(FAMILY NAME) Qualified Small Employer Health Reimbursement Arrangement
|
|
- Mervin Newman
- 5 years ago
- Views:
Transcription
1 (FAMILY NAME) Qualified Small Emplyer Health Reimbursement Arrangement Effective Date:
2 Emplyer / Plan Administratr Emplyer Name: Address: Phne Number: ( ) - Federal Emplyer Identificatin Number: The emplyer named abve will serve as Plan Administratr. The Plan Administratr has the authrity t: Interpret the Plan fr eligibility and benefits determinatins, Determine Plan eligibility fr individuals, And Terminate r Amend the Plan. Plan Year: Waiting Perid: (Nt t exceed 90 days frm start f emplyment.) Maximum Benefit: This is the maximum amunt f benefits that will be paid ut during the curse f the Plan Year. Emplyees enrlled in the Plan will be eligible t receive reimbursements frm the Emplyer Health Care Expenses in a Plan Year r the remaining Plan Year in which they are enrlled. Emplyee Only: Family: $ (Nt t exceed Federal limits f $5,150 annually r $ mnthly fr emplyees nt enrlled fr the full Plan Year.) $ (Nt t exceed Federal limits f $10,450 annually r $ mnthly fr emplyees nt enrlled fr the full Plan Year.) Carry Over: $ NO CARRY OVER OF UNUSED BENEFITS BETWEEN PLAN YEARS This is the maximum amunt f unused benefits that can be carried ver frm ne Plan Year t the next Plan Year. Cash Outs are nt permissible. (May nt exceed the Annual Maximum Benefit as defined by the Cures Act. Carry ver benefits are nt required under the CURES Act.)
3 Health Care Expense: Health Care Expense means any amunt paid by a Participant, cvered Dependent and/r Spuse that is an expense fr individual health insurance plicy premiums reimbursable under 213(d) f the Internal Revenue Cde, excluding expenses reimbursed by any ther health plan. Individual health insurance plicies must ffer minimum essential cverage as defined by the Affrdable Care Act t be eligible fr Plan reimbursement. Health care sharing plans cannt be reimbursed under a QSEHRA Plan. Shuld the emplyee fail t maintain cverage that cnstitutes minimum essential cverage, the emplyee may be subject t penalties under the individual mandate prvisins f the ACA, and the QSEHRA reimbursements might be included in the emplyee s grss incme. HRA Accunt: The HRA accunt established fr each individual Eligible Emplyee is fully funded by the Emplyer, and any amunts remaining at the end f the plan year in excess f the Carry Over defined abve are frfeited. Any remaining funds at time f terminatin are frfeited. Eligibility and Enrllment: Eligible Emplyee: An Eligible Emplyee will autmatically becme a participant in this Plan upn cmpletin f the Waiting Perid as defined abve and submissin f an enrllment frm. Eligible emplyee is actively emplyed n the date befre the effective date, as well as any newly hired r rehired active full time emplyee. Part time emplyees, temprary emplyees, and emplyees under the age f 25 wh are included n a parent s plan are nt eligible t participate in the Plan. Enrllment: An Eligible Emplyee must cmplete an enrllment frm t participate in the Plan. Cverage will begin n mre than thirty (30) days after the cmpleted enrllment frm is received by the emplyer. Terminatin: An Eligible Emplyee s participatin in the plan shall terminate as f the earliest f: The date the emplyee ceases t be emplyed by the emplyer; The date f Plan terminatin. Cverage fllwing Terminatin f Emplyment: The terminated emplyee has a perid f thirty (30) days fllwing terminatin f emplyment fr any reasn t submit eligible expenses incurred prir t emplyment terminatin fr reimbursement by the Plan subject t the emplyee s HRA balance.
4 Plan Recrds: The emplyer/plan Administratr is required under the CURES Act t maintain recrds t dcument prper Plan Administratin. The Plan participant is required t furnish the emplyer/plan Administratr with the data the Administratr reasnably requests t ensure the prper administratin f the Plan, with dcumentatin f items such as prf f relatinship as needed. Expense Reimbursement The fllwing must be bserved fr eligible reimbursement f Health Care Expenses: Participant must submit a cmpleted REIMBURSEMENT REQUEST FORM n later than thirty (30) days after the clse f the Plan year OR- n later than thirty (30) days after the terminatin f emplyment. The REIMBURSEMENT REQUEST FORM must include the fllwing: Name and address f the participating emplyee; Name f the persn wh incurred the expense (emplyee, spuse, r eligible dependent); The name and address f the health care prvider r rganizatin t whm the health care expense was paid r is t be paid and the amunt f the payment; Type f eligible expense; Cpy f receipt r bill.
