Domestic Partnership Overview

Transcription

1 Domestic Partnership Overview Introduction and Eligibility You are eligible to enroll a Domestic Partner in medical, dental, vision and dependent life insurance benefits if you are an active benefits-eligible MassMutual employee, career contract agent, general manager or general agent. What health benefit options are available? The medical, dental, and vision coverage options described in the current year s benefits enrollment materials and applicable summary plan descriptions (SPDs) are available to you, your Domestic Partner and your Domestic Partner s eligible children. You may add or drop your Domestic Partner and your Domestic Partner s eligible children from coverage during annual benefits enrollment or during the year if you experience a mid-year qualifying event. Notification and benefits changes must be completed within 30 days of the mid-year qualifying event (60 days for birth, adoption or placement for adoption). What other benefit options are available? In addition to medical, dental and vision benefits, Domestic Partners and their children may qualify for limited participation in other benefit programs: You may elect to name your Domestic Partner and/or your Domestic Partner s children as beneficiaries under any of your MassMutual-sponsored benefits. 1 You may elect dependent life coverage for your Domestic Partner and your Domestic Partner s children. You may submit claims with respect to your Domestic Partner or Domestic Partner s children under health-care and dependent-care flexible spending accounts (FSAs), but only if they qualify as your tax dependents. Your Domestic Partner and your Domestic Partner s children may be covered as a dependent under the MassMutual high deductible health plan (HDHP), and you may be eligible to make before-tax contributions to your health savings account (HSA) up to the family contribution maximum. However, generally you can only use your HSA funds to pay for your Domestic Partner s and your 1 Certain restrictions apply to MassMutual Pension Plan beneficiaries that are domestic partners. For details, refer to the MassMutual Pension Plan Summary Plan Description online on myhr for employees (from MX, click I need to, then Find My Benefits (myhr)) or mybenefits for agents (from FieldNet, click My Practice, Benefits and then mybenefits) Massachusetts Mutual Life Insurance Company (MassMutual), Springfield, MA All rights reserved. DomPartnerAGTEE 1217 Page 1 of 12

2 Domestic Partner s children s eligible medical expenses if they are your tax dependent(s). If your Domestic Partner is covered under MassMutual s HDHP, he or she may be eligible to open his or her own HSA at a financial institution of his or her choice, using his or her own dollars and submit his or her qualified medical expenses to that HSA. Contact your tax advisor for complete details, including questions about annual contribution maximums and how to take tax deductions for aftertax deposits. (Employees may consult Ayco Financial Counseling at ; this service is not available to career contract agents.) You may be eligible to use the Adoption Assistance Program to help pay for the costs of adopting your Domestic Partner s children. For more information on the Adoption Assistance Program, refer to myhr (employees) or mybenefits (agents) for details Who qualifies as a Domestic Partner? Someone of the same or opposite sex who: has lived together with you as a domestic partner for at least 12 consecutive months prior to enrollment in the plan; is at least 18 years old; is not legally married to anyone else; is not related in such a way that would make a marriage between you illegal in your state of residence; is your sole domestic partner and intends to remain so indefinitely; shares financial responsibilities and expenses with you; and has resided together with you as if married and intends to do so indefinitely. In addition to meeting the requirements above, for an individual to be treated as a Domestic Partner, you must provide a satisfactorily completed and signed Affidavit of Domestic Partnership, available at the end of this guide. This document must be provided to MassMutual prior to you enrolling your Domestic Partner or your Domestic Partner s children in MassMutual benefit programs. You are required to notify MassMutual if your Domestic Partner no longer meets the definition set forth in this policy by submitting a Termination of Domestic Partnership form within 30 days (available on myhr (employees) and on mybenefits (agents)). The termination of your domestic partnership will generally result in a termination of that individual s participation in MassMutual benefit programs, as well as the participant of their children (unless such children have a separate legal relationship to you). 2 2 Your Domestic Partner and his or her children may be eligible for continuation coverage under COBRA if they have a loss of coverage due to change in Domestic Partner status. Page 2 of 12

