Employee Benefits 101

Table of Content

  1. Header
  2. Benefit Plan Package
  3. Eligibility
    1. Employee Eligibility
    2. Dependent Eligibility
    3. Qualifying Events
  4. Medical/Rx
    1. Components of a Medical Plan
    2. Funding Methods
    3. Funding Methods 2
    4. Funding Methods 3
    5. Funding Methods 4
    6. Funding Methods 5
    7. Plan Types
    8. Plan Types 2
    9. Plan Flow
    10. Plan Variations
    11. Plan Variations
  5. Dental
    1. Sample Plan
  6. Vision
    1. Sample Plan
  7. Life / AD&D
    1. Life/AD&D
    2. Common Terms
  8. Disability
    1. Short Term Disability (STD)
    2. Long Term Disability (LTD)
    3. Sample Timeline
    4. Common Terms
  9. Worksite
  10. Health Savings Account (HSA)
  11. Flexible Spending Accounts (FSA)
  12. COBRA
  13. FAQ
  14. Footer

Benefit Plan Package

Eligibility

EMPLOYEE ELIGIBILITY

•Affordable Care Act requires that full time employees working 30 or more hours per week be eligible for health insurance

•New Hire Waiting Period (NHWP): The amount of time a new employee must be employed before they are eligible for coverage

•Cannot exceed 90 days for health insurance as required by the ACA

•Common NHWP’s include:

•Date of Hire

•First of the month following date of hire

•First of the month following X number of days (30 or 60)

•X number of days (30, 60, or 90)

E

DEPENDENT ELIGIBILITY

• You may also enroll eligible dependents for benefits coverage.

•A ‘dependent’ is defined as the legal spouse and/or ‘dependent child(ren)’ of the plan participant or the spouse.

•Domestic Partners – You can request the carrier to allow coverage for Domestic Partners


Dependent Children could include:

• Natural child & step- child

• Adopted child, child of which you have legal guardianship for

•Medical – dependent children are eligible until age 26 (26th birthday, end of the month of 26th birthday, or end of the year the child turns 26)

•Dental & Vision typically follow suit for dependent children, until age 26

•Voluntary coverages are typically age 19, or 25/26 if full-time student

DE

QUALIFYING EVENTS

After an employee's opportunity to make an election as a new hire or at open enrollment, they cannot make changes to their elections unless they have a QUALIFYING EVENT. Common Qualifying Events listed below, please note, there are additional events that may allow for a mid-year election change.

Qualifying events discussed in this presentation are dependent on an Employer's plan design and what types of qualifying events are permitted.

QE

QE

Medical/Rx

Components of a Medical Plan


Funding Arrangements

Funding Arrangements – Fully Insured

Funding Arrangements – Self Funded

What is Stop-Loss Insurance?