5 HEALTH SAVINGS ACCOUNT REIMBURSEMENT FORM (ATTACH RECEIPT)
MICRO GROUP EMPLOYER DOCUMENTATION REQUIREMENTS
Seattle, Washingtn 98101 MICRO GROUP EMPLOYER DOCUMENTATION REQUIREMENTS D nt cancel any existing plicies until yu receive cnfirmatin f final rates and/r acceptance f the grup by Regence BlueShield (Regence).
More informationEmployer Shared Responsibility (ESR) Provisions under the ACA Part II
April 1, 2013 Emplyer Shared Respnsibility (ESR) Prvisins under the ACA Part II Treasury and the IRS released prpsed regulatins n the new Emplyer Shared Respnsibility (ESR) prvisins (a/k/a Play r Pay,
More informationFrequently Asked Questions for Blue Shield Producers Guarantee Issue for Children Under Age 19 Updated June 7, 2011
Frequently Asked Questins fr Blue Shield Prducers Guarantee Issue fr Children Under Age 19 Updated June 7, 2011 What are the new health refrm requirements fr applicants under age 19? The Affrdable Care
More informationSteps toward Retirement
Steps tward Retirement Eligibility, Actin Steps, and Benefit Optins fr Faculty and Staff Nearing Retirement Eligibility fr Official University Retiree Status The fllwing jb types f the University are eligible
More informationHow to Count Employees Determining Group Size Under the Medicare Secondary Payer Regulations
Hw t Cunt Emplyees Determining Grup Size Under the Medicare Secndary Payer Regulatins 1. Wh is an Emplyee? An emplyee is an individual wh wrks fr an emplyer r an individual wh, althugh nt actually wrking
More informationGuide to Young Adult Dependent Coverage
Guide t Yung Adult Dependent Cverage The New Yrk State Legislature passed a law in 2009 which extends the availability f health insurance cverage t yung adults thrugh the age f 29. As a result, Freelancers
More informationSummary Plan Descriptions (SPD)
Descriptins (SPD) SPDs What Are They and Wh Needs Them? What is an SPD? The DOL defines the SPD as the Primary vehicle fr infrming participants and beneficiaries abut their plan and hw it perates. Must
More informationRev. 7/1/11. Sprint Flex Plans Eligibility and Enrollment Section
Rev. 7/1/11 Sprint Flex Plans Eligibility and Enrllment Sectin TABLE OF CONTENTS SPRINT FLEX PLANS 3 WHO IS ELIGIBLE TO PARTICIPATE IN SPRINT FLEX PLANS 3 DUPLICATE COVERAGE.. 7 ENROLLMENT.. 7 ENROLLMENT
More informationCafeteria Plan for the Employees of Central Rivers Area Education Agency. Plan Document and Summary Plan Description
Cafeteria Plan fr the Emplyees f Central Rivers Area Educatin Agency Plan Dcument and Summary Plan Descriptin Originally Effective July 1, 2003 Amended and Restated July 1, 2017 Summary Plan Descriptin
More informationIRS Notice CLICK HERE to return to the home page
CLICK HERE t return t the hme page IRS Ntice 2012-9 I. PURPOSE This ntice restates and amends the interim guidance n infrmatinal reprting t emplyees f the cst f their emplyer-spnsred grup health plan cverage
More informationInformation Package CAFETERIA 125 PLANS
Infrmatin Package CAFETERIA 125 PLANS Shaffer Insurance Services, Inc. Benefits Divisin 902 E. Ave Q-9 Palmdale Ca. 93550 Tll Free (866) 412-5872 Office Tel (661) 575 9331 Fax (661) 280 2016 Sectin 125
More informationPolicy & Procedure Manual
Plicy & Prcedure Manual Agency Vacatin Reviewed Date HR0701 Revised Date May 12, 2014 Apprved Date December 19, 1990 Intrductin The Bard f Health believes in prviding fair and equitable benefits t all
More informationSummary Plan Descriptions
Summary Plan Descriptins All grup health plans subject t the Emplyee Retirement Incme Security Act (ERISA) are required t prvide participants with a Summary Plan Descriptin (SPD). An SPD must be written
More informationJanuary 2017 *Benefits Highlights for Medical Center Employees
January 2017 *Benefits Highlights fr Medical Center Emplyees Health Insurance Plans A Tricare Supplement plan is ffered t Tricare eligible emplyees: all ther emplyees have t the ptin t enrll in the MUSC
More informationInstitute For Orthopaedic Surgery (IOS) Subject: Billing and Payments: General Guidelines
Institute Fr Orthpaedic Surgery (IOS) Plicy and Prcedure Manual Subject: Billing and Payment: General Statements Purpse: T prvide directin t staff members in their interactin with patients and guarantrs
More informationPREPARING TO TERMINATE DROP
PREPARING TO TERMINATE DROP If yu wrk until yur riginal Deferred Retirement Optin Prgram (DROP) terminatin date, the Divisin f Retirement will mail yu yur DROP Terminatin Packet apprximately 90 days prir
More informationHighlights for 2017 Compliance
Prvided by Natinal Insurance Services, Inc. Highlights fr 2017 Cmpliance The Affrdable Care Act (ACA) has made a number f significant changes t grup health plans since the law was enacted in 2010. Many
More informationTable of Contents. About Your Benefits 1. Medical Plan 2. Prescription Drugs Plan 3. Vision Plan 4. Dental Plan 5. Employee Assistance Program 6
Table f Cntents Sectin Tab Abut Yur Benefits 1 Medical Plan 2 EPO 2-1-1 PPO 2-2-1 Chice Fund HSA 2-3-1 PPO Cre 2-4-1 PPO Select 2-5-1 Open Access Plus 2-6-1 Indemnity 2-7-1 Prescriptin Drugs Plan 3 Visin
More information2018 Employee Benefits Program (U.S.) Qualified Status Changes
2018 Emplyee Benefits Prgram (U.S.) Qualified Status Changes SUMMARY PLAN DESCRIPTION (SPD) 2018 Emplyee Benefits Prgram (U.S.) Qualified Status Changes TABLE OF CONTENTS WHAT HAPPENS TO YOUR BENEFITS...
