Domestic Partner Policy and Forms

Transcription

1 omestic Partner Policy and orms omestic Partner Benefit Policy 2 omestic Partner Enrollment Addendum 6 eclaration of Tax Certification of omestic Partner ependency 9 Affidavit of omestic Partnership 10 omestic Partner Policy and orms 10/09 1

2 OETIC PARTER BEEIT POLIC REVIE A O 10/15/09 IRA seeks to promote and recognize the diverse needs of its employees. In furtherance of this goal, benefits will be provided to domestic partners under certain benefit programs in a similar manner as provided to spouses of legally married employees (under ederal law.) omestic Partner Eligibility omestic partners are defined as two individuals of the same or opposite-gender* who meet either (A), (B) or (C) below: (A): (B): (C): arried as same-gender spouses, or have entered into a civil union, under the state s law in which the individuals reside. Registered domestic partners in accordance with applicable state or municipal law. Individuals who meet all of the following criteria: Both 18 years of age or older; ot related by blood, not married under federal law, or are not legally separated; Have resided together continuously for at least six months with the intent to continue doing so indefinitely; Have not had a different domestic partner within the previous six months prior to residing together; Are not legally married to someone else nor have another domestic partner; Have agreed to be jointly responsible for each other s welfare including living expenses; Are in an intimate, committed relationship of mutual caring; and Are not in their current relationship solely for the purpose of obtaining benefits coverage. * ome HOs do not extend coverage to opposite-gender domestic partners. Benefits Available to omestic Partners omestic partners are eligible for the following benefit plans or programs on terms similar to those for spouses of legally married employees (under federal law): edical ental amily medical and personal leave of absence policy Continuation of benefits under the Consolidated Omnibus Budget and Reconciliation Act (COBRA) following a status change that results in a loss of applicable coverage Employee Assistance Program (EAP) Health Advocate IRA Employees Retirement Plan (pension plan) IRA Retiree edical Plan omestic Partner Policy and orms 10/09 2

3 Important ote: 1. Kaiser Colorado HO does not allow opposite-gender domestic partner benefits. All HO plans will allow same-gender domestic partners. 2. The IR does not permit the use of Health or ependent Care lexible pending Accounts (As) for expenses incurred by a domestic partner or his/her children. IRA-ponsored Benefits Available to a omestic Partner Welfare Plan Coverage Under federal law, a same-gender spouse or a domestic partner is not eligible for taxfree employer-paid (either by direct employer subsidy or with respect to premiums that you pay) health care coverage. The one exception to this rule is a domestic partner who qualifies as a dependent domestic partner. In order to qualify as a dependent domestic partner (P) for purposes of tax-free health-care coverage under the definition in ection 152 of the Internal Revenue Code, your omestic Partner is your dependent if all three of the following tests are met: 1. ou provide over one half of the support of your omestic Partner for the year. In calculating support you must compare the amounts you contribute to your omestic Partner with the amounts your omestic Partner receives from ALL other sources including earnings and interest; 2. our omestic Partner is a member of your household for the year; and 3. our home is the principal place of residence of your omestic Partner for the year. Thus, under the Internal Revenue Code (IRC), the value of the coverage provided to a domestic partner, who does not qualify as a dependent, is taxable. The tax consequences are the responsibility of the employee, as opposed to the domestic partner or IRA. The premium to cover domestic partners and their dependent children is the same as the premium to cover other eligible family members. However, in light of the above ruling by the IR, any employee premiums for domestic partners and/or the dependent children of the domestic partner must be made on an after-tax basis and any employer subsidy is taxable. ependent children of the domestic partner that also qualify as dependent children of the employee (by blood, adoption or legal guardianship) may qualify for tax-free benefits. Please refer to the definition of dependents for the health care programs available on OAI or from HR-Benefits. ince the value of any employer subsidy for a non-dependent domestic partner and a domestic partner s eligible children is considered a part of the employee s taxable income, it is subject to ICA, edicare, federal, state and city taxes. IRA will withhold the taxes on the value of those benefits from the employee s paycheck. or additional information regarding the tax implications of covering a domestic partner, employees are strongly encouraged to consult with a tax advisor. IRA cannot and will not provide tax advice and/or counseling on any tax issues involving domestic partner benefit coverage. omestic Partner Policy and orms 10/09 3

