Archive for the ‘Compliance and HR’ 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.

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?

Answer:

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.

Filing for Divorce and Group Health Insurance

Author: Michelle Montoya, MLR, SPHR

Client question:

Will filing of a divorce be enough to cancel a spouse from coverage on our Company’s health insurance plan and be offered COBRA?

Answer:

No. The qualifying event is the date of the divorce decree (or legal separation). Merely filing for divorce is not considered a qualifying event, and will not render the spouse automatically eligible for COBRA. Courts often order a spouse to be reinstated on insurance plans if dropped before final divorce decree or legal separation, at which point, back premiums will be due, and can be quite expensive.

Termination: Employee signature required?

Author: Michelle Montoya, MLR, SPHR

Client question:

When terminating an employee, am I, as an HR Professional, required to have the employee sign the termination documentation?

Answer:

No. There are instances when terminated employees do not want to sign any termination documentation, and that is their choice. An employer is required to give notices and termination documents to the employee, but not required to receive signature. Do make a note on the document that the employee refused to sign.

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