leevena

What is a PRP?

As I read the reply by Chaz, I had a knee-jerk reaction to agree with his two comments. But as I thought about it more it may not be that big of a problem. There is not enough information for us to give you a definitive answer, but you might pass the 125 discrimination testing. If all of the employees were to be offered the 125 plan, the salespeople have the greatest incentive to join it becasue they pay the most for their premiums. The current employer contribution is 80% for the self-funded and 20% for the fully-insured. There is a high probability that most of the HCE's and Key are in the self-funded. And becasue the fully-insured participants contribute 80% of the cost, there is $4 of fully-insured premium going into the plan for every $1 for the self-funded.f What I do agree with and strongly suggest, is that you get some competent person to review the details and make a recommendation for you. Good luck.

I would agree with masteff. Here is a link to irs. www.irs.gov/pub/irs-tege/fringe_benefit_fslg.pdf Good luck.

Nobody would "want" to do that, but if you are following Section 125 that would be the only available option of a mid-year change (sure, employee can cancel medical insurance if carrier allows it, but they have contracted with employer to have pre-tax deductions taken out for the entire year, unless they have a qualifying event). Hoosier is correct. As for why would someone do that, don't know. My best guess is that the employee and the HR department was unaware of this requirement. An employee cancels the medical/dental, the HR cancels the deductions and now is technically in violation of Section 125. Unless the Section 125 police are notified...

They are not paying the funds to the carrier, the funds that are deducted become assets of the plan. It's the risk the employee takes.

I don't see anything wrong with the policy as long as the pre-tax deductions continue. The Section 125 rules apply to the deduction and favorable tax treatment.

This is the first I have heard about this, and could not find anything about it either. Are you sure the person was discussing all HRA's or just the use of HRA's to fund individual plans? Treasury is most concerned about using HRAs to fund individual policies but the representative seemed to take the position that any HRA not linked to a medical plan will be subject to PPACA's market reforms on annual and lifetime limits. The way I understood stand-alone's is that they are permissable if there is a cap on the roll-over amount and you should keep long term care premiums out of it. Is this not true, or do you think it may be that there is so much confusion out there?

This is the first I have heard about this, and could not find anything about it either. Are you sure the person was discussing all HRA's or just the use of HRA's to fund individual plans?

HRA's reimburse employees for out-of-pocket medical expenses and individual health insurance premiums. So there does not need to be a corporate sponsored health insurance plan in place, nor an individual health plan in place either. I would suggest doing a little research, google and you will find many vendors. Also, go to the IRS website.

this is very difficult to do without losing control of the companies they restructure. what I believe will happen to many of the smaller groups that are over 50 lives, is that they will begin to limit the number of full-timers and increase the number of employees who work below the threshold for coverage. Since the key hours number is 30, my guess is that they will start to target 25 as a maximum number of hours per.

I am a health guy and I don't how this affects retirement, so go easy on me. lol Employers with 50 or more are now requried to define 30 hours or more per week as a full timer. My guess is that many employees will now begin to see their hours worked reduced, with employers targeting a safe level of hours to be 25 or so. My guess is that this will reduce the number of employees eligible for retirement benefits. Also, I see an uptick in the number of outside consultants or independent contractors being used.

If this group is self-funded, then the insurance company is not responsible. You need to work with the plan administrator.

There is no requirement for someone to join a plan, free or not. No law, including ERISA states this. No need to give them the money instead either.

For 2014 IRS 4980H requires each large employer to either offer at least 95% of its full-time employees health coverage, not their dependents. Send me your email address via the message function here and I will forward to you a document.

Don't know I am answering what you want to know, so I apologize ahead of time. 1. The employer mandate does not require coverage for all dependents, it requires plans to offer coverage to children to 26. So it is possible for the employer to offer medical coverage to just employees, dependents to 26 and not any spouses. 2. You are correct regarding the penalty, it is triggered when an employee enrolls at the exchange and receives the subsidy. Does this answer your question(s)?

Yes because PPACA does not draw a distinction between union and non-union. Other than some minor Grandfathering issues, all of PPACA applies to union plans. By the way, Union H&W plans have concerns about PPACA. Their concern is that their membership would leave their plan and go to the Exchange. These types of plans are usually closed to non-union members and as such cannot participate in the Exchange. It will be interesting to see if some accommodation is made. Just some food for thought.

You are missing; Mental Health/substance/behavioral, rehabilitattive and habilitative, preventive/wellness/chronic disease mgt, and pediatric.

I believe (99% sure) that grandfathered plans can deny coverage to these types of dependents if they have access to coverage at their employer. Assuming that the grandfathered plan has a "students covered to age xx" in their plan, this would explain why the administrator is asking.

The $5,000 is per household, not individual/child.

I'm getting no where with the insurance company. It's hit or miss that I receive reimbursement checks. What specialty lawyer would I contact to assist me with getting the insurance company to comply with a QMCSO? Sorry to hear about your frustrations. Hard to say what type of attorney you will need. If you do not get a recommendation from anyone, you may want to try researching/calling attorney's in your area. Even if they will work in this field, you may find some that don't want to litigae.

This is an interesting question, and I agree with the earlier post that I have not seen anything specifically addressing this issue. But based on what I have seen, and the intent of the law, I don't know if I were the employer I would drop the child in question. Let me explain. 1. The intent of PPACA was to get people insured. For a company to drop a dependent at the request of the parent, and then have the dependent want coverage, seems like a formula for disaster. 2. Reading the definition of who is eligible, it states that the "group plan or health insurer must base eligibility for dependent child coveage in terms of the relationship between the child and the participant (or primary subscriber) and may not deny or restrict coverage based on factors, such as financial dependency on the participant (or primary subscriber),etc. I receive many newsletters/opinions from legal firms and many describe the relationship as between the carrier and the dependent. For example, The new regulations provide that effective for plan years beginning on or after September 23, 2010 (effective date), any group health plan or group health insurance issuer (plan), which provides coverage to dependent children must make coverage available to dependent children until they have attained the age of 26. So, nothing definitive, but as I start to read more about this subject, I would be leary about dropping the kid. Hope this helps.

Thank you for your thoughts. Let me ask it another way. Does anyone tell participants in their open enrollment materials that the employer does not monitor the limit? I don't and I am not aware of anyone else who does. When the issue is brought up (usually with an employer) I tell them it is between the IRS and the employee. Usually the question is asked within the context of an employee who overcontributes due to the employee making a deposit outside the employer normal deduction/remittance process.

But can you consider the HRA linked if you are not permitted to be in the base health plan? I just re-read and saw the "unlinked" in your posting, sorry. I don't know the answer to that. There are other options other than an HRA that can be used to fund this, so they may choose another route, or just simply drop it all together. Don't really know yet. Sorry.

Time will tell since not all of the guidance/regulations have been released. But based on what the regulatory agencies have announced so far, this could very well continue. The HRA can have a limit if it is integrated with another plan and that plan's coverage alone complies with PPACA annual and lifetime requirements.

I am not an expert on this, but I do know that the issue will between the employee and the IRS. I do not believe the employer has any liability, but only 95% confident. You may have a discrimination issue with the 125 plan, all depending on the size, take up rates, etc.