Q & A by HR Service, Inc.
Everything you wanted to know about health plan benefit programs, HR compliance, TPA’s, & Human Resources Management. We have explained the most common terms.
What is an SPD?
One of the most important documents participants are entitled to receive automatically when becoming a participant of an ERISA-covered retirement or health benefit plan or a beneficiary receiving benefits under such a plan, is a summary of the plan, called the summary plan description or SPD. The plan administrator is legally obligated to provide to participants, free of charge, the SPD. The summary plan description is an important document that tells participants what the plan provides and how it operates. It provides information on when an employee can begin to participate in the plan and how to file a claim for benefits.
Employees must receive a Summary Plan Description (SPD) from their employers. The plan describes the program benefits and how the plan works.
The plan must answer specific questions such as the plan name, the plan’s IRS-assigned number, the employer’s name and address, and a statement of health and accountability rights.
Under the Affordable Care Act, there are various provisions that apply to group health plans and health insurance issuers and various protections and benefits for consumers that are beginning to take effect or that will become effective very soon. What is the Departments’ basic approach to implementation?
The Departments are working together with employers, issuers, States, providers, and other stakeholders to help them come into compliance with the new law and are working with families and individuals to help them understand the new law and benefit from it, as intended. Compliance assistance is a high priority for the Departments. Our approach to implementation is and will continue to be marked by an emphasis on assisting (rather than imposing penalties on) plans, issuers and others that are working diligently and in good faith to understand and come into compliance with the new law. This approach includes, where appropriate, transition provisions, grace periods, safe harbors, and other policies to ensure that the new provisions take effect smoothly, minimizing any disruption to existing plans and practices.
What health coverage pays first if I’m enrolled in both Medicare and COBRA?
If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.
What is the Health Insurance Portability and Accountability Act (HIPAA)?
HIPAA offers protections for workers and their families. The law provides additional opportunities to enroll in a group health plan if you lose other coverage or experience certain life events. HIPAA also prohibits discrimination against employees and their dependents based on any health factors they may have, including prior medical conditions, previous claims experience, and genetic information.
What is Special Enrollment?
Special enrollment allows individuals who previously declined health coverage to enroll for coverage. Special enrollment rights arise regardless of a plan’s open enrollment period. There are two types of special enrollment – upon loss of eligibility for other coverage and upon certain life events. Under the first, employees and dependents who decline coverage due to other health coverage and then lose eligibility or lose employer contributions have special enrollment rights. For instance, an employee turns down health benefits for herself and her family because the family already has coverage through her spouse’s plan. Coverage under the spouse’s plan ceases. That employee then can request enrollment in her own company’s plan for herself and her dependents. Under the second, employees, spouses, and new dependents are permitted to special enroll because of marriage, birth, adoption, or placement for adoption. For both types, the employee must request enrollment within 30 days of the loss of coverage or life event triggering the special enrollment.
What is People Management Support?
People Management, otherwise known as HR Management, can include the following: compensation, hiring, performance management, organization development, safety, wellness, benefits, employee motivation, communication, administration, and training.
What can an HR Help Desk Service do for you?
HR Service, Inc. Help Desk Services will help you resolve:
Legal Compliance Issues
HR People Management Challenges
HR Help Desk Support for Easy and Effective
Best Practice Techniques and more!
What Compliance Laws Pertain to my State and Company?
Which Laws Apply to Me?
The laws and regulations that apply to each organization are based primarily on three things:
The number of employees
The states in which you conduct business
Whether or not you conduct business with the government
Read more by visiting our page: https://www.hrserviceinc.com/creating-legally-compliant-employment-practices.
Employee Handbook – Do you Need One?
An employee handbook is a document that communicates your company’s mission, policies and expectations. Employers give this to employees to clarify their rights and responsibilities while they’re employed with the company. Find more information: https://www.hrserviceinc.com/employee-handbook-design/
What is HR eSolutions?
HR eSolutions – 100% online tools and solutions that help simplify human resource management practices. We help you attract and retain your best talent, maximize the productivity of an organization by optimizing the effectiveness of its employees, and create an outstanding culture.
