Benefits Frequently Asked Questions
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Dependent age limit is 26 on all plans. Coverage termination varies by the Situs location:
* FL Trad/HNO coverage is to the end of the calendar year in which the dependent reaches the limiting age (includes CO Front Range and TX Memorial Hermann)
* CA HMO coverage is to the end of the month
* AZ Situs (Trad) coverage is to the end of the month
* TX Situs (Trad & HMO) coverage is to the end of the month
* WV Situs (Trad) coverage is to the end of the month
FSA will allow up to $500 to rollover per year. Due to Covid, IRS for 2020-2021 will allow FSA rollover per year up to $550.
HSA plans are client-owned. However, there are no rollover limitations for HSA plans. 100% of the funds can rollover.
Quotes will expire 90 days after group is approved by Benefits
After 90 days, the prospect will need to provide updated documents submitted for review:
› Current Census
› Updated Signed GHQ (In lieu of an updated GHQ, the group can provide a a signed document stating that there have been no changes to the GHQ from the original quote date.)
Exceptions: Rare and would have to just exceed the 90 day time period from time of initial quote.
Specific to plans offered for enrollment, the highest cost plan and lowest cost plan may not exceed more than a 35%
difference in premium.
Exceptions: Rare and must be approved by benefits underwriting. Most notable exception would be if the client is coming from a plan that already exceeds the limitations on Vensure’s plans.
Allowed # of plans based on size:
› 5-9 eligible shall not exceed 3 plan offerings
› 10-24 eligible shall not exceed 4 plan offerings
› 25-49 eligible shall not exceed 5 plan offerings
› 50+ eligible shall not exceed 6 plan offerings
Exceptions: Must be approved by benefits underwriting. Most notable exception would be if the client is coming from another plan where they are already exceeding the plan limits for Vensure. Benefits underwriting would still need to review and approve on a one-off basis.
1. Census – including all dependents on Vensure’s census format
2. Group Questionnaire – completed in full and signed by an officer of the company
3. Benefit Summaries – full summaries for all plans with enrollment
4. Invoice – most recent invoice or benefits register showing itemized list of employees, benefit plans, and total monthly premiums.
5. Renewal – must provide if within 60 days of renewing (60 days pre and post renewal).
*If internal UW has been notified that a specific PEO has released renewals, UW will require the renewal for final pricing regardless of 60 day rule.
6. Claims – needed for open market opportunities of 100+ enrolled. Also needed for level-funded and self-funded opportunities regardless of size.
7. Personal Questionnaires – need for all groups with less than 11 Eligible. Need to be completed if full by each employee on census regardless of enrolling or waiving.
Exceptions: Extremely rare. Must be approved by benefits underwriting prior to quoting without any of the required documentation.
S-corp K1 owners that own less than 2% of the company are able to participate in Vensure’s Section 125 plan.
Any K1 S-Corp owner that owns 2% or more of the company can participate in Vensure’s major medical, dental and/or vision on a post-tax basis only, and are advised to consult with their CPA to discuss how to report as taxable income.
All K1’s can participate in voluntary benefit plans on a post tax basis excluding any FSA plan offering.
Underwriting Guidelines for NPOs
– No more than 10% of the group may be NPO’s.
– No more than 5 total NPO’s are allowed no matter the size of the group.
– A separate Benefit Election & Contribution Contract (BEC) will need to be created for the NPO class.
* The NPO class must have all benefits Employer paid at 100%.
* The NPO class is not eligible for Life, STD, or LTD (to include Employer paid).
* All contributions are on a post-tax basis
* NPO’s are not eligible for any Section 125 plan(s).
All K1 NPO’s are required to agree to and sign our K1 NPO Addendum and will be charged a $50 monthly fee for each NPO in the client.
NPO will receive no W-2 income processed through the PEO. NPO will either (I) receive 100% of payments from Client on IRS Schedule K-1 or IRS Schedule C or (ii) receives no compensation from Client. As an NPO, NPO shall retain full tax responsibility for any payments made to NPO and agrees to indemnify the PEO for any tax liability that may be imposed on the PEO as a result of NPO’s failure to fulfill individual tax responsibilities.
NPO may participate in the PEO welfare benefits plan (the “Plan”) only under the following terms and conditions (1) if NPO is a Partner within a Partnership, a 2% or greater Principal within an S-Corp or (2) A Member of a Single Member LLC or an LLC that is taxed as a Partnership. NPO may participate in the Plan solely on a company-paid basis, and NPO may not participate in the Life/AO&O and Disability plans or the Flexible Spending Account. As an NPO, any employer-paid contributions will be reportable as income to me. Participation in all Health and Welfare plans are subject to post-tax contributions and NPO cannot participate in any Section 125 plan(s).
NPO represents that NPO has “actively-at-work” status because NPO works full-time (a minimum of 30 hours per week) for Client and agrees to immediately inform the PEO in writing by email or certified mail if NPO falls below 30 hours a week.
NPO understands that any eligibility for health and welfare coverage under the Plan is based on full-time work status as determined by insurance carriers under the Plan.
When a client elects to offer these plans on a voluntary basis and does not offer any other plans through Vensure, the Eligibility Period for these plans will be 1st of the month following 30 days of full time Active Employment.
When a client elects to offer these plans along side of Vensure’s other benefits, they will have the same eligibility period as their other offered benefits.
A client in a PEO, ASO, or PRO relationship is able to offer these plans to their employees if they are PT or FT working at least 16 hours per week. Seasonal and temporary workers are not eligible to participate.
When a client elects to offer the AFLAC plans to their employees, the sales person is responsible for requesting an Ancillary /AFLAC BEC from Underwriting. The client must sign off on the plans and rates. The BEC should then be sent to Benefit Implementations through Client Space to initiate the client setup to enroll in these plans.
Plans can be set up to have rates/deductions calculated as:
1) weekly, 48 pay cycles;
2) bi-weekly/semi-monthly, 24 pay cycles, or monthly, 12 pay cycles
Yes, however, the HSA plans are client owned. An HSA Plan must be offered alongside a HDHP (High Deductible Health Plan). HealthEquity assists with the management of the HSA Plan.
Employee contribution towards Medical, Dental, Vision, FSA, Dependent Care, and HSA can be set-up as pre-tax. For Voluntary Life, Short Term and Long Term Disability, in order to qualify for a tax-free life/disability benefit, the employee’s contribution needs to be on a post-tax basis.
Employer contributions can be set up three (3) different ways:
1) Cafeteria plan structure: A flat amount to be applied to Medical, Dental and/or Vision benefits. Clients can offer only one cafeteria plan benefit structure;
2) A percentage or fixed amount for an employee and/or dependents based on coverage level;
3) A percentage or fixed amount by eligible class (all ee’s in defined class must be treated the same)