More informationRev. 1/1/12. Sprint Flex Plans Eligibility and Enrollment Section
Rev. 1/1/12 Sprint Flex Plans Eligibility and Enrllment Sectin What is Inside Sprint Flex Plans... 3 Wh Is Eligible T Participate In Sprint Flex Plans... 3 Duplicate Cverage... 6 Enrllment... 6 Enrllment
More informationHealth Benefits Effective January 1, Subject to change.
Health Benefits Effective January 1, 2019. Subject t change. Purpse: T utline the guidelines related t medical, prescriptin, dental and visin benefits. Scpe: All team members f Hackensack Meridian Health.
More informationTown of Palm Beach Retirement System. Deferred Retirement Option Plan (DROP) Policies and Information for Participants
Twn f Palm Beach Retirement System Deferred Retirement Optin Plan (DROP) Plicies and Infrmatin fr Participants Twn f Palm Beach Retirement System Deferred Retirement Optin Plan (DROP) Plicies and Infrmatin
More informationHRA s and HSA s GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. AJG.COM G-FORMS\GBS Forms\Template - Word - 1 margins.
HRA s and HSA s 1. HRA/HSA What Are They? 2. Can I have ther cverage and still cntribute? 3. Can I cntribute t my FSA if s, full r limited? 4. Can I have bth an HRA and an 5. Can I have bth an HSA and
More informationTable of Contents. About Your Benefits 1. Medical Plan 2. Prescription Drugs Plan 3. Vision Plan 4. Dental Plan 5. Employee Assistance Program 6
Table f Cntents Sectin Tab Abut Yur Benefits 1 Medical Plan 2 PGU Chice Fund HSA 2-1-1 PGU PPO Cre 2-2-1 PGU PPO Select 2-3-1 Chice Fund HSA 2-4-1 PPO Cre 2-5-1 PPO Select 2-6-1 Open Access Plus 2-7-1
More informationInstruction Page. Verification of 2014 Income Information for Individuals with Unusual Circumstances
Instructin Page Imprtant Nte: Please ntify the financial aid ffice if the student r their parents had a change in marital status after the end f the 2014 tax year n December 31, 2014 and als if the parents
More informationFOR PLAN ADMINISTRATORS
QDRO INFORMATIONAL KIT FOR PLAN ADMINISTRATORS T ensure cmpliance with requirements impsed by the IRS, we infrm yu that any infrmatin cntained in this cmmunicatin (including any attachments) was nt intended
More informationSWEET HOME SCHOOL DISTRICT. SUMMARY PLAN DESCRIPTION Flexible Spending Account
SWEET HOME SCHOOL DISTRICT SUMMARY PLAN DESCRIPTION Flexible Spending Accunt Effective: 10/1/2016 This dcument explains in detail the peratin and rules that gvern yur Plan. Sme features f a Flexible Spending
More informationPreparing for Your Early Retirement
Preparing fr Yur Early Retirement Imprtant Infrmatin fr Railrad Emplyees Eligible fr GA-46000 Eligibility fr Railrad Annuity Railrad Retirement Bard https://secure.rrb.gv/ Call yur lcal Railrad Retirement
More informationVision Service Plan (VSP) New Group Implementation Guide
Visin Service Plan (VSP) New Grup Implementatin Guide Nrth Ranch Benefits Trust (NRBT) Administered by HealthSmart Benefit Slutins, Inc. Agents shuld submit the cmpleted New Grup Implementatin Guide back
More informationExecutive Search (headhunt)
Executive Search (headhunt) Page 1 f 6 Standard Terms & Cnditins UK Trjan Management Search Ltd. 3rd Flr, 63 66 Hattn Garden, Lndn, EC1N 8LE t:+44 (0)20 7841 1600 f:+44(0)20 7841 1601 e:inf@trjan.c.uk
More informationCONNECTICUT CARPENTERS HEALTH FUND COBRA CONTINUATION COVERAGE ELECTION NOTICE
