Unit 4.12 - Benefit Laws and Regulations Flashcards
What is the Pregnancy Discrimination Act?
Amendment to Title 7
Defines discrimination because of sex to include “pregnancy, childbirth, or related medical conditions.”
What are the details of FMLA?
Family and Medical Leave Act (FMLA) applies to employers with 50 employees within 75 miles and entitles eligible employees to take up to 12 weeks of unpaid leave each year for specified family and medical reasons.
- A new child is born to the employee.
- A new child is placed with the employee for adoption or foster care.
- The employee is needed to care for a seriously ill spouse, child, or parent (not a parent-in-law).
- The employee has a serious health condition.
- The spouse, son, daughter, or parent of a person on or about to be on active military duty for any “qualifying exigency.”
What is the National Defense Authorization Act?
Extended FMLA by providing 12 weeks leave for family members impacted by active military duty.
Plus 26 weeks of military caregiver leave for the families of service members injured in the line of duty.
What is HIPAA?
Health Insurance Portability & Accountability Act (HIPAA) provides greater portability in health care coverage and limits the exclusions for pre-existing conditions and places other restrictions on an insurance carrier’s ability to exclude a worker from insurance coverage.
HIPAA Provisions:
* Pre-existing Condition Exclusions
* Creditable Coverage
* Break in Coverage
* Recent Care
* Pregnancy
* Newborn and Adopted Children
* Health Related Exclusions
* HMO Affiliation Periods
* Renewal of Coverage
* Medical Savings Accounts
* Tax Benefits
* Privacy Provisions
If someone changes jobs, their pre-existing conditions won’t harm them in terms of insurance
What is PPACA?
Obamacare
The Patient Protection and Affordable Care Act (PPACA) regulates medical
services and insurance coverage, among other things.
Individual Responsibility:
* All U.S. citizens are required to maintain minimum health insurance coverage.
* They are expected to purchase their own healthcare plan if not covered by an employer’s.
Employer Responsibility:
* Employers are not required to offer healthcare coverage.
* Employers with 50 or more full-time employees (FTEs) will have to pay a penalty if even one employee receives a federal government subsidy and purchases coverage in an exchange.
* FTEs are calculated by totaling all hours worked in a year by all employees (both full-time and part time) and dividing by 2080.
Preventative care should be 100% covered
What is ERISA and its requirements?
Designed to ensure that employees covered under private pension plans and employee welfare benefit plans would receive the benefits promised.
Requirements:
* Eligibility requirements
* Vesting requirements
* Portability practices (ability to transfer funds to new employer)
* Funding requirements
* Fiduciary responsibilities (assigning a trustee to distribute funds)
* Reporting and disclosure requirements
* Compliance testing
What is COBRA and its qualifying events?
The Consolidated Omnibus Budget Reconciliation Act (COBRA) was designed to protect people who leave an employer from losing their benefit coverage.
Companies w/ 20+ employees
Qualifying events:
* Termination of the employment relationship (voluntary or involuntary)
* Reduced hours
* Death
* Divorce or legal separation
* Becoming disabled
* Dependent child is no longer considered a dependent child under plan rules.
- For 18 months or until another job; all is paid by employee
- COBRA disappears when a company closes
- 60 days to enroll in COBRA