We offer effective people-management and compliance-solutions to many important business challenges, including: managing human resources to drive business strategy, improving productivity, building effective work environments, meeting legal requirements, optimizing, and impacting overall business performance. We have provided a complete Human Resource Management Solution to help you manage your time more effectively.. https://www.hrserviceinc.com/hr-e-solutions-hr-package/
What is a POP Section 125 Plan?
The name “Section 125 Plan” POP, derives from Title 26, Section 125 of the United States tax code. This law outlines the rules employers must follow when establishing a cafeteria plan. It defines the term cafeteria plan and describes the types of benefits such a policy may include. The law prohibits programs that discriminate against lower-paid workers by favoring those who have high compensation. If you are found to be discriminatory, the benefits it provides to highly-paid workers will be taxed.
Cafeteria 125 plans, POP is an employee benefit that allows employees to pay for their portion of insurance premiums with pretax dollars saving on federal, state, and Social Security taxes. The plan enables pretax offerings on benefits.
The 125 plan or POP Plan includes health, dental, accidental death and dismemberment, and even voluntary benefits. Volunteer benefits include examples such as cancer, accident, and other benefits. IRS tax laws require a 125 Premium Only Plan (POP) or a Flexible Spending Account (FSA) to pay medical, dental, and other eligible insurance premiums on a pretax basis. Read more: https://www.hrserviceinc.com/125-premium-only-plan/
What is a TPA?
Third-party administrators are prominent players in the health care industry and have the expertise and capability to administer all or a portion of the claims process. They are normally contracted by a health insurer or self-insuring companies to administer services, including claims administration, premium collection, enrollment, and other administrative activities. A hospital or provider organization desiring to set up its own health plan will often outsource certain responsibilities to a third-party administrator. Outsourcing employee benefits services is an excellent idea for businesses looking to attract skilled and experienced staff to their organization. Benefits are what any professional severe looks out for before joining an organization. They are the motivation for employees to work at the highest level of their efficiency, and facilitate higher retention of staff. Without benefits, your company loses its ability to attract the most skilled personnel and fades away in the job market. Benefits also show employees that the company values its association with them.
What is a Flexible Spending Account (FSA)?
An FSA is an employer-sponsored plan that allows you to deduct dollars from your paycheck and deposit them into an individual account that’s protected from taxes. FSA accounts are exempt from federal taxes, Social Security (FICA) taxes, and, in most cases, state income taxes. The money in an FSA can be used for eligible health and/or dependent care expenses that are incurred while you are participating in the plan.
When do I need to file form 5500?
For most plans, Form 5500 must be filed once per year, before July 31 (if July 31 is not a business day, the next business day). However, if the ERISA plan is not a calendar year plan, Form 5500 must be filed no later than the last day of the calendar month following the seventh calendar month following the end of the plan year. Extensions can be requested by submission of a Form 5558. If Form 5558 is correctly submitted before the deadline, an automatic 2.5-month extension will be granted.
What is form 5558?
Form 5558 is an application used by employers to request more time to file certain employee plan returns. Employers use Form 5558 when they need more time to file other forms; employers can file Form 5558 for one extension.
What is an HRA?
Health Reimbursement Arrangements (HRAs) are employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Unused amounts may be rolled over to be used in subsequent years. The employer funds and owns the arrangement. Health Reimbursement Arrangements are sometimes called Health Reimbursement Accounts.
Can I Contribute to my HRA?
You cannot contribute to your HRA. It is owned, defined, and completely funded by your employer. It’s one of the ways your employer helps you make healthcare more affordable.
What is the Difference between HRA, HSA and FSA?
There are unique differences between the plans. To get a detailed analysis, read our article “Comparing FSA, HRA and HSA’s”.
What is an HSA?
An HSA is a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in a Health Savings Account (HSA) to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall health care costs. HSA funds generally may not be used to pay premiums.
What is Continuation of Health Coverage (COBRA)?
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102% of the cost to the plan.
COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end.
What are Fringe Benefits?
A fringe benefit is a form of payment for providing a service. For example, using your company car for personal errands is a form of fringe benefit. Any fringe benefit is taxable unless it is specifically excluded by the law. Taxable fringe benefits must be included in wages and reported on the W-2.