4 Retirement Plan Coverage The IRA Employees Retirement Plan (pension plan) defines an employee s spouse as a legally married spouse or qualifying domestic partner (as defined by this policy). Employees are encouraged to make sure that beneficiary information for the plan is kept current and that IRA is notified of the existence of a spouse or domestic partner. Enrollment in the pension plan is automatic so nothing other than notifying IRA that you have a domestic partner is required. Retiree edical Coverage Retiree medical, dental and vision coverage is available to an employee s domestic partner at the time of the employee s retirement. All of the same eligibility and coverage provisions apply the same as under the health and welfare program and the Retiree edical Plan, with the exception of how the premiums for non-dependent domestic partners are taxed. ore information on the taxation of the retiree medical plan benefits for non-dependent domestic partners is available at the time of the employee s retirement. Enrolling a omestic Partner in Benefits To apply for domestic partner benefits you must: 1. Complete and sign an Affidavit of omestic Partnership that will certify that you meet the efinition of omestic Partnership and proof of registration as a omestic Partner where such registration is possible and/or provided by law. 2. Provide supporting documentation: Proof of qualifying same-gender marriage or civil union by the state of residence of the employee; OR Proof of qualifying P registration; OR A combination of the following: o Proof of joint residency (i.e., a lease, mortgage or deed with the names of both partners noted thereon) (required) o Proof of joint ownership of vehicle o Proof of joint financial responsibilities o Proof of joint ownership of checking account or credit card o Granting power of attorney o esignation of sole beneficiary/executor 3. If applicable, complete and sign the eclaration of Tax Certification of omestic Partner ependency form that will certify that your domestic partner is a dependent for purposes of tax-free health care coverage. Upon receipt of the properly completed form and documentation, HR-Benefits will consider the partnership registered as of the date signed on the form. Please note that the date must be within 31 days of receipt. Application for domestic partnership benefits must be made: Within 31 days of hire or first becoming eligible for benefits, uring the annual enrollment period for coverage beginning January 1 of the following year, or omestic Partner Policy and orms 10/09 4

5 Within 31 days of an eligible life status event such as marriage, civil union, etc. Contact HR-Benefits for more information on qualifying life events. ubmit your application by mail, fax or scan to: IRA HR-Benefits 9509 Key West Avenue Rockville, ax: can to: Termination of omestic Partnership Employees receiving benefits under a domestic partnership must notify HR-Benefits within 31 days of the dissolution of the relationship and complete a Termination of omestic Partnership form. The employee must then wait six months from the date of termination before registering another domestic partnership except in the case of dissolution due to death of the employee s domestic partner. ote: ome courts have recognized non-marriage relationships as the equivalent of marriage for the purpose of establishing and dividing community property. A declaration of common welfare, such as the registration of a domestic partnership, may therefore have legal implications. IRA reserves the right to unilaterally change the terms, conditions for qualification, or discontinue eligibility for its omestic Partnership benefit coverage at anytime without notice. The falsification or withholding of any information is grounds for immediate dismissal. omestic Partner Policy and orms 10/09 5

6 omestic Partner Enrollment Addendum Use this form to provide information on all persons covered by your benefit elections. Covered Persons Information ame (Last ame, irst ame, I) Relationship* P P Birth ate (dd/mm/yy) ocial ecurity o.* ex (/) ull- Time tudent (/) Benefits (Check all that apply) * = aughter; = on; P = on-ependent omestic Partner 1 ; P = ependent omestic Partner 2 ; = omestic Partner Child 3 ; ocial ecurity umbers edical ental edical ental edical ental edical ental edical ental edical ental edical ental edical ental 1 A P is a domestic partner who does not qualify as your dependent for purposes of receiving taxfree employer-paid (either by direct employer subsidy or with respect to premiums that you pay on a pre-tax basis through IRA s cafeteria plan) health care coverage. Please see the omestic Partner Benefit Policy for more information. 2 A P is a domestic partner who is a dependent for purposes of receiving tax-free employer-paid (either by direct employer subsidy or with respect to premiums that you pay on a pre-tax basis through IRA s cafeteria plan) health care coverage. In order to designate your domestic partner as such you must have completed the eclaration of Tax Certification of omestic Partner ependency form. Please see the omestic Partner Benefit Policy for more information. omestic Partner Policy and orms 10/09 6

