Benefits 101

For a Form 5500... let's say the year end 2022 plan assets (snapshot as of 11:59PM on December 31, 2022) was $652,325. However, profit sharing contributions / contributions attributable to the 2022 PLAN YEAR are made on March 2nd of 2023 FOR the 2022 plan year. Those assets deposited on 3/2/23 for the 2022 PLAN YEAR... SHOULD THEY be included in the "year end plan assets 2022" for the 2022 Form 5500? I just want to double check question this with the wisdom of the crowd here.

Great thanks. This is for a temp staffing firm so 99% of the employees are new hires.

IF we used a 12 month look back period to determine "eligibility".... do we need to issue Form 1095C to people who were not employed for a full 12 months? https://www.irs.gov/affordable-care-act/employers/questions-and-answers-about-information-reporting-by-employers-on-form-1094-c-and-form-1095-c That link FAQ question #6 seems to say if they were not a "full time employee" at any point, we don't need to issue a 1095C. Since we use that 12 month look back period to determine "full time"... it seems like any employee not employed for at least 12 months is categorically NOT full time. Thoughts?

Thanks! Can you offer some guidance to some law / IRS code / FAQ? I've received a myriad of conflicting answers. The ICHRA / QSEHRA people say "yes! you can offer either with a group dental plan! no problem!" Then some people say NO! A group dental plan is considered a GROUP health plan.

Just polling here.... can a group offer a QSEHRA / ICHRA ONLY for health insurance, but then have a group plan for dental / vision? There's folks out there that are saying, "no, because the dental is considered a group health plan... you cannot combine it with a QSEHRA and you cannot offer the medical insurance ICHRA with the traditional group plan dental". I disagree, but figure I should poll it here.

An employer wants to pay for all the participant related fees, so that no fees are taken from employee account balances. However, they do NOT want to pay for the participant fees once the employee leaves employment and becomes a former employee. If the employee fails to roll out the 401k account balance, the fees will be taken from their account. Anyone see any issues with this? Is there guidance / best practices around this?

When starting a new plan, must eligibility be waived for ALL employees? Or can we say "eligibility is waived for ALL full time employees"? However full time is defined.

Thanks!

Couldn't find a direct answer on this: Company has a 3 year cliff vesting schedule. Employee has been working at the company for 5 years. Then, finally decides to enroll into the 401K... but he leaves 9 months later. Is he fully vested? I think yes, because he has more than 3 full years of service... but wanted to get confirmation. Thanks!

So company XYZ is slowing going through bankruptcy / asset sales while ramping down their operations. The last employee enrolled in the health plan was laid off. There's still about 4 people there, and the doors / wind down might be another 4 to 6 months. Is the company required to offer cobra to the last participant? No one else took cobra. Since the plan has no participants... Its done, right? There's no health plan for the last employee to enroll into. So why even send out the cobra letter. If he accepts... He has no plan to enroll into.

For a stand alone vision plan... do they require COBRA notices to be sent? Let's assume no other benefits are being offered. Just vision insurance, that's it.

Great, thanks folks!

The look back period is undesirable because the stability period is undesirable. Now back to the question at hand: are the "units" in measuring the 95% safe harbor based on people, months, years, etc.?

So how is the 95% threshold calculated? So lets say that an employer fails to offer coverage to an employee for one month... i.e. they forget to offer coverage to a part time employee who becomes full time (due to an accident like scheduling too much overtime)... for a month. But only one month, because that employee was an "accidental full timer" in that they were a part time employee who worked more than 30 hours a week for one month due to too that employee being scheduled a bit too much overtime (or they stay late to do extra work when it was busy). Then a few months later, that employee becomes full time officially and enrolls in benefits. For this employee, was there a "offer of coverage"? Or is there NOT an offer of coverage because one month was missed?

Enter 1A IF they lost coverage and offer of COBRA was made because there was a reduction of hours... i.e. the employee still works for the employer. 1H if they are eligible for COBRA because they no longer work for the employer. 2A is pretty much always right.

Thanks for staying on point John. You know if anyone's tried to extend §147.104(e) to challenge this practice... or if HHS has commented on this by issuing guidance? The argument being: 1. I have cancer 2. I complete a health application as part of my employer's plan 3. insurance company increases rates to the point where the insurance is unaffordable 4. therefore the insurance company has constructively discouraged me to enroll / apply for the coverage. I understand that (e) was created to make insurers cover things like diabetic supplies, but does the force of that section merely end there? Is "rating up" a "marketing practice", and if so, does it discourage people with health needs from applying? Two insurers in my area might think so, because they won't even issue rates without the questionnaires, therefore eliminating step 3 of my argument. United Health Care will, but required questionnaires after the fact. A judge could strike this practice down with one ruling and then have that ruling survive a few appeals, then this medical questionnaire non-sense goes away. I'm thinking informal guidance might have been given by HHS to the insurers (i.e. HHS told insurers: "we won't regulate that practice if you do it")... because its such wide spread practice. But it seems worthy of impact litigation... in a plaintiff friendly anti insurance kind of court. If public guidance was given, I'm wrong and that argument probably doesn't have a shot and these insurers can go on doing this obtrusive practice.

