Primmer Piper Eggleston & Cramer PC (the “Firm”) is committed to providing quality coverage for our employees and is pleased to present an employee benefits package reflecting that commitment.
Employee Eligibility – ACA Look-Back Measurement Method—Employees who are hired to work an average of at least 30 hours per week (“ACA full time”) are eligible to participate in group health benefits effective on the first day of the month following the date of hire. Employees who work less than ACA full time on average generally are not eligible for group health insurance coverage. To determine an employee’s ongoing eligibility for health benefits, the Firm tracks hours of service for each employee during what is called a “measurement period.”
New variable hour employees hired to work less than ACA full time are tracked for an initial measurement period (“IMP”) consisting of 11 months from the first of the month following the date of hire. During the 12th month they are measured. If they are found to have met the ACA full time standard during the IMP, they are eligible for enrollment on the first day of the 13th month.
Ongoing employees are tracked using the standard measurement period (SMP). The Firm’s SMP runs from November 1 through October 31. To be eligible for group health benefits, an employee must have met the ACA full time standard during the SMP. Hours of service that count toward the ACA full time standard are: (1) hours for which an employee is paid to work, (2) hours for which an employee is paid for vacation, holiday, illness, incapacity (including disability), and any approved leave, including jury duty, bereavement and leaves of absence. If an employee meets the ACA full-time standard during the SMP, then he or she will be eligible for health benefits for the next plan year (January 1 through December 31).
An example follows:
SMP: November 1, 2022, through October 31, 2023
Coverage Period: January 1, 2024, through December 31, 2024
The employee must elect coverage, pay all premium contributions and continue employment during the coverage period to maintain coverage.
Health Insurance Marketplace – The Firm’s group plan meets the standards created under the Affordable Care Act for affordability and value which means you can enroll in the plan, receive the employer contribution and deduct your portion of premium using pre-tax dollars as indicated above. As an alternative you may choose to purchase your plan in the Marketplace. If you choose to do so, you will not receive the employer contribution toward your premium, you cannot make premium payments using pre-tax dollars and because the Firm’s plan meets the affordability and value standards, you may not qualify for federal subsidy money, which may be available under the law. More information is available at www.healthcare.gov. Employees who are Vermont residents may also visit www.healthconnect.vermont.gov.
NOTICE REGARDING PRE-TAX ELECTION STATUS FOR PREMIUM PAYMENT BENEFITS ENROLLMENT:
The Firm’s pre-tax premium program was designed to help lower your costs through favorable tax treatment of insurance premiums. By electing to enroll in the health, dental and vision benefits we offer, you will automatically be enrolled in our Section 125 Flexible Benefits Plan for all elected premium payment benefits unless you elect, in writing provided to us, to pay your insurance premium contributions with after tax dollars. Paying for your benefits pre-tax saves you money. By enrolling in the pre-tax premium program, you must maintain your coverage for the entire plan year unless you have a qualifying life event (see the last section of this Overview). To accept participation in the pre-tax program, no action is required. You will automatically be enrolled when you enroll in the benefits. If you wish to decline and pay your premiums with after tax dollars, then you must make the appropriate election on the form provided by Human Resources for this purpose.
CHANGES IN ENROLLMENT/QUALIFYING LIFE EVENTS:
After enrollment in most of the plans described above, you cannot make changes to your coverage during the year unless you experience a change in family status, such as: loss or gain of coverage through your spouse; loss of eligibility of a covered dependent; death of your covered spouse or child; birth or adoption of a child, marriage; divorce or legal separation; and switch from part-time to full-time. You are responsible for notifying Human Resources of any such changes and have 30 days to do so following a change in status.
COBRA Information:
COBRA continuation coverage is a temporary extension of coverage under the group health plan. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Benefits Coordinator in Human Resources.
Health Insurance Marketplace:
You may have other options available to you when you lose group health coverage. You may be eligible to buy an individual plan through the Health Insurance Marketplace (www.healthcare.gov). By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30- day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
HIPAA Information:
Special Enrollment Right Mandated by the Health Insurance Portability and Accountability Act of 1996
Group health plans and health insurance insurers are required to provide special enrollment periods during which individuals who previously declined coverage for themselves and their dependents may be allowed to enroll without having to wait for the plan’s next open enrollment period. A special enrollment period can occur if a person with other health coverage loses that coverage or if a person becomes a new dependent through marriage, birth, adoption or placement for adoption. If you refuse enrollment for yourself or your dependents for medical coverage, you may later enroll within 30 days of a change in family status or loss of health coverage.
Individuals may not be denied eligibility or continued eligibility to enroll for benefits under the terms of the plan based on specified health factors. In addition, an individual may not be charged more for coverage than similarly situated individuals based on these specific health factors.
CHIP Information:
Effective April 1, 2009, the Children’s Health Insurance Reauthorization Act of 2009 (CHIPRA) created a new 60- day special enrollment period for eligible Team Members and dependents to immediately enroll in the plan if they become ineligible for Medicaid or any state’s Children’s Health Insurance Program (CHIP) and lose coverage or become eligible for that state’s premium assistance program. The Team Member must request coverage within 60 days after the termination of coverage or the determination of subsidy eligibility.
Women’s Health and Cancer Rights Act of 1998 (WHCRA):
WHCRA requires a group health plan to notify you, as a participant or a beneficiary, of your potential rights related to coverage in connection with a mastectomy. Your plan may provide medical and surgical benefits in connection with a mastectomy and reconstructive surgery. If it does, coverage will be provided in a manner determined in consultation with your attending physician and the patient for a) all stages of reconstruction on the breast on which the mastectomy was performed; b) surgery and reconstruction of the other breast to produce a symmetrical appearance; c) prostheses; and d) treatment of physical complications of the mastectomy, including lymphedema. The cover age, if available under your group health plan, is subject to the same deductible and coinsurance applicable to other medical and surgical benefits provided under the plan. For specific information, please refer to your summary plan description or benefits booklet, or contact Human Resources.
References
If you have any questions or need assistance with any of your benefits, please contact:
Human Resources
Kathy Landry
Director of Administration & Human Resources
802-660-3316
klandry@primmer.com
Melissa Mullarkey
Human Resources/Administrative Services Coordinator
802-660-3315
mmullarkey@primmer.com