Qualifying Events, Re-Instatements/Settlement Agreements, Job Data - - PowerPoint PPT Presentation

Qualifying Events, Re-Instatements/Settlement Agreements, Job Data Entry, Flexible Spending, and Special Announcement

Qualifying Events

■ Un Under der IRS S Gui uidel elines ines, an emplo loyer r may allow w emplo loyee ees to elect ect certain tain benef enefit its on a pre-tax basis. These arrangements are considered “Cafeteria Plans. "Which are sub ubject ject to certain tain gui uidel deline ines s and rul ules.

• s. Un

Unde der a c cafeteria ia plan, , an emplo loyee ee can change nge thei eir r pre-ta tax x deferr rral al electi ction

• n dur

uring ng the e Open en En Enrol

• llme

lment nt Period

• d or in the

e case of a “Qualifying Event.” Employees must sub ubmit mit an electr ectron

• nic

ic enroll

• llment

ment form rm withi hin n 31 days of a Qu Qualify fying ing Ev Event nt in order der to make e a related ed bene nefit it change nge. ■ https://www.mybenefitsnm.com/Enrollment.htm – Gold tab at the top “Enrollment” ■ The e follo lowing ing se secti tions

• ns provi

vide de an overvi view w of IRS S Qu Qualify fying ing Ev Events nts and the corre respon ponding ding bene nefits ts that can be changed nged for each h event. ent.

Quali ualifying fying Ev Even ents ts Continued ntinued

• Permitt

rmitted d cafeteri ria plan change nges s based sed on n specif ecific ic Quali lifyi fying ng Events nts are re as fo follo lows: ws: – Change nge in job b statu tus s of spou

• use

se/do /domestic tic partne ner r resu sult lting ing in loss s of gro roup p cover erage ge or gain in of ot

• ther

r cover erage fro rom new w empl ploym yment nt. – Change nge in job b statu tus s of empl ployee (such as redu duction tion of hours s due to FMLA, LWOP OP, , and d Disabil ility ity). ). – Marriag rriage e or a chang nge in mari rita tal l statu tus, s, such as divor

• rce

e or lega gal l separa paratio tion, n, resu sult lting ing in a loss s of cover

• erage. This

s include ludes satis tisfyi fying ng requir irement nts s fo for r Domestic tic Partne nersh ship ip elig igibi ibili lity ty. . – Death of the e empl ployee ee. . *Death eath of a spouse se or eligib ible le depen ende dent, t, resu sult ltin ing in a loss s of group coverage. e. – Birth th of a child ld, , a court t app pproved ed adop

• ptio

tion n or lega gal l guardia diansh ship ip. – Any y oth

• ther

er circ rcumsta tanc nce e wher ere the e indivi dividu dual l had d oth

• ther

er cover erage e and nd loses ses it due e to circumsta tanc nces beyond nd thei eir r contr ntrol

• l must

t be eva valuat luated by RMD D fo for r elig igib ibil ility ity. . NOTE: : Los

• ss

s of a pro rovid vider er or pro rovid vider er gro roup p is not t a qualify ifying ing even ent t to chang nge carr rrie iers. s.

Quali ualifying fying Ev Even ents ts Continued ntinued

■ If there has been a qualifying event, coverage becomes effective the day following loss of coverage, providing the enrollment is made within 31 days of the Qualifying Event. Payroll deductions must begin at the start of the pay cycle in which the Qualifying Event occurs. ■ Dependents that were covered under another group plan and lose that coverage due to a qualifying event may be immediately insured under the State plan, provided adequate proof of previous group coverage is submitted to ERISA and the

• employer. Enrollment of the dependents

must be made within 31 days of the loss

• f coverage. Proof of dependency must be

submitted before coverage will begin. ■ A qualifying event acts like an Open/Switch Enrollment for the employee, with the exception of Life coverage. ■ Dropping Benefit Coverage

• When employees cancel

medical/dental/vision coverage, re-enrollment cannot occur until the next open/switch enrollment unless there is a new Qualifying

• Event. Since Disability and Dependent/

Supplemental Life premiums are post-tax, these coverages can be cancelled by employees at any time

Quali ualifying fying Ev Even ents ts Cont…..

