owners, with 50 or fewer employees, may enroll in the Covered California SHOP plans”.

So a group with 50 full-time employees, but 60 full-time equivalents, is not eligible to purchase coverage in the exchange at this time?

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