3 You cannot enroll a new or the same Domestic Partner as a dependent for at least 12 months after dissolving the previous domestic partnership. In addition, you cannot enroll a Domestic Partner as a dependent for at least 12 months after a divorce. If you and your Domestic Partner marry, this is considered a mid-year qualifying event. You must notify MassMutual to change his/her status from Domestic Partner to spouse within 30 days of the mid-year qualifying event. Do not skip this: a change in status from domestic partner to spouse favorably changes the tax treatment of your health premiums. Can I enroll children of a Domestic Partner? You can enroll children 3 of a Domestic Partner in a plan if: (1) your Domestic Partner is enrolled in coverage under that plan, and (2) the children meet the plan s requirements for eligible dependents. Refer to the applicable SPDs on SPD Source on myhr (employees) or on mybenefits (agents) for details about eligibility for dependent children. Can I cover my adopted children? If you have legally adopted the children of your Domestic Partner, these children will be eligible for coverage like any other legally adopted child. It is not necessary to enroll legally adopted children through the Domestic Partner procedures described in this guide. When can I enroll? If you are a current benefits-eligible employee or career contract agent, you have four opportunities to enroll a Domestic Partner: during annual benefits enrollment for coverage effective the following January 1; within 30 days of your date of hire (employees) or contract endorsement date (agents); within 30 days of a mid-year qualifying event (for example, if your Domestic Partner loses coverage through his or her employer); or within 30 days of reaching 12 consecutive months of domestic partnership per conditions of a qualifying domestic partnership (see page 2 of this kit). For a list of mid-year qualifying events, see the applicable summary plan description (SPD). 3 Domestic partners must be enrolled for their children to be covered. Page 3 of 12

4 You can enroll your Domestic Partner s eligible children at the same time as your Domestic Partner, or within 30 days of their initial eligibility (90 days for birth, adoption, placement for adoption), if later. Elections can be changed during the year based on mid-year qualifying events, as described in the applicable plan. Refer to applicable SPDs for further information on myhr (employees) or on mybenefits (agents). Enrollment procedures 1. Contact a Benefits representative via phone or to determine if you are eligible to enroll your Domestic Partner and, if applicable, your Domestic Partner s children. Go to page 7 for contact information. 2. Complete an Affidavit of Domestic Partnership, available at the end of this guide, which certifies that you are in a domestic partner relationship. Both you and your Domestic Partner must sign and date the form and return it with the required documentation of domestic partner status. The form and all supporting documents must be received within the time frame identified above. 3. Mail, fax, or scan and the forms and required supporting document to MassMutual at the appropriate address. Go to page 7 for the mailing address. Once the signed Affidavit of Domestic Partnership and supporting documents are received and approved by MassMutual, you will be permitted to add your Domestic Partner to your coverage online. You must complete the online enrollment within the time frame identified above. Are your Domestic Partner and/or your Domestic Partner s children your IRS tax dependents? If your Domestic Partner or your Domestic Partner s children are your IRS tax dependents, complete the Domestic Partnership Dependent Tax Certification, available at the end of this guide. This form allows you to avoid imputed taxable income on Domestic Partner benefits. Consult IRS publications or your tax advisor to determine tax-dependent status. 1. Mail, fax or scan and the following completed forms to the appropriate address. Go to page 7 for contact information. o o Affidavit of Domestic Partnership Domestic Partner Dependent Tax Certification (if applicable) Page 4 of 12

5 What happens if I leave the company (employees) or if my contract is terminated (agents)? If you leave the company (employees) or if your contract is terminated (agents), you and your covered dependents (including your Domestic Partner and your Domestic Partner s children) may be eligible to continue your health plan participation under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Cost of Domestic Partner Coverage MassMutual may subsidize the cost of Domestic Partner coverage, if eligible. You pay your portion of the medical and dental coverage premiums (and the entire vision and dependent life premium) for Domestic Partners through payroll deduction (employees) or commission-voucher deduction (agents), the same as any other employee or career contract agent paying for coverage. Are there tax or any other implications? Because of IRS rules, the full, unsubsidized cost of your Domestic Partner s medical and dental coverage will be treated as taxable income to you. You pay federal and state income taxes, and Social Security taxes based on the unsubsidized value of the coverage (called imputed value ). These taxes will apply unless you meet any of the following criteria: Your Domestic Partner and your Domestic Partner s covered children are your IRS tax dependents. Please check with your tax advisor or IRS representatives for information about who qualifies as an IRS tax dependent. You must submit a Domestic Partnership Dependent Tax Certification if you qualify; or You pay the full cost of coverage on an after-tax basis as an unsubsidized agent or through COBRA; or You are a general agent of MassMutual for whom the portion of coverage subsidized by MassMutual is already fully attributed to your income. This income is generally listed on your pay statement or commission voucher as a separate line. The cumulative taxable income for the year will be reported as income on Form W-2 at year-end. How do I calculate taxable income amounts? Taxable income amounts for Domestic Partner coverage depend on whether you are enrolling just your Domestic Partner, or your Domestic Partner and one or more of your Page 5 of 12

