Question: When may an employee continue to cover a disabled child under the health plan after the child reaches age 26? Compliance Team Response: Most employer-sponsored group health plans permit employees to cover disabled children beyond age 26 under certain conditions. Eligible Post-Age 26 Disabled Children: Fully Insured Plan If the plan is fully insured, […]
Question: What are the issues with employers offering group health and welfare plan benefits to independent contractors? Compliance Team Response: Offering group health and welfare plan coverage to independent contractors in most cases will not be a realistic option because it would create a MEWA. Offering Coverage to Independent Contractors Creates a MEWA A multiple […]
Question: Which plan options must the employer offer to COBRA qualified beneficiaries? Compliance Team Response: Threshold Issue: Only Covered Individuals Experience COBRA Qualifying Event An individual must be covered under the group health plan—and experience a qualifying event while covered by the plan—to be eligible for COBRA coverage as a qualified beneficiary. Individuals who are […]
Question: When does an employer need to enter into a HIPAA business associate agreement (BAA) with an outside service provider for the plan? Compliance Team Response: HIPAA Business Associate Defined A HIPAA business associate is a third-party that creates, receives, maintains, or transmits PHI for any of the following services: Claims processing or administration Data […]
Question: How does an employee’s change to a full-time position during the initial measurement period affect eligibility for medical coverage? Compliance Team Response: Reminder: Very Different Approach Depending on Measurement Method There are two different approaches for an applicable large employer (ALE) subject to the ACA employer mandate pay or play rules to determine employees’ […]
Question: Can a child’s tax-dependent, employment, marital, student, or any other status other than age affect medical plan eligibility? Compliance Team Response: The ACA has made any status of that type irrelevant for purposes of a child’s eligibility for the employer’s medical plan. ACA Age 26 Mandate: General Rule The ACA requires that a health […]
Question: When an employee terminates a domestic partnership, does the domestic partner losing health coverage have COBRA rights? Compliance Team Response: Domestic Partners Are Not COBRA Qualified Beneficiaries Individuals must be a COBRA “qualified beneficiary” to have independent COBRA rights. Domestic partners are not qualified beneficiaries. Qualified beneficiaries include the following individuals covered under the […]
Question: Can employees use the dependent care FSA or health FSA to reimburse special education expenses for their children? Compliance Team Response: Dependent Care FSA: Generally Not An Eligible Expense Educational expenses are not an eligible dependent care FSA expense. Those expenses are not considered to be for the “care” of the child. However, the […]
Question: When can employees change their HSA pre-tax contribution elections? Compliance Team Response: HSA Contributions Governed by Cafeteria Plan Rules The Section 125 cafeteria plan is the exclusive mechanism for employees to make pre-tax contributions to an HSA through payroll. Therefore, all employee pre-tax HSA contributions are governed by the cafeteria plan rules. Employers Must […]
Question: Can an employer make an exception for an individual who failed to timely elect or pay for COBRA coverage? Compliance Team Response: The COBRA rules generally require that qualified beneficiaries elect COBRA within 60 days of receiving the election notice, and that they make the first premium payment no later than 45 days after […]
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