The question I asked can only be answered by seeing the quesionnaire!?! Ummm.. Ok, if you say so, Please explain why seeing the the individual health questionnaire is required to answer the question. If you really thought that, why not just ask "can you post the questionnaire" from the beginning then? Its very rude considering that I assured you that it is factually correct and insurance companies are requesting this information. Now most of this thread has been trying to satisfy your demand that what I am saying is true (so you've basically hi-jacked my attempt to get some quality input). I would have preferred you not hi-jack the thread, maybe I would have been able to get some real input towards the question I asked. Anyway, to get this moving in the event you actually have something to contribute, here you go... your proof you so insistently demanded: https://www.dropbox.com/s/i6qcn4j1qpis9qy/Virgin%20Group%20Questionnaire.pdf?dl=0

GBurns... I bet you $10,000 that it is a requirement. My goal here was to analyze this for legality, not for anyone to question what I say is fact. If you do not believe me, please take me up on my wager. Your comments are not helpful and in no way help to answer the question I originally posed in this thread.

Independence Blue Cross & Aetna in PA. Yes, separate form for Blue Cross. Pre-2014 enrollment application for Aetna. Yes, I assure you that I am not lying about this.

For the 51+ market, it seems that individual health questionnaires can still be required. In fact, many health insurance companies are in fact requiring this. Now all this seems to me to be in violation of §147.104: Guaranteed availability of coverage: Guaranteed availability of coverage in the individual and group market. Subject to paragraphs (b) through (d) of this section, a health insurance issuer that offers health insurance coverage in the individual, small group, or large group market in a State must offer to any individual or employer in the State all products that are approved for sale in the applicable market, and must accept any individual or employer that applies for any of those products. Also this: (e) Marketing. A health insurance issuer and its officials, employees, agents and representatives must comply with any applicable state laws and regulations regarding marketing by health insurance issuers and cannot employ marketing practices or benefit designs that will have the effect of discouraging the enrollment of individuals with significant health needs in health insurance coverage or discriminate based on an individual's race, color, national origin, present or predicted disability, age, sex, gender identity, sexual orientation, expected length of life, degree of medical dependency, quality of life, or other health conditions. I can see the insurance company saying: The health questionnaires are part of our application process. Fair enough, that might fly. But then if they are using the information to jack up the rates, doesn't that qualify as a marketing practice to discourage the enrollment of individuals with health needs?

This is purely guessing on anyone's part in my book... but if I were to bet on an outcome, I'd bet on #2. I'd advise and practice as if #1 were true.

Your guess would be as good as anyone's, unless someone has some case law about it. But here's the citation, interpret it how you will: (ii) As a condition of participation in a voluntary employee benefit plan. An older employee within the protected age group may be required as a condition of participation in a voluntary employee benefit plan to make a greater contribution than a younger employee only if the older employee is not thereby required to bear a greater proportion of the total premium cost (employer-paid and employee-paid) than the younger employee. Otherwise the requirement would discriminate against the older employee by making compensation in the form of an employer contribution available on less favorable terms than for the younger employee and denying that compensation altogether to an older employee unwilling or unable to meet the less favorable terms. Such discrimination is not authorized by section 4(f)(2). This principle applies to three different contribution arrangements as follows: (A) Employee-pay-all plans. Older employees, like younger employees, may be required to contribute as a condition of participation up to the full premium cost for their age. (B) Non-contributory (“employer-pay-all”) plans. Where younger employees are not required to contribute any portion of the total premium cost, older employees may not be required to contribute any portion. © Contributory plans. In these plans employers and participating employees share the premium cost. The required contributions of participants may increase with age so long as the proportion of the total premium required to be paid by the participants does not increase with age.

No, you are incorrect. The ACA says "no limits on essential benefits"... not just preventative as you claim. Now let me remind you that the IRS & DOL have forcefully said "bare bones plans" are illegal. So yes, one could reimburse individual premiums on an after tax basis AND implement a compliant group health plan... however, the cost of implementing both make that strategy a loser. I've actually looked into this arrangement for a non-profit with high premium costs and very low wages... making a carve out very attractive. I found out Its just not worth it. The "juice isn't worth the squeeze". But according to your website, you don't advertise it this way, so again, purchase more E&O is my advice. I think we are all engaged because somehow your website appears fairly high in Google searches. Congrats on the SEO. But when these ideas you advocate arise (and they do because of your website's SEO), the competent advisors here have to spend our time convincing clients how non-compliant your ideas are. It also adds confusion to the general public and they "don't know who to believe" which creates more busy work for us. So if you could just stop, that'd be great. Now, If you are telling your clients all this, the incredible legal risk they take to save a few bucks... and they are willing to "go to bat" with you, cheers. But advertise it that way. Not doing so is malpractice.

An employer has 3 job classes: Drivers General Laborers Administration They want to do the following: Drivers with less than 1 year of employment with the company must pay for 50% of their insurance premiums. Drivers with 1 to 2 years of employment with the company must pay for 40% of their insurance premiums. Drivers with 2 to 3 years of employment with the company must pay for 30% of their insurance premiums. Drivers with 3 or more years of employment with the company must pay for 20% of their insurance premiums. General Laborers with less than 1 year of employment with the company must pay for 60% of their insurance premiums. General Laborers with 1 to 2 years of employment with the company must pay for 50% of their insurance premiums. General Laborers with 2 to 3 years of employment with the company must pay for430% of their insurance premiums. General Laborers with 3 or more years of employment with the company must pay for 30% of their insurance premiums. Admins with less than 1 year of employment with the company must pay for 40% of their insurance premiums. Admins with 1 to 2 years of employment with the company must pay for 30% of their insurance premiums. Admins with 2 to 3 years of employment with the company must pay for 20% of their insurance premiums. Admins with 3 or more years of employment with the company must pay for 10% of their insurance premiums. Besides having to test for Section 125 discrimination... what must we consider?

IMO, yes it does. 29 CFR 1625.10(d)(4)(ii) clearly confirms what you say Flyboy. I'm watching this eagerly as very large institutions are pitching "defined contribution". Sorry for the late reply, just browsing the forums.