Frequently Asked Questions

Cafeteria Plans/Section 125 Plans

A cafeteria plan is a separate written plan maintained by an employer for employees that meets the specific requirements of and regulations of section 125 of the Internal Revenue Code. It provides participants an opportunity to receive certain benefits on a pretax basis. Participants in a cafeteria plan must be permitted to choose among a least one taxable benefit and one qualified benefit. Read more.

ERISA

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for retirement and health benefit plans in private industry. ERISA does not require an employer to establish a plan. According to ERISA, an employee welfare benefit plan is any plan, fund, or program which is established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established for is maintained for the purpose of providing: Medical, surgical, or hospital car or benefits; benefits in the event of sickness, accident, disability, death or unemployment; vacation benefits, etc. Read more.

Health Care Reform

Learn more about Health Care Reform.

Exchange/Marketplace

By 2014, all states are required to have a Health Insurance Marketplace where individuals and small businesses can purchase health insurance. States may establish their own Marketplace, develop a Marketplace in partnership with the federal government or allow the federal government to create the Marketplace for their state (i.e. Texas option).

COBRA & ARRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 is a complex law with unique administrative challenges for employers. Severe penalties for non-compliance place employers at risk if they are unable to manage the administrative process in accordance with ever-changing COBRA regulations. Learn more about COBRA & ARRA.

Medicare

Medicare is government health insurance for People 65 or older, People under 65 with certain disabilities, and People of any age with End-State Renal Disease. Medicare's Annual Open Enrollment is October 15-December 7. Each year the Centers for Medicare & Medicaid Services publishes a detailed resource booklet called "Medicare & You" available online at www.medicare.gov. You can call 1-800-MEDICARE (1-800-633-4227) for specific questions. 

Medicaid & CHIP

Learn more about Medicaid in Texas and the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). These acts offer Free or Low-Cost Health coverage to children and families. In some states, including Texas, you may also be eligible for assistance paying premiums for the health plan offered by your employer. Learn more about Medicaid & CHIP.

Eligibility Notifications

Timeliness in adding and terminating employees is essential. All eligible employees/dependents must be added to the Employer's health insurance plan(s) within 31 days of their eligibility date. Learn more about these eligibility notifications.

CMS Reporting

The Centers for Medicare & Medicaid Services (CMS) require most Plans to perform annual functions. Learn more about these reporting requirements.

 

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