6 Domestic Partner s eligible children. Imputed value may affect your tax bracket. Consult your tax advisor for details. Note: If you and your Domestic Partner marry, please notify MassMutual within 30 days of the marriage. The unsubsidized value of your Domestic Partner s coverage may no longer be taxable. Failure to notify MassMutual within 30 days may result in the inability to change your status from domestic partners to spouses until the next annual benefits enrollment. If your Domestic Partner is Medicare-Eligible If you cover your Domestic Partner covered under your MassMutual active employee or active agent medical coverage, the MassMutual plan may or may not pay first under Medicare rules. In some circumstances, Medicare enrollment and coverage rules can be significantly different for Domestic Partners from those for federally recognized spouses. Failure to comply with Medicare enrollment rules can result in penalties. Contact Medicare at for clarification and to determine when your Domestic Partner needs to enroll to avoid potential penalties. If your Domestic Partnership Ends If you and your Domestic Partner no longer meet all the domestic partner eligibility criteria outlined on the Affidavit of Domestic Partnership, you must submit a Termination of Domestic Partnership form, available under: Employees: myhr > Forms, benefit resources and coverage charts > Benefit forms Agents: mybenefits > Forms, benefit resources and coverage charts > Benefit forms The end of your domestic partnership will be considered a mid-year qualifying event, allowing you to change your benefits accordingly within 30 days from the end of your domestic partnership. The date you sign your Termination of Domestic Partnership form will be used to measure the 12-month period during which you may not enroll a new Domestic Partner. If the partnership ends, your Domestic Partner and your Domestic Partner s covered children may be eligible to elect continued health coverage individually for up to 36 months under COBRA, as described in your health plan SPD. Page 6 of 12

7 Questions Mail EMPLOYEES MassMutual Benefits, F State Street Springfield, MA AGENTS Producer Services & Operations, C State Street Springfield, MA Fax Phone or Ext , business days, 10 a.m. 4 p.m. ET , ext , business days, 8 a.m. 6 p.m. ET Disclaimer If there are any discrepancies between descriptions in this publication and information in relevant plan documents or from plan carriers, the plan documents will govern. This is not a summary plan description or plan document. This material is intended for active, benefits-eligible employees, career contract agents, general managers and general agents of MassMutual for benefits enrollment. The material is for informational use only and is not intended to create, nor is it to be construed as, a contract between MassMutual and any one or all of its employees, career contract agents, independent contractors or their beneficiaries. MassMutual reserves the right to modify, suspend or terminate any plans, programs or services described in this publication or the underlying plan documents at any time or from time to time, with or without notice. Page 7 of 12

8 Affidavit of Domestic Partnership This affidavit certifies that you and your domestic partner have an established relationship. It must be completed by each employee or career contract agent electing to cover a domestic partner under Massachusetts Mutual Life Insurance Company ( MassMutual ) medical, dental, vision and dependent life coverage programs. Coverage for domestic partners is conditioned upon the accuracy of the certifications provided below (including accompanying documentation), and remains in effect only while the certifications continue to be valid, and under the terms of the MassMutual employee or agent benefit plans. Both you and your domestic partner must sign this Affidavit. Please review this with an attorney prior to signing, as this may create financial and legal obligations between you and your domestic partner. Disclaimer If there are any discrepancies between this document and information in relevant plan documents, the plan documents will govern. MassMutual reserves the right to modify, revoke, change, suspend, or terminate any one or all plans, programs, policies, benefits, or services described in this document or the underlying plan documents at any time or from time to time. The language in this document is not intended to create, nor is it to be construed as, a contract between MassMutual and any one or all of its employees, agents or independent contractors. Employee or Agent and Domestic Partner Certification We do hereby certify that we are domestic partners and we meet the following conditions: We are each other s sole domestic partner and intend to remain so indefinitely. We reside together as if married and intend to continue to do so indefinitely. We have lived together as domestic partners for at least 12 consecutive months prior to enrollment of the individual in the plan. We are at least 18 years of age. We share financial responsibilities and expenses. We are not legally married to anyone else nor do we have another domestic partner. Page 8 of 12

