The answer to this question is not straightforward, as it depends on several factors, such as the state where the substitute teacher works, the number of hours they work per week, the type of contract they have, and the policies of their school district. In general, substitute teachers may or may not get health insurance, depending on their eligibility and availability of coverage. In this article, we will explore some of the aspects that affect the health insurance status of substitute teachers in the United States.
Understanding the PPACA Mandate for School Districts
The 2010 Patient Protection and Affordable Care Act (PPACA), popularly known as Obamacare, is one of the primary sources of health insurance for school workers. The Supreme Court affirmed it in 2012. Large companies, including school districts, must provide health insurance to full-time workers and their families or pay a penalty under the PPACA. A full-time employee under the PPACA works at least 30 hours per week or 130 hours per month. Under the PPACA, substitute teachers who work 30 or more hours per week for 120 days or more are deemed full-time and eligible for health insurance.
The PPACA also authorizes employers to adopt a “look-back measurement method” to verify full-time status, notably for variable-hour workers like substitute instructors. This strategy allows firms to monitor their workers’ average hours over a 3-12 month period and then provide them coverage for a six-month “stability period” if they are full-time. A school district may measure the previous school year (September to June) and give health insurance to substitute teachers who worked 30 or more hours per week for the following school year.
Employers must also provide “affordable” health insurance that fulfills a “minimum value” criterion of 60% of benefit costs under the PPACA. If the employer does not provide such coverage and the employee is not qualified for Medicare or Medicaid, a state or federal exchange may offer subsidized health insurance. The company may be fined $3,000 per year for each employee who gets exchange-subsidized coverage.
Differences in State Policies
The PPACA provides minimum health insurance standards for school workers, however, certain states have rules that influence substitute teacher coverage availability and pricing. For instance, Washington State’s School Personnel Benefits Board (SEBB) Program and California’s Education Code Section 7000 provide health benefits for school personnel. Others’ laws change the definition of a full-time employee or give substitute instructors with health insurance incentives or subsidies. State health insurance coverage for substitute teachers varies:
California Substitute Options
Without working 30 hours per week for 120 days per year, California substitute teachers are not eligible for PPACA health insurance. Some school districts may provide health insurance to substitute teachers who work fewer than 30 hours a week, depending on collective bargaining agreements or local rules. Some districts provide health insurance to substitute teachers who work 20 or more hours per week or a specified number of days per month or year. Some districts, like Fresno Unified School District, provide health, dental, and vision insurance to unionized substitute teachers.
California law also enables substitute teachers to get health insurance from CalPERS, which provides health benefits to state and municipal government workers. California Education Code Section 7000 mandates school districts to provide substitute teachers the opportunity to join in CalPERS health insurance and pay the entire price if they work at least 100 days per year. The bill also compels school districts to record substitute teachers’ days worked to CalPERS and advise them of their health plan eligibility.
Benefits for Permanent Substitutes
Some school districts may hire permanent substitute teachers, who are assigned to a specific school for the entire school year, and report to work every day, regardless of whether a regular teacher is absent or not. Permanent substitute teachers may have different contracts and benefits than regular substitute teachers, depending on the district and the state. For example, some districts may offer permanent substitute teachers a higher pay rate, a guaranteed number of hours or days, and health insurance. Other districts may treat permanent substitute teachers as regular employees, and offer them the same benefits as other full-time teachers, such as retirement, sick leave, and professional development.
Substitutes Covered under the SEBB Program in Washington State
The 2017 SEBB Program started offering health insurance to substitute instructors in Washington State in 2020. School workers get statewide health benefits via the Washington State Health Care Authority’s SEBB Program. The SEBB Program determines eligibility, authorizes premiums, and provides medical, dental, and vision coverage to over 130,000 state school district, charter school, and educational service district workers.
Full-time employees in the SEBB Program work at least 630 hours every school year, or 17.5 hours per week. This implies that SEBB Program health insurance is available to substitute instructors who work 17.5 or more hours per week for a school year. If they work for various school districts in a month, the SEBB Program lets substitute instructors combine their hours. So, substitute teachers who work fewer than 17.5 hours per week in one district but more than 17.5 hours per week overall may still qualify for SEBB health insurance.
Substitute teachers who work at least 630 hours but do not enroll in health insurance during the first open enrollment period may participate in the SEBB Program. These substitute instructors may enroll in health insurance during the following annual open enrollment period or 60 days after working 630 hours, whichever comes first. The SEBB Program offers continuous coverage for substitute instructors who lose health insurance due to job loss or reduced hours. These replacement instructors may keep their health insurance for 18 months provided they pay the full rate.
