Discrimination favoring management or highly paid employees is not permitted for deductible health and accident insurance plans. For self-insured medical reimbursement plans (i.e., direct payment or reimbursement by the employer of the medical bills of the employee or family), no discrimination, either in eligibility or benefits, is permitted if "highly compensated individuals" are to receive all plan benefits tax-free. The plan must benefit, in general, at least 70% of employees who are not highly compensated employees. However, there are exceptions. A "highly compensated employee" is one who has a significant ownership interest in the company, or who is one of the five highest paid officers or employees. An alternative designation is an income threshold, currently $80,000. If a self-insured plan is discriminatory, an employee who is considered a highly compensated employee must include the amount of discriminatory benefits received in gross income.
Palm Beach Florida Corporate Resolution Establishing a Self-insured Medical Payment Plan for Key Employees
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How to fill out Corporate Resolution Establishing A Self-insured Medical Payment Plan For Key Employees?
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FAQ
Under 50 employees ACA exempts all employers with up to 50 full-time employees from any of the penalties or taxes applied above to 50+ employers.
Affordable Care Act In addition, it only applies to a plan, or a portion of a plan, that is self-funded (not covered by a health insurance policy). It does not apply to any other types of employers, whether their plans are insured or self-funded.
For example, a driver might elect to self-insure a minor fender-bender with a $500 deductible on auto insurance collision coverage, but carry $300,000 of liability coverage (or even a $1 million umbrella policy) in the event of a lawsuit resulting from an accident.
Being self-insured means that rather than paying an insurance company to pay medical, dental and vision claims, we pay the claims ourselves, using a third-party administrator to process the claims on our behalf.
Self-insured plans do not have to include coverage for the ACA's essential health benefits (with the exception of preventive care, which must be covered?with no cost-sharing?on all non-grandfathered plans).
Fully-insured plan?employer purchases insurance from an insurance company. Self-funded plan?employer provides health benefits directly to employees. insurance company assumes the risk of providing health coverage for insured events.
A fully insured contract transfers the risk of loss to an insurance carrier in exchange for a fixed premium paid to the carrier by the employer. Self-insured companies retain the risk themselves, paying for all claims either from a trust or directly from corporate funds.
Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees' and dependents' medical claims.
Saving Money. There are many reasons to self-insure your company, but one of the most logical reasons is to save money. According to the Self-Insurance Education Foundation, companies can save 10 to 25 percent on non-claims expenses by self-insuring. Employers can also eradicate costs for state insurance premium taxes.
Who must comply with the ACA? The ACA applies to applicable large employers (ALEs), which are businesses that had 50 or more full-time and full-time equivalent (FTE) employees on average during the previous year.
