Archive for the ‘Employees’ Category

Open Enrollment and Special Enrollment Periods

One VERY significant change to the individual health insurance market made by The Affordable Care Act (ACA, Obamacare) is the implementation of open enrollment and special enrollment periods.  Prior to the ACA, an individual could purchase health insurance from an insurance carrier anytime, but the insurance carrier could reject an application, based on a pre-existing condition of the applicant.

Open Enrollment and Special Enrollment Periods

The ACA bans insurance carriers from denying applications based on pre-existing conditions, so without a stricter enrollment period, consumers could simply wait until they were stricken with a severe condition to purchase health insurance.  This is referred to as “adverse selection”, and defined open enrollment periods attempt to limit such negative statistics for insurance carriers.

Corporate Wellness programs – Are They Discrimination?

Kelley-Jensen2Author:  Kelley Filice Jensen

Biometric Screenings in the break room?  Yoga classes at lunch?  “Walking” meetings?  What is going on at work?  Corporate wellness programs are all the rage, and there are two simple reasons:  reducing employee absenteeism  and decreasing health care costs.  But, what if you do not want to participate in a wellness program, can your boss make you?  Isn’t that discrimination?  And, how can they ask you health questions that are private information protected by HIPAA (Health Insurance Portability and Accountability Act)?  Get answers about wellness programs here.

What exactly is a Workplace or Corporate Wellness Program?             

A Check From My Insurance Company, Why?

Author: Kelley Filice Jensen

Your daily trip to the mail box just got more interesting, you received a check from your health insurance provider.  But, why?  What is it, and is it taxable to you?  What if you have insurance through your employer, will you get a check, or rebate?

Why are you receiving this check from your health insurance provider?

Many major medical insurance carriers (Anthem Health Insurance, Kaiser Insurance, Blue Shield Health Insurance, to name a few) have begun issuing rebates to affected customers.  This rebate is the result of the health insurance provider’s MLR or Medical Loss Ratio calculation.

Health Care Tax Credit Update, IRS Outreach to Small Businesses

The Health Reform Law, the Patient Protection and Affordable Care Act, signed by President Obama on March 23, 2010, gives a tax credit to certain small employers that provide health coverage to their employees, effective for tax years beginning in 2010. As the tax filing extension deadlines near, the IRS and the Department of Health and Human Services (HHS) announce a new round of outreach to Small Businesses and Practitioners about the small business health care tax credit.

Adult Children and HSA’s

Health Care Reform requires health plans to cover adult children to age 26. For plan years effective after 9/23/10, plans that cover dependent children must also provide coverage for adult children through age 26. However, this new rule does not allow out of pocket expenses for these adult children to be reimbursed out of HSAs. Check out more blogs about HSA’s.

This brings up a number of questions for HSAs. These talking points should help you when discussing the impact to HSAs on your family. Review the rules for determining dependent status.

Tax Dependent v. Non-Tax Dependent Child

Questions and Answers about the Health Care Tax Credit

The Health Reform Law, the Patient Protection and Affordable Care Act, signed by President Obama on March 23, 2010, gives a tax credit to certain small employers that provide health coverage to their employees, effective for tax years beginning in 2010. As a small business owner, what does this mean to you? Are there real tax savings from providing health insurance coverage to your employee? Maybe. Use the following as your guide when talking to your tax preparer:

How does this affect the normal business deduction for expenses paid for employee health insurance premiums?

Who is a “Dependent” For Health Insurance Plans

Author: Filice Insurance Compliance Department

Many health plans provide coverage for dependent children of the plan’s participants. Traditionally, health plans have had significant flexibility in determining which individuals would be eligible to be covered as dependents. However, this flexibility is affected by the health care reform requirement to provide coverage up to age 26 and by some state laws.

Whether dependent coverage under a health plan is tax-free (at the federal level) depends on whether the individuals covered as dependents also qualify as dependents under the Internal Revenue Code (the Code or tax code). An individual can qualify as a dependent under the Code by being any one of the following:

Determining Eligibility for Unemployment Benefits

Author: Michelle Montoya, MLR, SPHR

Client question:

Who determines a terminated employee’s eligibility for unemployment benefits? Does the employer have any control over the unemployment claim?


Eligibility for unemployment benefits is determined by the state agency (EDD, Employment Development Department, in the case of California) where the employee files a claim. The employer has no control over the filing or determination of eligibility.

When an unemployment claim is filed, the agency will request information from the employer about the facts surrounding the termination. This is the time an employer can state the reason for the termination, give supporting evidence, and state a case for denying unemployment benefits. The final determination will be made by the EDD.

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