9 We are not related in such a way that would make a marriage between us illegal in our state of residence. This does not bind MassMutual for any reason. Instead, it certifies to MassMutual that we have an established relationship. MassMutual is not obligated to recognize this relationship for any reason. We understand the value of the domestic partner s benefit coverage and that of any eligible dependent children of the domestic partner may be taxable to the employee or agent. The full, unsubsidized value of this benefit (as determined by MassMutual) will be attributed as income to the employee or agent. Documentation of Status Along with this form, submit a photocopy of one (1) of the documents below as proof of your relationship within 30 days of your date of hire or contract endorsement date, or within 30 days of a mid-year qualifying event, or during the annual benefits enrollment period: Copy of joint credit card bills Copy of joint saving or checking account statements Copy of joint utility bill Copy of a joint instrument of indebtedness such as a loan, mortgage, or contract of sale Copy of a joint lease agreement or deed of joint ownership of residence or motor vehicle Evidence of designation of the domestic partner as primary beneficiary in a will or for life insurance Evidence of designation of the domestic partner as primary beneficiary in a retirement contract Assignment of durable power of attorney for property or health care Domestic partner agreement validly entered into in a jurisdiction allowing registration of domestic partnership Please block out all financial data and any Social Security numbers, but leave in names, relationships and addresses. My domestic partner and I (by our signatures below) hereby affirm the assertions in this Affidavit are true and accurate. Page 9 of 12

10 PRINT NAME OF EMPLOYEE OR AGENT EMPLOYEE OR AGENT SIGNATURE TODAY S DATE MM OR AA NUMBER PRINT NAME OF DOMESTIC PARTNER DOMESTIC PARTNER SIGNATURE TODAY S DATE I agree to notify MassMutual if there is any change of circumstances in the relationship attested to in this Affidavit, within 30 days of the change, by filing a Termination of Domestic Partnership form. I understand that a copy of this form may be mailed to my domestic partner. I will be precluded from enrolling a new domestic partner or the same domestic partner for at least 12 months from the date the termination form was signed. In addition, I understand I cannot enroll a new domestic partner as a dependent for at least 12 months after a divorce. I understand that I am liable for any losses suffered by the plans attributable to false statements or my failure to notify MassMutual in the event any of the above certifications cease to be valid. DATE SIGNATURE Please return this Affidavit of Domestic Partnership and your documentation of status to: Mail EMPLOYEES MassMutual Benefits, F State Street Springfield, MA AGENTS Producer Services & Operations, C State Street Springfield, MA Fax BenefitQuestions@MassMutual.com AgentBenefitQuestions@MassMutual.com Page 10 of 12

11 Domestic Partnership Dependent Tax Certification Only use this form if you claim your domestic partner and/or your domestic partner s child(ren) as (a) dependent(s) when you file your income taxes. This certification must be completed if your domestic partner or domestic partner s children are your tax dependents. Proper tax treatment is contingent upon the accuracy of the certifications provided below, which MassMutual will rely upon until you submit a new form notifying MassMutual of a change in your domestic partner dependent tax status. PRINT NAME OF EMPLOYEE OR AGENT MM OR AA NUMBER AGENCY NAME (IF APPLICABLE) AGENCY NUMBER My purpose in signing this form is to (check one; see description of each option below): Domestic Partner Dependent Tax Certification (initial declaration only) I hereby certify that my domestic partner or any of my domestic partner s children, whom I am electing to cover under MassMutual medical, dental, vision or dependent life benefits, are all my legal tax dependents as defined by the Internal Revenue Code Section 152. I authorize MassMutual to provide domestic partner benefits to me on a tax-free basis starting with the date of this certification, and agree to notify MassMutual immediately (by submitting another copy of this form to MassMutual) if my tax dependency situation changes. If my tax dependency situation changes during the course of a calendar year, I recognize that I will be subject to taxable income based on the value of coverage provided for the entire year. Revocation of Prior Declaration I hereby certify that my domestic partner, or one or more of my covered domestic partner s children, no longer qualify as my legal tax dependent(s) under Internal Revenue Code Section 152. I acknowledge and agree that I will be subject to taxable income based on the value of medical and dental plan domestic partner coverage provided for the entire calendar year. Page 11 of 12

12 Certification and signature I certify that the above information is correct. I understand I am liable for any losses or tax penalties suffered by MassMutual attributable to false statements or my failure to notify MassMutual in the event any of the above information ceases to be valid. EMPLOYEE OR AGENT SIGNATURE DATE List tax dependents on the lines below. Identify domestic partner by writing DP after their name. Include date of birth for tax-dependent children. TAX DEPENDENT NAME TAX DEPENDENT NAME TAX DEPENDENT NAME TAX DEPENDENT NAME TAX DEPENDENT NAME TAX DEPENDENT NAME Page 12 of 12