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Should not because it appears that the HRA you are considering is a stand-alone and not integrated into the health plan.

Chaz is correct. I would question the effectiveness of this program. The idea that someone would visit a nurse practitioner for a well visit strikes me as a win for the NP (income)and a lose for the employee. What would the NP do, a check-up? To what end? The chance of finding something is very slim. Seems to me that if the employer wanted to provide something of value, this would not be the way to go. Perhaps he should consider another benefit, such as dental, life, DI, etc.

See IRS Notice 2013-54 for the details. It can, but has restrictions.

The non-discrimination rules, which many believed would follow the self-insured non-discrimination rules, were never issued. However, there were rules released as it pertains to non-discrimination of groups of people, such as genetics, LBGT etc. Hope this helps.

Yes. To me she is saying that the medical eligibility and the fsa eligibility are the same, which is usual.

Lou S is correct, what is the eligibility definition in the SPD? Usually the definition is 30+ hours. If so, and if the employer would like to allow for 20+, the plan sponsor will need to amend the SPD.

Change in Status 26 CFR §1.125-4©(1)(i) See above.

With all due respect, I believe you are incorrect. Please provide back-up references to your statements. To begin with, a change in number of employee's dependents (birth, adoption, or placement for adoption)is a qualifying event that may allow an employee to change their elections mid-year. Additionally, your statement "and whatever the plan says or doesn't say you need to interpret it with the limitations in those regulations in mind." is also incorrect. While the IRS does not require mid-year election changes, sponsors are allowed to adopt plan provisions that do allow these changes.

QDROphile is correct, you need to review the 125 plan spd to determine which changes are allowed and which changes are not allowed. However, you may have a bigger issue here, that of what the carrier will allow. Check with the health plan spd/plan documents and with the carrier also. The employee may need to wait till OE.

Maybe I am wrong, but I assumed that the coverage offered satisfied both the affordability and MV. So if the employee was offered affordable and MV coverage on 1/1 and turned it down, the employer cannot be penalized.

I believe you may be confused on the penalty issue, (The rule is quite clear that coverage must be offered to the formerly part-time now full-time employee by the end of the required period (to paraphrase) in order to avoid a penalty) because the penalty is applicable if someone from the group obtains a credit via the exchange. It is possible, though not probably, that an employer could offer a plan of benefits that is not affordable nor meets minimum value and not get fined. If no one obtains the credit, than the employer is ok. That being said, and I am not an attorney, but I believe the employer is ok because they offered the plan to the employee before they were required to offer.

Sorry, but a little confused. If the employee has been offered coverage already because of the 20-hour minimum for coverage, why is there any concern? What am I missing?

thanks so much.

Here you go. https://www.dol.gov/general/topic/health-plans/planinformation

I am not an expert on this matter, but something did jump out at me. I thought all FSA's could only be funded with employee monies? If that is the case, how can the HRA monies be used? My vote would be a 1/2 of no.

IRS set out their rules for this in 2013. I saw a few vendors/administrators hawking their solution to this issue via other avenues, but they always fell flat. As for reading the right articles, best I can suggest is what I do. I have subscribed to all of the govt sites ( IRS, DOL, HHS) for their email updates. There are a few industry sites (benefitslink and others) that provide articles, and a few law firms for their updates. Good luck.

You should investigate a Section 105 option, I do not keep up with this anymore, but it might be a better fit. Suggest you use an administrator that does this, such as Core or some other.

I am from the health side, so I cannot comment on retirement issues. Agree with comments made about hiring someone with experience if you do not already have someone. As a former CEBS instructor, I can tell you that "book learning" is only part of the equation. There is only so much that educational programs can provide. Over the years I have found that sites such as DOL, IRS, Law Firms, SHRM, etc. have provided better information because they tend to describe issues in terms of implementation and often times discuss the pitfalls to avoid.

Doubt if there are many benefits guys on this site, seems to be mostly retirement. Yes, you are correct about community rating, but to a point. When there are other options available in that market, say for example self-funding, the good risk will exit the community-rated pool and migrate to the lower cost option(s). The effects on this can be devastating. A case in point is the PacAdvantage model from California which lasted about 10 years. With multiple carriers competing for small group business via an exchange the death spiral began as some carriers "pool" became populated with higher cost due to the built in adverse selection characteristic of the program. As they raised their premiums to cover the cost, good risk began to flow to the other lower cost carriers. Eventually the carrier would exit the exchange. It all started again, with the new "high cost" carrier, and so the cycle continued until closing down. Yes, the small groups struggle with this constantly, but keep in mind the old 80/20 rules. In group health more than 80% of the claim cost comes from less than 20% of the group population. Just like the PacAdvantage, the better risk (employees) drop coverage. Problem is they represented very little claim cost and a larger premium cost.

Does this mean a health insurer may nonrenew a group contract (perhaps one that had its initial enrollment in an open-enrollment period) merely because an insufficient number of eligible employees choose coverage? Yes. Is it fair that a worker could be denied health coverage because his coworker refuses to enroll? Absolutely. Think of it from another perspective, is it fair that the carrier will have to keep a group with adverse selection causing higher costs for others?

Regarding the above comment “Since "minimum participation" requirements are no longer legal and in the small group environment the insurer's age banded, community rated premiums are available to all comers I also don't understand how the insurer is saying your client isn't meeting underwriting requirements.”, this is not true. To be fair, this can be a confusing issue. Reference the PHS Act sections 2701-Fair Premiums, 2702-Guaranteed Issue, and 2703-Guaranteed Renewability. To begin with, self-funded carriers and Grandfathered plans are not subject to these, so they are free to set participation and contribution requirements as they see fit. A carrier in the small group market can have a minimum participation requirement, but with caveats. ACA provides for guaranteed coverage but only during the special enrollment period for small group which is Nov 15-Dec 15. However at renewal the carrier could require the participation requirement be met and if not could cancel the coverage.

Thanks for the clarification. I incorrectly assume it was a large group since you mentioned the pay or play. The answer for this under-50 group is no, the employer cannot require someone to enroll and pay a contribution. But a quick caveat, they can if the employee has an employment contract that requires it or if part of a collective bargaining agreement that requires employee to enroll. The employer could require if there is no employee contributions.

If you are asking me, I do not know the answer to that. I am a benefits guy, not an HR.

Yes, that is the way I and our consulting attorney understand the law. Difficult to believe that an employer would require an employee to enroll when the employee must make a contribution, but I am sure there are some out there.

A group of 100+ FTE can force enroll the employee in the company plan if that plan meets the requirements (affordability, min. coverage). And, there is no need to offer the employee an opt-out provision, even if the employee must pay for the coverage. Keep in mind to meet the requirements, the employer cannot charge the employee more than the 9.5. The employer may not force the employee to take coverage elsewhere though.