Q.-The number of days in a month varies. Does this matter for determining if someone is a full-time employee for ACA purposes?
The Department of Labor issued an Opinion Letter on whether 15-minute rest breaks required by an employee’s serious health condition under the FMLA should be paid or unpaid. While an Opinion Letter applies only to the individual seeking the letter, all employers can get a glimpse into the DOL’s stance on the issue at hand.
The Medical Loss Ratio (MLR) provisions of the Affordable Care Act require insurers to spend at least a certain percentage of employees’ premium dollars on clinical care, instead of on administrative expenses such as executive salaries, overhead, marketing and profit. If an insurer does not spend enough on patient care to satisfy the MLR provisions, the insurer must make financial adjustments and provide rebates to customers. Health care reform sets the minimum MLR level at 85 percent for the large group market (policies covering over 50 employees) and 80 percent for the small group market. This means that administrative and other non-clinical costs can be no more than 15 or 20 percent of the insurer’s revenue. If an insurer fails to meet these standards, the insurer will be required to provide a rebate to customers.
Q.- An employee’s spouse is on Medicare. Can the employee be reimbursed from his health FSA for the cost of the spouse’s Medicare premiums?A.- No. Premium payments for other health coverage are not eligible to be reimbursed under a health FSA.
The Department of Labor released guidance to help higher education institutions understand when they must pay overtime to employees. Fact Sheet # 17S: Higher Education Institutions and Overtime Pay Under the Fair Labor Standards Act (FLSA), discusses the applicability of the FLSA overtime exemptions to jobs that are common in higher education institutions.
The IRS has been notifying employers of penalty assessments for non-compliance with the Employer Shared Responsibility Provisions of the Affordable Care Act. ACA requires applicable large employers (ALEs) to offer their full-time employees affordable, minimum essential coverage or pay a tax penalty.
Q.- An employee has family coverage under our medical plan and pays for the coverage on a pre-tax basis through our cafeteria plan. She is getting a divorce, and she wants to change her medical plan election. However, the change she is requesting is to drop coverage altogether (not just remove her ex-husband from coverage). Do we have to allow the requested change?
The U.S. Department of Labor has a Reporting and Disclosure Guide for Employee Benefit Plans. The Guide may be accessed by clicking here.
The Affordable Care Act created the Patient-Centered Outcomes Research Institute (PCORI) to improve the quality of health care and provide information to help consumers make informed health care decisions. Most health plans must pay an annual fee to fund PCORI research. An exception is made for stand-alone dental or vision plans, EAPs, wellness programs, plans for employees outside of the U.S., HSAs, and almost all HRAs and FSAs. Click here for a chart explaining the types of plans that must pay the PCORI fee. The next PCORI fee is due July 31, 2018.
MyEnroll.com offers employers a way to “pend” a dependent in the system to obtain documentation of dependent status before enrolling the dependent for coverage. This feature allows employers a method of confirming that they are covering only those individuals eligible for benefits under the terms of their plans.