■ Employees must notify ERISA when a dependent’s eligibility ceases due to the following circumstances: Divor

• rce

e from the emplo loyee, ee, child ld marries ies (is under er age 26 and choos

• ses

es to to elect t cover verage age elsewhe here) e), , or ot

• therwis

ise e fa fails to to meet eligibilit igibility guidelin delines es. . The depen endent t must be waived ed from benef efit its. . NEVER ER delet ete e any spouse/ e/dom domes esti tic partne ner/ r/child( hild(ren ren) ) from the system. . –

• a. Cov
• vera

erage e fo for depend endent ent childr dren en turn rnin ing 26 term rmin inates es at t the end of the e last t day of the e mont nth in which they turn n 26. . –

• b. Cov
• vera

erage e fo for a spou

• use

se becoming

• ming non-elig

eligible ible due to divorc rce e must t be term rmina inated ed on the date e of the Divor

• rce Decree.

ee. –

• c. Domes

esti tic Partn tner ers s must t also lso be term rmin inated ed fro rom cov

• vera

rage e on the e date e of term rmin ination ion of domes estic ic partner nersh ship ip. . –

• d. Medic

ical, l, Dent ntal l and d Vision ion cov

• verage

e fo for deceased eased empl ployees ees or dependent endents termin rminates es on the last day of the e pay period iod fo for which deductions/payments were made. The actual date of an employee’s death should be recorded, in SHARE, in the employee’s Biographical Details tab at the “Modify a Person” module. –

• e. If the ineligible dependent is the employee’s last or only dependent, ERISA will change the payroll coverage from family to couple

le

• r single.
• le. If there

ere are e ot

• ther

er cov

• vered

d depend endent ents, s, the e cov

• verage

e type e and d prem emium ium may not

• t change.

e. –

• f. If a Non-POP

OP emplo loyee ee chooses ses to waive e any depend endent ents fo for any reason son ot

• ther

er than ceasin sing to

• meet

t eligib ibilit ility requirem uirement ents, s,

• btain a signed and dated form documenting the employee’s intent to cancel coverage. Coverage will terminate on the last day of

the e pay period iod in which the applica lication ion is signed ned and a deducti tion

• n has

s been taken. en.

Tra ransf nsfer ers

■ State Employees who transfer from one State agency to another State agency or covered LPB*, with no break from employment, may transfer their employee benefits coverage without the waiting period that applies to new employees. Benefits must remain the same and will be effective the first day of employment at the new agency with no break in coverage. ■ Employees who transfer must keep the same coverage(s) they previously had. They cannot add or delete coverage(s) at the time of transfer. If the employee chooses to add a benefit not previously enrolled in, they will need to be treated as a new hire, with appropriate eligibility waiting periods. ■ It is recom comme mend nded ed that t emplo loyees es only y transf sfer r at the e begi ginning nning of a p pay period iod. . ■ NOTE: : With any break in service followed by a rehire (even for 1 day), the employee is considered a new hire. – Re-Instatements are only considered with a court order and review/approval by the Employee Benefits Bureau.

Re-Instatements/Settlement Agreements

Human Resource Personnel are responsible for working with their legal team along with DFA in regards to any settlement agreements granted.  Reinstat nstateme ments nts are only considered with a court order and review/approval by the Employee Benefits Bureau.

• DFA Requirements for settlement Agreements can be found at the link listed below.

http://www.nmdfa.state.nm.us/uploads/FileLinks/142e987c03644bda92401c7c85f0 8944/DFA_Requirements_for_Settlement_Agreements_.pdf

Job Data Entry

*Job Data Change ge- Ad Additiona nal action

• n may be r

requ quired d if the following wing occurs

• Chang

nge e of Date

• Row is Removed

Job Data Entry

Job Data Entry

Out of Sequence Event-Action Required

Job Data Entry Continued…

• Please

ase Advise se Eris isa a Adminis inistrativ trative e Se Servi vices ces

• jdillon@e

lon@easi sitpa.co tpa.com Templat plate

• Sub

ubject ject Line: ne: Action ion Required uired- On On Dema mand nd Ev Event nt Maintenance enance Gree reeti tings: ngs: A jo A job data entr try y has been en process cessed ed for emplo mployee ee (Emplo Employee e Name) me) (Empl Empl. . ID ID#.)Th .)This s has posit itione ioned d events ents to be out ut of sequenc ence, , left t the e last event ent

• pen

en, , or left t bene nefits ts active e when en they y sh should

• uld be terminat

minated ed. . Please e re re- process cess events ents accordingl dingly y to corre rect ct recor cord. d. Thank ank you u for your ass ssista stance nce. (Your

• ur Signa

nature ture)

Individual Premium Payments for Flexible Spending Account

• Flexib

xible Spendi ding ng Ac Accoun

• unts

ts (FSA) A) allows ws emp mployees ees to set et aside e money for eligible ible expen enses ses prior to taxes es being ng withhel held. d.