CONNECTICUT CARPENTERS HEALTH FUND COBRA CONTINUATION COVERAGE ELECTION NOTICE DATE Dear : This ntice cntains imprtant infrmatin abut yur right t cntinue yur health care cverage in the Cnnecticut Carpenters
More informationREFERENCE NUMBER: PFS.PDS.115. TITLE: Patient Billing and Collections CURRENT EFFECTIVE DATE: 01/01/2018. PAGE 1 of 8 SCOPE:
PAGE 1 f 8 SCOPE: This Patient Billing and Cllectins Plicy applies t all Presbyterian Healthcare Services (Presbyterian) hspital facilities, including inpatient, utpatient, hme health care services and
More informationEXXONMOBIL SAVINGS PLAN Hardship Withdrawal Form
EXXONMOBIL SAVINGS PLAN Hardship Withdrawal Frm Name: Sc. Sec #: Wrk Phne: ( ) Hme Phne ( ) Yu may request a hardship withdrawal when yur financial need cannt be met thrugh: Reimbursement r cmpensatin
More informationInstitute For Orthopaedic Surgery (IOS) Subject: Healthcare Financial Assistance Policy
Institute Fr Orthpaedic Surgery (IOS) Subject: Healthcare Financial Assistance Plicy Plicy and Prcedure Manual Subject: HealthCare Financial Assistance Plicy Purpse: T establish guidelines fr financial
More informationThe Safety Net Foundation
The Safety Net Fundatin Instructins fr Kineret (anakinra) and Sensipar (cinacalcet HCl) Instructins The Safety Net Fundatin prvides temprary prduct assistance t financially needy patients wh meet predetermined
More informationSection 125 Flexible Benefit Plan Plan Year Frequently Asked Questions & Answers and 125 Plan Summary of Reimbursement Account Arrangement
PLACER COUNTY OFFICE OF EDUCATION Sectin 125 Flexible Benefit Plan 2015-2016 Plan Year Frequently Asked Questins & Answers and 125 Plan Summary f Reimbursement Accunt Arrangement 800-248-8858, Ext. 251
More informationPHILADEPHIA PROMOTING HEALTHY FAMILIES AND WORKPLACES ORDINANCE (PAID SICK LEAVE LAW)
PHILADEPHIA PROMOTING HEALTHY FAMILIES AND WORKPLACES ORDINANCE (PAID SICK LEAVE LAW) Eligibility Wrkers emplyed in Philadelphia fr at least 40 hurs in a calendar year (January 1 t December 31) will accrue
More informationCRG PATIENT REGISTRATION FORM
CRG PATIENT REGISTRATION FORM PATIENT INFORMATION Patient s Name: Birth : (Last) (First) (Middle) Scial Security Number: Male: Female: Hme Address: (Street / RR Bx # / Apt. #) (City/State) (Zip) Preferred
More informationInformational Sheet- Application for Pension
33 Plaza La Prensa, Santa Fe, NM 87507 (505) 476-9401 Fax (505)476-9300 Vice (800) 342-3422 Tll-Free www.nmpera.rg Infrmatinal Sheet- Applicatin fr Pensin If yu are cnsidering retiring, PERA requests that
More informationWhat employers need to know about The Patient Protection and Affordable Care Act (PPACA)
What emplyers need t knw abut The Patient Prtectin and Affrdable Care Act (PPACA) 1. It is nw the law. Dept. f Health & Human Services (HHS) guidance is still needed n pen issues. 2. New state insurance
More informationMid-Market Underwriting Guidelines for Brokers (Groups of 51-99)
Mid-Market Underwriting Guidelines fr Brkers (Grups f 51-99) Independence Blue Crss Underwriting Department Applies t grups effective r renewing n r after 1/1/2014 This dcument is fr infrmatinal purpses
More informationThis Agreement is hereby confirmed to vary Terms & Conditions of employment between The Company and you.
