leevena

You are required to provide a copy of your SPD(s) to all employees. If an employee is asking a specific question about a particular coverage, such as vision, I would send them a Summary of Benefits and Coverage, but you can always send another SPD.

An employer does not need to offer more than a single group health plan. Does this answer your question?

Not enough info to give a definitive answer, but it is possible. Would at least need to see the spd and the EOB for reason of payment. Remember, not all group health plans need to offer EHB’s.

I agree, see IRS publication 502 on eligible expenses.

I do not believe the issue of commissions is relevant. I reviewed the instructions on the IRS website, indicates the requirement is a plan provided through insurance contract, Blues, etc. https://www.dol.gov/sites/dolgov/files/EBSA/employers-and-advisers/plan-administration-and-compliance/reporting-and-filing/form-5500/2019-instructions.pdf

Disclaimer, I am not an attorney and am going on what I have learned and remember from over the 37 years as a group rep. I believe you can amend the plan as you suggest. sorry, having issues copying links, here is something from a source, Flexbenefit.com. Google “premium only plan non discrimination” and you will find more. Good Luck, Lee But there is some good news for POP plans! Employers will get an automatic pass of the three non-discrimination tests if they can satisfy one simple requirement. If the ratio of non-highly compensated employees participating in the POP plan compared to the ratio of highly compensated participating in the POP plan is 50% or greater, the employer will be treated as passing all of the non-discrimination tests. Okay, maybe that actually sounds complicated, but it’s pretty simple to understand once you’ve seen an example. The following information applies to XYZ Company: 100 non-highly compensated employees 60 participate in the POP plan (60 / 100 = 60%) 30 highly compensated employees 25 participate in the POP plan (25 / 30 = 83.33%) We’re not done yet. There is one more math problem to calculate: 60% / 83.33% = 72.03% 72.03% is greater than 50% so XYZ Company automatically passes the three non-discrimination tests. It would probably be more appropriate to say XYZ Company does not have to conduct the tests relating to contributions and benefits or key employee concentration because the IRS is comfortable that enough non-highly compensated employees are eligible and participating in the POP plan. Employers that satisfy the 50% ratio are considered to have met the POP plan “safe harbor test for eligibility.” If the ratio is less than 50%, the employer doesn’t necessarily fail the non-discrimination testing. They might even be able to pass this test with a ratio that is less than 50%. The ratio to pass actually gets smaller as the concentration of non-highly employees participating in the POP plan increases. However, at a high level, understand that a ratio of 50% or greater will guarantee a pass for any employer.

If an employer offers a Premium Only Plan (POP), the only testing that needs to be done is the Eligibility. Assume that there are 2 HCE’s and all the other employees are offered coverage, then it appears to me that this plan is in compliance.

Chaz is correct. By way of example, I am hired on Jan , have a waiting period of 60 days, and become eligible on March 1. I have been at work since Jan 1, but injure my back on Feb 27 and am in the hospital on March 1. The employer cannot deny my coverage becoming effective Mar 1 because I am not at work due to a health factor. By way of another example, I am hired Jan 1, with an immediate eligibility. Work is closed that day, I cannot report, therefor my coverage will be delayed until the first day that I work, presumable Jan 2. Some actively at work definitions do not meet the HIPPA requirements.

Great story

Not needed. We do keep a record of who was given a notice, copy of notice, and date.

True. Happy New Year.

A little confused, I have never heard of a “dependent beneficiary” as a term. Is the stepmother asking to add the child as a beneficiary or is she asking the for dependent life insurance coverage for the child?

I agree with Brady, doubt if it would work in this situation.

Little confused, sorry. Are you asking about having the plan pay for medical expenses that are not eligible? If so, it is determined by the plan administrator. That is how I understand the question.

The use of a forum such as this does not lend itself to answering this question easily. There is too little info provided. Might be better to discuss with a competent advisor in person. Short answer, an opt-out is allowable, but there are many variables that need to be taken into account when designing. I do not believe I understand the scenario you outlined. Are you saying the opt-out is only available to employees who were participating in the plan during the previous plan year? Or to say another way, to be eligible for the opt-out the employee must take the health insurance for one year? If this is true, I doubt if it meets the requirements, but again, too many missing pieces to give you a definitive answer. Or are you asking if an opt-out is allowable?

Based on what you have outlined above, it is illegal. The key here is the fact that the employer offers a group health plan. Option could be to up their compensation.

I do health, and agree with Peter. Have never seen any requirement for this in the health market. Ask for proof.

5500 filing requirement is dependent upon the number of “participants” in the plan, so based on what you have outlined it appears to be yes. Voluntary plans are a non-Erisa plan if there is no sponsorship by employer. But, assuming their dental plan is a voluntary plan, with employer contribution for some/all participants, the employer contribution causes the plan to become Erisa.

It’s been a long time since I learned this, and I cannot remember any source for you to reference, sorry. But the employer is correct in denying the employees’ request. I confirmed this with a friend in the HR department of a large, national company. Like me, she could not remember the source, but her company would deny the request too.

No, individual medical premiums cannot be run through a 125 plan. Also, keep in mind part-timers probably do not qualify as an eligible employee anyway.

Did some thinking about your question over the last few days and may have an answer for you. Some plans will cover this and some will not. If you want to know about your plan you should read the summary plan description for specific wording about surrogacy expenses. I would not rely on the prohibition of occ illness clause for this one. Good luck.

I actual agree with GBurns and the separate counsel. As GBurns correctly states that if the plan prohibits occupational you should be ok. But as I read your statement about the counsel, it occurred to me that he/she may have a point. It is possible that the employee could submit, and have paid, a medical expense that was caused by my other job. It would be near impossible for the employer to know about the true reasons. The definition of ineligible expenses should be written very clearly, with wording stating something along the lines of “arising from the course of employment, profit, etc. Not being able to see the definition for your plan I cannot state with certainty, but if the definition is weak the attorney may have a point.

My bad. When you wrote “ the definition and eligibility of any employee health whether insured, or self-Funded is determined under IRC 105” I took it to mean something entirely different. It sounded as if you said Section 105 discussed what these plans did and how employees would be eligible for such plans, when in fact you were discussing the deductibility of each. Thanks.

I have never heard this before, and have my doubts about it too. Could you please explain in more detail?

What is a cafeteria plan? Below is a cut and paste from IRS site. They are 2 different plans. A cafeteria plan is a separate written plan maintained by an employer for employees that meets the specific requirements of and regulations of section 125 of the Internal Revenue Code. It provides participants an opportunity to receive certain benefits on a pretax basis. Participants in a cafeteria plan must be permitted to choose among at least one taxable benefit (such as cash) and one qualified benefit. A qualified benefit is a benefit that does not defer compensation and is excludable from an employee’s gross income under a specific provision of the Code, without being subject to the principles of constructive receipt. Qualified benefits include the following: Accident and health benefits (but not Archer medical savings accounts or long-term care insurance) Adoption assistance Dependent care assistance Group-term life insurance coverage Health savings accounts, including distributions to pay long-term care services The written plan must specifically describe all benefits and establish rules for eligibility and elections. A section 125 plan is the only means by which an employer can offer employees a choice between taxable and nontaxable benefits without the choice causing the benefits to become taxable. A plan offering only a choice between taxable benefits is not a section 125 plan.