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Health Benefits Coverage Rules?
Benefits & Compensation
Health Benefits Coverage Rules?
Exchange ideas about health plans, retirement, work/life benefits, and employee assistance.
If a firm does have health benefits, what requirements are there to cover all employees uniformly? We are a non-union non-profit organization in California not subject to ERISA.
Specifically: Gener
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Forums » Topic Forums » Benefits & Compensation » Health Benefits Coverage Rules?
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Health Benefits Coverage Rules?
posted at 10/13/2010 2:59 PM EDT
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Posts: 4
First: 11/20/2009 Last: 8/17/2011 |
If a firm does have health benefits, what requirements are there to cover all employees uniformly? We are a non-union non-profit organization in California not subject to ERISA.
Specifically: Generally, we currently pay for health benefits for each employee who normally works 20+ hours a week, and these employees can pay for dependent coverage. I say generally, because some employees cobble together 20+ hours a week schedules from multiple divisions and the company denies these employees eligibility, while other divisions with budget funding are paying for the dependent health premiums for an employee and the company allows this. While these are not enlightened or best practices, and the exceptions are rare and kept confidential, are there any legal prohibitions to doing this? |
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Health Benefits Coverage Rules?
posted at 10/14/2010 5:24 AM EDT
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Posts: 562
First: 11/12/2009 Last: 9/14/2011 |
Do you have a Summary Plan Description for your health care insurance? This should give you specifics on who is covered.
As far as not paying because an employee "cobbles together 20 hours" from various divisions, this is a problem. Individual divisions are not individual employers. If the employee does work 20 hours for you as the employer, that employee -from your description - should be given the health insurance. I can definitely see some potential liability here. |
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Health Benefits Coverage Rules?
posted at 10/14/2010 1:43 PM EDT
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Posts: 2146
First: 2/15/2006 Last: 9/14/2011 |
And I am not so sure it wouldn't be an ERISA plan....most plans ARE...
"The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans....In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or plans which are maintained solely to comply with applicable workers compensation, unemployment, or disability laws. ERISA also does not cover plans maintained outside the United States primarily for the benefit of nonresident aliens or unfunded excess benefit plans. " from http://www.dol.gov/dol/topic/health-plans/erisa.htm ERISA covers a whole lot more than it doesn't cover. I would verify that you are correct first. But yes, you can class out different groups of employees. If you have Section 125 plan (where employees are paying their part of the premium pretax), you do have some nondiscrimination tests to pass though. But you should have a standard criteria and an SPD (summary plan description) that sets out your eligibility. Because not only could you get into trouble, but it could lead to claims of illegal discrimination if a disproportionate amount of excluded employees are a certain race, gender, religion, etc. |
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Health Benefits Coverage Rules?
posted at 10/18/2010 4:44 AM EDT
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Posts: 1047
First: 4/11/2002 Last: 9/14/2011 |
The SPD is the best place to start your review. If you are referring to the new non-discrimination rules that came out of health care reform, the following are exceptions to offering uniform coverage:
* Employees with less than 3 years of service. * Employees under age 25. * Part-time or seasonal employees. * Collectively bargained employees. This provision of health care reform will not impact an employer that has part-time employees "cobbling" together a little over 20 hours per week. It will, however, impact employers that exclude classes of full-time employees. |
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