Salary Sacrifice Agreement Terms & Cnditins This Agreement regulates yur participatin in the Simplydriveit prgramme, which has been implemented by Pendragn Cntracts Ltd fr (cmpany name here) Under the
More informationYelm Prairie PTO - Audit Worksheet Responsibilities The auditors need to complete their report by: Frequency of Audit Audit Committee/Auditor
Yelm Prairie PTO - Audit Wrksheet Respnsibilities T certify the accuracy f the bks and recrds f the financial fficer; and T assure the membership that the assciatin's resurces/funds are being managed in
More informationTufts Health Plan Policy #
Cverage Highlights Yur Plan Eligibility Cverage Amunts Tufts Health Plan Plicy # 425544 All full-time and part-time emplyees in active emplyment in the United States wrking at least 20 hurs per week. Cverage
More informationPERKINS REALTY RENTAL PROCEDURES
PERKINS REALTY RENTAL PROCEDURES PERKINS REALTY DOES BUSINESS IN ACCORDANCE WITH THE FAIR HOUSING ACT, AND DOES NOT DISCRIMINATE ON THE BASIS OF SEX, SEXUAL ORIENTATION, MARTIAL STATUS, RACE, CREED, RELIGION,
More informationDear State of Florida Retiree:
Peple First Service Center P.O. Bx 6830 Tallahassee, FL 32314 Tel: 866 663 4735 Fax: 800 422 3128 TTY: 866 221 0268 Dear State f Flrida Retiree: Cngratulatins n yur retirement! As a new retiree, yu need
More informationApplication for Coverage Under the Pre-Existing Condition Insurance Plan administered by the Arkansas Comprehensive Health Insurance Pool (CHIP)
P. O. Bx 1460 Little Rck, AR 72203 Applicatin fr Cverage Under the Pre-Existing Cnditin Insurance Plan administered by the Arkansas Cmprehensive Health Insurance Pl (CHIP) This Applicatin fr cverage thrugh
More informationOPEN ENROLLMENT GUIDE. October 18 TH - November 3 rd 2017
OPEN ENROLLMENT GUIDE Octber 18 TH - Nvember 3 rd 2017 LIVING WELL WITH THE WAVE BENEFITS OPEN ENROLLMENT OCTOBER 18 TH N O V E M B E R 3 RD, 2017 WHAT S INSIDE Yur benefits checklist... 3 TU benefits
More informationOFFICE OF THE PRESIDENT HUMAN RESOURCES POLICY MANUAL SECTION 11 JULY 28, 2006 REDUCTION IN FORCE GUIDELINES
Purpse A reductin in frce is an actin t reduce the number f emplyees in a wrk unit r university-wide. A reductin in frce may becme necessary due t reduced funding, rerganizatin, change in wrklad, r ablishment
More informationYour Retirement Guide. Employees
Yur Retirement Guide Emplyees Retirement is a big step. Over the next few weeks and mnths yu ll be asked t make many imprtant decisins abut yur New Yrk Life benefits and yur financial security. This easy-t-use
More informationEmployee Benefits Guide. January 1 December 31, 2019
Emplyee Benefits Guide 2019 January 1 December 31, 2019 Medical and Prescriptin Drugs Benefits are insured by: 4 Medical Plan Optins Effective January 1, 2019 Premium Netwrk HDHP 1 Nn-Premium Netwrk Nn-Netwrk
More informationEMPLOYMENT APPLICATION LEE COUNTY GOVERNMENT P.O. Box 398 ATT: Human Resources Fort Myers, Florida (239)
PERSONAL INFORMATION EMPLOYMENT APPLICATION LEE COUNTY GOVERNMENT P.O. Bx 398 ATT: Human Resurces Frt Myers, Flrida 33902 (239) 533-2245 http://www.lee-cunty.cm JOB NUMBER: JOB TITLE: EXAM ID#: Received:
More informationRenewal of Manager s Certificate
Applicatin fr Renewal f Manager s Certificate Sectin 219, Sale and Supply f Alchl Act 2012 General infrmatin: Yu must renew yur manager s certificate befre it expires. Once yur manager s certificate has
More informationPLAN DOCUMENT TEMPORARY DISABILITY INSURANCE PROGRAM FOR LAY EMPLOYEES DIOCESE OF METUCHEN OFFICE OF HUMAN RESOURCES. Effective January 1, 2014
DIOCESE OF METUCHEN OFFICE OF HUMAN RESOURCES TEMPORARY DISABILITY INSURANCE PROGRAM FOR LAY EMPLOYEES PLAN DOCUMENT Effective January 1, 2014 (Replaces January 1, 2013 Plan Dcument) 1 CONTENTS OVERVIEW...
More informationCompass Critical Illness Insurance Enrollment at a glance An affordable way to help protect against the financial stress of a serious illness.
