CLICK HERE
for an Overview of the "Patient Protection and Affordable Care Act of
2010", better known as "Obamacare" and other Health
Care Reforms.
Group Health Insurance:
We
offer programs and plans from hundreds of companies and prefer to have
you complete a
Employee
CENSUS so that we can provide recommendations on the programs best suited
& tailored specifically to you and your employees needs.
To obtain quick numbers
comparing several Small Group (2 - 50 employees) Plan offerings click onto the following link now,
although we recommend that you complete an
Employee
CENSUS and
send it to us for personalized handling and advice. For Groups size 51+ please
contact us for assistance at: 800.482.5347.
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This a highly specialized and technical field that we have been working in
since 1981. Today, most Employers should not install or continue
a Group Health Plan without also installing a Cafeteria Section 125-Full
Flexible Benefits Program. WHY? In order for Employers to be able to continue
in the full or partial support of the costs of these plans for their valued
employees cost reduction is a necessity. A "Cafeteria Plan" allows
Employers & Employees to move certain eligible expenses from after-tax
to PRE-TAX. The result is substantial savings to both parties in
Taxes (see our Services web page and click onto "Cafeteria Section 125
Programs").
Group
Health Plans come in all forms. We design, advise, and implement
all types of programs including: Participatory (sometimes referred
to as "Self/Shared Funded Plans"), fully insured Indemnity, PPO, EPO, POS, HMO,
as well as MSA's or Medical Savings Accounts.
Please
allow us to bring our expertise to bear for your company by providing us
a thorough employee Census by clicking below on "Employee Census" and completing
that form:
A.)
PARTICIPATION RULES:
Insurers typically require you to include at
least 75% of your employees (some go as low as 50%) and do not include
in this “percentage test” employees who waive coverage due to being covered
elsewhere (i.e. on a spouses plan who works for another employer) for eligibility
requirements.
Group size (i.e. the number of employees to be covered)
feeds into this with smaller companies typically being required to have 100%
participation by most Insurer's - though, not all.
"Late Enrollees" are treated under special rules that
allow the Insurer 3 options: fully exclude the late enrollee; or,
waive coverage on only the pre-existing condition but for only up to 12
months; or, accept without any waiver at all.
AB 1672
- Landmark legislation requiring group health insurers to accept small
employer groups (defined as those with 2-50 employees) regardless of any
negative health histories (i.e. insurers can no longer decline a case based
upon medical factors alone). The legislation also regulates the range of
premiums that insurers can charge such groups based upon insurer published
SERR rates (Standard Employee Risk Rates), limiting them to a range, based on
other underwriting criteria, from 10% above to up to 10% below the SERR rates
(this is known as the "RAF" or Risk Adjustment Factor). Pre-existing
exclusionary clauses of up to a maximum of 6-months are permitted (in PPO
or Indemnity Plans - N/A in HMOs), with credit against such periods for prior
private health insurance coverage (group or non-group) that covered any
insured for at least 180 days, and without a gap in such coverage greater than
180 days.
AB 1790
- allows employers to include, as eligible employees, those working as few as
20 hours per week in their group benefits plans.
SB
719 - LAW EFFECTING GROUPS SIZED 2-19 EFFECTIVE 1/1/98
The number of employees to be
counted towards eligibility is based on employee eligibility to participate in the Group Health
Plan on 50% of the employer’s business days in the preceding calendar year).
California Senate Bill 719 of 1997, or the Continuation Benefits Replacement
Act (“CAL-COBRA”), requires Health Plans to offer continuation
coverage to enrolled employees and their family members following their
loss of coverage due to termination of employment, reduction in work hours,
divorce, death, loss of dependent child status or Medicare entitlement.
It is the Employers responsibility to notify the Insurer of these “qualifying
events” and the Insurers to then notify the covered party. Severe
penalties exist for non-compliance with the provisions and requirements
of this new law.
Many new Laws
continue to be passed as well as amended. Please contact us for the most
up to date information in these areas.
See this
information on one such major law:
HIPAA
- the Health Insurance Portability & Accountability Act.
Compliance Corner
IRS Notice 2006-86 (2006): The IRS recently published Notice
2006-86 which clarifies the applicability of “tie-breaking rule” for
determining which taxpayer may claim a qualifying child when two or more
taxpayers claim the same child for a taxable year. The Notice applies to the
head of household filing status under § 2(b), the child and dependent care
credit under § 21, the child tax credit under § 24, the earned income credit
under § 32, the exclusion for dependent care assistance under § 129, and the
dependency deduction under § 151.
The tie-breaking rule provides the following:
• If one or none of the taxpayers claiming the child is the child’s parent,
the child is treated as the qualifying child of (i) the taxpayer who is the
child’s parent, or (ii) if none of the taxpayers is the child’s parent, the
taxpayer with the highest adjusted gross income for that taxable year.
• If both taxpayers of the qualifying child are the child’s parents who do not
file a joint return, the child is treated as the qualifying child of the
parent with whom the child resides for the longer period of time during the
taxable year. If the child resides with both parents for the same amount of
time during the taxable year, the child is treated as the qualifying child of
the parent with the higher adjusted gross income for that taxable year.
Special Rule for Non-Custodial Parents:
A child may be treated as the qualifying child of the non-custodial parent,
for certain purposes, if:
-
the child is in
the custody of one or both parents for more than one-half of the calendar
year;
-
the child
receives over one-half of the child’s support during the calendar year from
the child’s parents;
-
the parents (a)
are divorced or separated under a decree of divorce or separate maintenance,
(b) are separated under a written separation agreement, or, (c) live apart at
all times during the last 6 months of the calendar year; and
-
the custodial
parent releases the claim to the exemption to the non-custodial parent in a
written declaration that the non-custodial parent attaches to the
non-custodial parent’s tax return.
If the
special rule outlined above does not apply, the tie-breaking rule applies
to the provisions listed above as a group, rather than on a section-by-section
basis. Therefore, if a child is treated as the qualifying child of one
taxpayer for one purpose (e.g. earned income credit), the child may not be
treated as the qualifying child of any other taxpayer for any other purpose
(e.g. child tax credit, the child and dependent care credit, and/or exclusion
under a dependent care FSA).
If, however,
the special rule applies, a child may be treated as the qualifying child
of two taxpayers. As such, the non-custodial parent may claim the child as a
qualifying child for purposes of the child tax credit under § 24 and the
dependency deduction under § 151; however, for purposes of determining the
head of household filing status, the earned income credit, the dependent care
credit or the exclusion from income for dependent care FSAs, the non-custodial
parent may not claim the child as a qualifying child. For these purposes, only
the custodial parent (or other eligible taxpayer) may claim the child as a
qualifying child. “Custodial parent” is defined as the parent having custody
of the child for the greater portion of the calendar year, and “non-custodial
parent” as the parent who is not the custodial parent.
Note for
purposes of dependent care FSAs, the child is always treated as the qualifying
child of the custodial parent. There are several examples included in the
Notice. A copy of IRS Notice 2006-86 is available by
clicking here.
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