Sandra Pearce

While allowable to have a qualified 401k Plan as a benefit in a Section 125 Cafeteria Plan it is not required. We have our 125 plan and our 401k plans separate; i.e., separate plan documents, separate tax filings, etc. It would seem having the 401k as a benefit under your 125 plan is limiting.

In the state of Louisiana the calculation is based on gross wages. In the determination of "wages" and the average weekly wage at the time of the accident, no amount shall be included for any benefit or form of compensation which is not taxable to an employee for federal income tax purposes; however, any amount withheld by the employer to fund any nontaxable or tax-deferred benefit provided by the employer and which was elected by the employee in lieu of taxable earnings shall be included in the calculation of the employee's wage and average weekly wage including but not limited to any amount withheld by the employer to fund any health insurance benefit provided by the employer and which was elected by the employee in lieu of taxable earnings shall be included in the calculation of the employee's wage and average weekly wage. Using your example in Louisiana the wage definition would include pre-tax benefits. Your state WC statute defines the calculation.

Our company has had dependent life insurance available for employees for the past 25 years with many different carriers over those years. All of our contracts were written with the employee as the beneficiary for all dependent life insurance, spouse and/or child(ren), It is possible the form filled out was actually a combination form for Voluntary Employee Life Insurance - requiring a beneficiary - and Dependent life insurance. Meaning the employee, when filling out the form, believed the beneficiary was applicable to both the employee and dependent life elections. Like one of the other posters I have never seen a dependent life insurance election form with a beneficiary named.

Our company offers benefits that are not subsidized/contributed to by the employer and we do not put up-charges on those benefits. If the vision plan for employee only costs $95 per year, the employee pays $3.65 per pay period (26). We offer the benefit under our Section 125 Plan so it is pre-tax to the employee and it removes some tax burden from the employer as well. Not sure why an employer would want to inflate the cost.

Healthcare.gov has a step by step process for Special Enrollment periods outside of Open Enrollment. Regarding the specific circumstance the wording on the site is: You DON’T qualify for a Special Enrollment Period if: You decide to end COBRA early (and are paying the full cost yourself). You lose your COBRA coverage because you didn’t pay your premiums.

A self insured plan, by it's nature, puts the employer fully at risk for the cost of all administrative expenses and claims whether or not those expenses and claims exceed the cost paid by the employees. When an employee reduces income to pay for a pre-tax benefit offered doesn't that benefit becomes equal to employer paid? I would expect the refund to be retained by the employer. No legal expert here but an HR practitioner with many years of experience in the area of benefits, including self-insured medical plans. This is simply my opinion.

I am curious what change in status prompted the employee to stop participating in the spending account. A reduction in work hours would have been a COBRA event. A medical leave of absence may have been covered under FMLA and allowed the person to continue in the plan, making normal contributions or catch-up contributions upon return.

There is a wealth of information regarding Qualified Medical Child Support Orders on the DOL web site at www.dol.gov/ebsa/publications/qmcso.html If the order is qualified then one of the responsibilities of the health plan is to allow the custodial parent to file claims on behalf of the child and to have benefit payments made to the custodial parent or health care provider. This means you have to provide the custodial parent with the information necessary to file a claim and seek reimbursement for a claim. An ID card is only part of what you need to provide. Add to that a Summary Plan Description, any claim forms or claim filing information, etc.

Our Plan Document and SPD have the following wording regarding pre-tax contributions to health and dental insurance: If you do not file a new Salary Reduction Authorization Agreement form with the Plan Administrator before the start of the new Plan Year, your previous election for Health and/or Dental Insurance Premiums will continue the same as in the previous Plan Year. The Employer will reduce your compensation accordingly. We do provide a notice to make the change from pre-tax to after-tax and vice versa.

We open our enrollment for the plan year 60 days before the beginning of the plan year because we have many employees that travel for 30 days or more out of the country on company business. This is our, albeit imperfect, fix.

The 125 regulations regarding significant cost or coverage changes apply when the person is a particpant in the 125 Plan. Termination of employment would end participation in the 125 Plan. COBRA continuation is offered for the option the QB is enrolled as a participant in on the day prior to the Qualifying Event.

There is no law that requires a health plan to have an annual open enrollment period. HIPAA requires that the plan adhere to HIPAA's Special Enrollment rules.

The four weeks of pay for the female who gives birth is similar to pay for the disability. The bonding time for adoptions for a female employee and the bonding time for the father for birth or adoption could be equal periods with pay. I would check any state regulations that might apply and then consider separating the "disabililty" of the birth from the other leave provisions. Our company is large enough that we must apply FMLA provisions. Those provisions do not require pay. The female employee delivering the child can apply for our salary continuation program for the period in which she is considered medically disabled. Once her disability ends she may continue to use available FMLA leave but must take all available vacation pay before being on FMLA leave without pay. The male employee must use any available sick leave (to care for the medically disabled spouse) and then any available vacation before leave is allowed without pay.

Depending upon what your plan says about deadlines for filing claims, the ex-employee can timely file a claim for out-of-pocket medical expenses incurred during the period of participation in the Plan year (period employed) and be reimbursed the entire amount elected at the beginning of the Plan year.

I reviewed the two sides of our QSLOB each year and if the information provided previously had changed (companies added or deleted, plans added or deleted) then I filed a new form.