Cmpass Critical Illness Insurance Enrllment at a glance An affrdable way t help prtect against the financial stress f a serius illness. Fr the emplyees f: ACME Truck Line, Inc. D yu knw smene wh has had
More informationFor the employees of: City and County of San Francisco Health Service System
Cmpass Critical Illness Insurance A limited benefit plicy Enrllment at a Glance An affrdable way t help prtect against the financial stress f a serius illness. Fr the emplyees f: City and Cunty f San Francisc
More informationHawaii Truckers Teamsters Health & Teamsters Legal Teamsters Training Teamsters Union Welfare Trust Fund Services Plan and Opportunity
HAWAII TEAMSTERS TRUST FUNDS 560 N. Nimitz Highway, Suite 209, Hnlulu, Hawaii 96817 Phne (808) 523-0199 Tll-Free 1 (866) 772-8989 Fax (808) 537-1074 Hawaii Truckers Teamsters Health & Teamsters Legal Teamsters
More informationFlorida Healthy Kids Uniform Credentialing and Recredentialing Policy
Each Managed Care Organizatin (MCO) must be accredited by a natinally recgnized accrediting bdy, such as the Natinal Cmmittee fr Quality Assurance, r have initiated the accreditatin prcess within ne year
More informationCAFETERIA PLAN AND FLEXIBLE SPENDING ACCOUNTS PARTICIPANT HANDBOOK
CAFETERIA PLAN AND FLEXIBLE SPENDING ACCOUNTS PARTICIPANT HANDBOOK PROVIDED BY MID- AMERICAN BENEFITS, INC. EXAMPLE OF TAX ADVANTAGE AVAILABLE THROUGH THE FLEX PLAN Under current tax law, yu may establish
More informationARIZONA FIRE DISTRICT ASSOCIATION FINANCIAL PROCEDURES POLICY
FINANCIAL PROCEDURES POLICY 1. PURPOSE The purpse f these Financial Prcedures is t prvide cnsistent applicatin f cnduct and prper internal cntrls t safeguard the assets f the Arizna Fire District Assciatin
More informationPaid time off is provided to eligible hourly and commissioned associates who need to miss work due to an illness or a personal situation.
Sick Time Plicy Paid time ff is prvided t eligible hurly and cmmissined assciates wh need t miss wrk due t an illness r a persnal situatin. Examples f when an assciate can use sick time include, but are
More informationAll Savers Alternate Funding Case Submission Checklist for Preliminary Quote (General HB2015 or LSHP groups in TX, OK, and IA)
All Savers Alternate Funding Case Submissin Checklist fr Preliminary Qute (General HB2015 r LSHP grups in TX, OK, and IA) All Savers PDF versins f the dcuments belw can be upladed t https://www.myallsavers.cm
More informationSignificant Financial Disclosure Policy for Investigators
Significant Financial Disclsure Plicy fr Investigatrs Disclsure Frm in Micrsft Wrd Frmat Intrductin Federal regulatins require the University t manage, reduce, r eliminate any actual r ptential cnflicts
More informationHIPAA Privacy Rule LINKS AND RESOURCES AFFECTED ENTITIES IMPACT ON EMPLOYERS. Provided by Brown & Brown of Louisiana, LLC
Prvided by Brwn & Brwn f Luisiana, LLC HIPAA Privacy Rule The HIPAA Privacy Rule establishes natinal standards t prtect individuals medical recrds and ther persnal health infrmatin. The Privacy Rule applies
More informationVOLUNTARY EMPLOYEE BENEFITS ENROLLMENT GUIDE
Plan Year 2018 Effective January 1, 2018 t December 31, 2018 VOLUNTARY EMPLOYEE BENEFITS ENROLLMENT GUIDE Internatinal Assciatin f Firefighters WHEN TO ENROLL When yu are initially eligible fr cverage.
More informationVOLUNTARY EMPLOYEE BENEFITS ENROLLMENT GUIDE
Plan Year 2018 Effective January 1, 2018 t December 31, 2018 VOLUNTARY EMPLOYEE BENEFITS ENROLLMENT GUIDE Plumbers Lcal 367 WHEN TO ENROLL When yu are initially eligible fr cverage. Yu have 30 days frm
More informationVODACOM BROADBAND FIBRE
VODACOM BROADBAND FIBRE SECTION A: Custmer Details & Package Selectin Surname First Names ID Number Street Address Estate Suburb City Prvince Phne Number (Hme) Phne Number (Wrk) Phne Number (Cell) Email
More informationFSB Press Release 20 August 2015
Retirement funds must take all reasnable steps t trace and pay millins f their members and beneficiaries wh remain untraced, the Deputy Registrar f Pensin Funds, Rsemary Hunter said n Wednesday. Addressing
More informationCOMPREHENSIVE BENEFITS SUMMARY (Health Plan)
2017 COMPREHENSIVE BENEFITS SUMMARY (Health Plan) Health Insurance Health insurance is prvided frm the 1 st f the mnth fllwing yur date f hire. Our current plan fferings are as fllws: HealthyBlue r ActiveUnivera
More informationPATIENT LIABILITY STATEMENT
PATIENT LIABILITY STATEMENT (Updated 6/17) We will nt initiate therapeutic services until signed authrizatin is prvided. I understand that I am persnally respnsible fr charges incurred fr services rendered
More informationSTATE OF NEW YORK MUNICIPAL BOND BANK AGENCY
STATE OF NEW YORK MUNICIPAL BOND BANK AGENCY Recvery Act Bnd Prgram Written Prcedures fr Tax Cmpliance and Internal Mnitring, adpted September 12, 2013 PROGRAM OVERVIEW The State f New Yrk Municipal Bnd
More informationEmployee Rights & Responsibilities Page 1 of 4 Traumatic Injury/Form CA-1
Emplyee Rights & Respnsibilities Page 1 f 4 Traumatic Injury/Frm CA-1 The Federal Emplyees Cmpensatin Act (FECA) utlines the benefits fr federal emplyees injured in the perfrmance f their duties. The Office
More informationYUM! Brands 401k Plan
YUM! Brands 401k Plan Final Distributin Electin Name: Scial Security #: Address: Daytime Telephne #: Evening Telephne #: Befre yu can prcess a Final Distributin Electin, yur status must be terminated.