7 are required if health insurance is requested because of Centers of edicare ervices regulation. Employee Life & A Insurance Beneficiary Information ame (Last ame, irst ame, I) Relationship Birth ate (dd/mm/yy) Primary or Contingent Primary Primary Primary Primary Contingent Contingent Contingent Contingent Life Insurance % Optional A& % 100% 100% 100% 100% If you designate more than one beneficiary, indicate the percentage that you would like each beneficiary to receive. The total must equal 100%. If you do not indicate a percentage, your insurance amount will be divided equally among your beneficiaries. 3 Under current federal law, a domestic partner s child s cost of coverage where employer-paid (either by direct employer subsidy or with respect to premiums that you pay on a pre-tax basis through IRA s cafeteria plan) is taxable to the employee, similar to a P. omestic Partner Policy and orms 10/09 7

8 eclaration of Tax Certification of omestic Partner ependency The value of the contributions made by IRA toward the cost of coverage for your omestic Partner under any IRA sponsored health, dental or vision plan is treated as taxable income to you unless your omestic Partner qualifies as a dependent under ection 152 of the Internal Revenue Code. If your omestic Partner qualifies as your dependent under ection 152 of the Internal Revenue Code, then IRA may provide coverage to your omestic Partner without imputing additional income to you. Please note, it is our understanding that under current law all coverage provided under the Plan to your domestic partner s children must be treated as taxable income to you and, as such, will show up on your orm W-2 as taxable wages. efinition of ependency Under the definition in ection 152 of the Internal Revenue Code, your omestic Partner is your dependent if all three of the following tests are met: 4. ou provide over one half of the support of your omestic Partner for the year. In calculating support you must compare the amounts you contribute to your omestic Partner with the amounts your omestic Partner receives from ALL other sources including earnings and interest; 5. our omestic Partner is a member of your household for the year; and 6. our home is the principal place of residence of your omestic Partner for the year. Certification Employee I: Employee ame Printed : omestic Partner ame Printed I certify that I have read the information outlined above and that my omestic Partner satisfies all three tests outlined above. I understand that falsely certifying dependency status could result various tax penalties and in IRA undertaking disciplinary action against me. I further agree to notify IRA immediately of any change in this tax status. ignature of Employee ate omestic Partner Policy and orms 10/09 8

9 AIAVIT O OETIC PARTERHIP ou must complete this statement and provide the required documentation (as described in the omestic Partner Benefit Policy) in order to qualify for domestic partner coverage. Employee ame (please print) Employee I# ate of Birth omestic Partner ame (please print) omestic Partner # omestic Partner ate of Birth We declare under penalty of perjury that we meet either (A), (B) or (C) below: (A): We are married as same-sex spouses, or have entered into a civil union, under the state s law in which we reside. (B): We are registered domestic partners in accordance with applicable state or municipal law. (C): We meet all of the following criteria: We are both 18 years of age or older. We are not related by blood, married or legally separated. We have resided together continuously for at least six months with the current intent to continue doing so indefinitely. either of us has another domestic partner. either of us have had a different domestic partner in the last six months. either of us is married to a third party. We have an intimate, committed relationship of mutual caring. We have agreed to be jointly responsible for each other s welfare including living expenses. We are not in this current relationship solely for the purpose of obtaining benefits coverage. We declare under penalty of perjury under the laws of the tate of that the statements above are true and correct. (Insert your tate of residence) urther: I agree to register with the IRA Benefits epartment any changes in circumstances attested to in this tatement within 31 days of the change. I have read the omestic Partner Benefit Policy and understand that I may be responsible for payment of income taxes as a result of the benefits provided to my domestic partner and/or my domestic partner s children. omestic Partner Policy and orms 10/09 9

10 I understand that IRA reserves the right to change its policy on domestic partners at any time and terminate all coverage. I certify that the information given on this form is correct. I understand that falsification or withholding of any information is cause for dismissal. Before signing this Affidavit you may wish to seek appropriate advice. or example, similar Affidavits have led some courts to recognize non-marriage relationships as the equivalent of marriage when establishing and dividing joint property. Employee ignature: ate omestic Partner ignature: ate Return this completed form along with two pieces of documentation (such as proof of joint residency (required), joint ownership of vehicle or, joint financial responsibility, or joint ownership of checking account/credit card) to: IRA HR-Benefits, 9509 Key West Avenue, Rockville, ax: (301) omestic Partner Policy and orms 10/09 10