More informationExit Interview Check List
Name: Exit Interview Check List Date Exit Interview Scheduled: Separatin/Retirement Date: Reasn fr Leaving (circle ne): Retirement Resignatin Terminatin Other: Health Benefits (COBRA) Life Insurance Cntinuatin
More informationCERTIFICATES OF INSURANCE PAGE
OAR (Online Assigned Risk) User s Guide Page 16 CERTIFICATES OF INSURANCE PAGE Clicking the Certificates f Insurance link in the menu bar at the tp f the OAR Hme Page will bring a prducer t the Certificates
More informationHOC Works Program Requirements
HOC Wrks Prgram Requirements Last Revisin: March 2018 INTRODUCTION The Husing Opprtunities Cmmissin f Mntgmery Cunty (HOC) established the HOC Wrks prgram in 2015 in rder t guarantee that HOC emplyment
More informationQUESTION WE VE BEEN ASKED
Date f issue: 23 February 2018 QUESTION WE VE BEEN ASKED QB 18/05 Incme Tax insurance persnal sickness and accident insurance taken ut by emplyer fr the benefit f an emplyee This Questin We ve Been Asked
More informationIRS ACA Employer Mandate Enforcement Employer Response FAQs
IRS ACA Emplyer Mandate Enfrcement Emplyer Respnse FAQs Intrductin The IRS has begun enfrcement activity n the Affrdable Care Act ( ACA ) Emplyer Shared Respnsibility Penalty ( ESRP ), smetimes called
More informationRelocation/Moving Procedures for New Employees
Relcatin/Mving Prcedures fr New Emplyees Purpse T prvide guidelines and restrictins regarding thse cases where relcatin csts are necessary fr an individual t accept emplyment with the University and t
More informationSuperannuation contributions tax ruling Tax deductibility of superannuation contributions
July 2011 Technical Bulletin Superannuatin cntributins tax ruling Tax deductibility f superannuatin cntributins Wh is impacted? As a result f tax ruling 2010/1 yur clients can n lnger claim a tax deductin
More information8722 S. HARRISON ST. SANDY, UT P.O. BOX 4439 SANDY, UT FAX
8722 S. HARRISON ST. SANDY, UT 84070 P.O. BOX 4439 SANDY, UT 84091 877-678-7342 FAX 800-478-9880 HOT AIR BALLOON PROPOSED EFFECTIVE DATE: A. General Infrmatin Applicant s Name: Applicant s Mailing Address:
More informationEXTENDED BENEFITS FOR TOTAL DISABILITY & SUCCEEDING CARRIER FOR INPATIENT ADMISSIONS
UnitedHealthcare Oxfrd Administrative Plicy EXTENDED BENEFITS FOR TOTAL DISABILITY & SUCCEEDING CARRIER FOR INPATIENT ADMISSIONS Plicy Number: ADMINISTRATIVE 149.11 T2 Effective Date: December 1, 2017
More informationSummary of Material Modification
Summary f Material Mdificatin T: Participants Frm: Human Resurces Re: Amendment t University f the Pacific Self-Funded Medical Plan Effective January 1, 2017, the University f the Pacific has amended its
More informationWELCOME. to The Orange Life! WORK, HOME and in the COMMUNITY. Benefits Orientation Guide for Permanent U.S. Part-Time Hourly Associates
WELCOME t The Orange Life!» WORK, HOME and in the COMMUNITY Benefits Orientatin Guide fr Permanent U.S. Part-Time Hurly Assciates We re glad yu decided t put n the range aprn and bring yur skills and knw-hw
More informationA Guide to Understanding Medicare Benefits
WEALTH SOLUTIONS GROUP A Guide t Understanding Medicare Benefits This cmprehensive guide prvides an verview f the key cmpnents f Medicare, including eligibility requirements, an explanatin f the different
More informationPROCESS FOR NATIONAL CAPITOL AREA GARDEN DISTRICTS, CLUBS AND COUNCILS CHOOSING TO FILE FOR 501(C)3 GROUP EXEMPTION
PROCESS FOR NATIONAL CAPITOL AREA GARDEN DISTRICTS, CLUBS AND COUNCILS CHOOSING TO FILE FOR 501(C)3 GROUP EXEMPTION What is a grup exemptin letter? The IRS smetimes recgnizes a grup f rganizatins as tax-exempt
More information2018 Healthy Boiler Wellness Incentive Program FAQs
2018 Healthy Biler Wellness Incentive Prgram FAQs As healthcare csts cntinue t rise acrss the cuntry, the university s best way t cmbat this is by helping t imprve the verall wellness f ur ppulatin. Therefre,
More informationCafeteria Plan. Explanation Booklet. For January 1, 2010 through December 31, 2010 Plan Year Elections
Cafeteria Plan 2010 Explanatin Bklet Fr January 1, 2010 thrugh December 31, 2010 Plan Year Electins 1 Table f Cntents Cafeteria Plan Overview 3 Medical Plan Optins. 5 Dental Plan Overview. 7 Flexible Spending
More informationNESA School Governance Compliance Requirements supporting the NSW Education Act 1990
NESA Schl Gvernance Cmpliance Requirements supprting the NSW Educatin Act 1990 NSW Educatin Standards Authrity (NESA) Registratin Systems and Member Nn-gvernment Schls (NSW) Manual (Refer t Schl Gvernance
More informationNRECA Long-Term Disability Plan
NRECA Lng-Term Disability Plan SUMMARY PLAN DESCRIPTION (BENEFITS BOOKLET) HOMEWORKS TRI-COUNTY ELEC 01-23026-001 EFFECTIVE DATE: January 1, 2016 Intrductin Summary Plan Descriptin This is a summary plan
More informationSummary Plan Descriptions (SPDs)
Prvided by McGriff Insurance Services, Inc., McGriff, Seibels & Williams, Inc., BB&T Insurance Services f Califrnia, Inc., and Precept Insurance Slutins, LLC Summary Plan Descriptins (SPDs) Delivery Requirements:
More informationILL HEALTH INCAPACITY: MANAGEMENT GUIDELINES
ILL HEALTH INCAPACITY: MANAGEMENT GUIDELINES PURPOSE The purpse f this dcument is t prvide guidelines t line managers regarding incapacity due t ill health, and t ensure alignment with prcedures and prcesses
More informationFinancial Terms for Service Providers to FWF
FWF financial terms fr service prviders December 2017 Financial Terms fr Service Prviders t FWF This dcument explains the financial terms fr all parties (service prviders) cntracted t wrk fr Fair Wear
More informationUBC Properties Trust (UBCPT) Restricted Faculty Second Mortgage Loan Program Summary of Key Terms. November 1, 2013
UBC Prperties Trust (UBCPT) Restricted Faculty Secnd Mrtgage Lan Prgram Summary f Key Terms Nvember 1, 2013 The Prgram is intended t assist full-time tenured and tenure-track faculty at UBC's Vancuver
More informationEnding Your Membership in the Plan
Ending Yur Membership in the Plan Yu must be eligible fr a valid disenrllment perid. Yur cverage will end the first day f the mnth after we receive yur request t disenrll. When can yu end yur membership
More informationWorkforce Housing Qualification Guidelines
Wrkfrce Husing Qualificatin Guidelines Prime Real Estate, LLC cmplies with the Federal Fair Husing Act. Prime Real Estate, LLC des nt discriminate n the basis f race, clr, religin, natinal rigin, sex,
More information2015 DATA ORGANIZER. First Name and Initial Last Name Social Security Number. (Optional: E-file confirmation will be sent to this address.
CLIENT CHECKLIST Cpy f Scial Security cards fr all individuals n the tax return Cpy f drivers licenses fr primary taxpayer and spuse (if applicable) Vided check if yu wuld like direct depsit r direct debit
More informationVerification Worksheet- V1 DIRECTIONS 2016 INCOME TAX FILER DIRECTIONS:
2018-2019 Verificatin Wrksheet- V1 DIRECTIONS 2016 INCOME Yur applicatin was selected by the U.S. Dept. f Educatin fr review in a prcess called "verificatin". Yu must submit the last 3 pages f this verificatin
More informationSalt Lake City Area Office 8722 S. Harrison St. Sandy, UT P.O. Box 4439 Sandy, UT Fax
Salt Lake City Area Office 8722 S. Harrisn St. Sandy, UT 84070 P.O. Bx 4439 Sandy, UT 84091 800-257-5590 Fax 800-478-9880 Chicag Office 303 W. Madisn Street Suite 2075 Chicag, IL 60606 800-456-4576 Fax
More informationNUMBER: BUSF 3.30 Business and Finance. Other Educational and General Program Accounts ("E" Funds) Date: October 18, 2006 I. PURPOSE OF THE POLICY
NUMBER: BUSF 3.30 SECTION: Business and Finance SUBJECT: Other Educatinal and General Prgram Accunts ("E" Funds) Date: Octber 18, 2006 Plicy fr: Prcedure fr: Authrized by: Issued by: All Campuses All Campuses
More information