• Employee

ee pledg dges s a speci cified ied amoun unt t for the e plan year.

• Pledg

dged ed amoun unt t is then en divided vided by 26 pay period

• ds.
• Pledg

dged ed amoun unt t is deduct educted ed each h pay period

• d in accor
• rdance

dance with th ot

• ther

her elect cted ed benef efits its. Thus, us, maki king g this premiu ium m also requi uired ed.

• Impor

mporta tant nt

• Individ

ividua ual premium um paymen ents ts shall be made for the exact ct premium um amoun unt t based sed on pledge ge and amoun unt t calcul culated ed for each h pay period

• d while

e out on leave. e.

• If the minimu

mum m of one pre remium um payme ment nt is missed, sed, Share re re reads s the miss ssed d payme ment

• nt. Theref

efore, e, premiu iums ms are automa

• matic

tical ally y increa eased sed for the remain ining ng periods ds of the year.  A qualify ifying ng event nt is requir uired ed to make any ch changes anges to this s benef efit. it.

Introducing: SaveonSP

Importa tant nt Pharmac acy Benef efit it Inform

• rmat

ation ion Begin inning ning Januar ary 1, 2020, , New Mexico Risk Manage agemen ent t Divis vision ion is partnering ering with Express-Sc Scrip ipts ts' ' progr gram am: : Saveon veonSP SP, , to to help you u save ve money

• n certain

ain specialt ialty medic icati tions

• ns.

. If you partic icip ipat ate e in this progr gram am, , select t specialt ialty medic icat ations ions will l be free of charge ge ($0). . Your prescrip riptions ions will l still l be filled led throug ugh h Accredo, edo, your r existing ing specialt ialty mail l pharmac acy. . If you are curren ently tly takin ing g or will l be taking ing a medic icati tion

• n on the attac

ached ed list (Non-Es Essen enti tial al Health th Benefit it Specialt ialty Drug g List), , you u are eligi gible le to to partic icip ipat ate e in the Saveon veonSP SP progr gram am. . To partic icip ipat ate, e, simply ly call l Saveon veonSP SP at 1-800 800-683-1074 prior r to to Januar ary 1, 2020 to to avo void id delays in obtaining aining your r prescrip ripti tion(

• n(s).

. Partic icip ipati ation

• n in this progr

gram am is vo volun luntar tary. . If you choos

• se

e not

• t to

to partic icip ipat ate, e, you will l be respons nsib ible le for

• r the copay provided

ided on the attached hed list. . Keep in mind that the copay will l not

• t count

nt towa towards ds your r deducti tible le or out-of

• f-poc
• cket

et maximum ums, , in accorda dance nce with the Affor

• rdab

dable le Care Act t (ACA CA). . For example: le: If you were taking ing Copaxone

• ne,

, your r copay is curren rently ly $70. . Effec ecti tive Janua uary 1, 2020, , your r copay will l increas ease e to to $1,0 ,000. If you partic icip ipat ate in the Saveon veonSP SP progra ram, , your ur full l copay will l be paid throug ugh h the manufac facturer turer copay assistanc ance progr gram am and d you will l pay not

• thing

ing ($0). If you choos

• se

e not

• t to

to partic icip ipat ate e in the Saveon eonSP SP program ram your ur finan ancial al respons nsib ibilit ility will l be the full l $1,0 ,000 copay. . In additi tion

• n,

, the $1,0 ,000 copay will l not

• t count

nt towar towards ds your r deducti tible le or out-of

• f-poc
• cket

et maximum um, , becaus use e Non-Es Essen enti tial al Health th Benefit its do not

• t apply

ly to to out-of

• f-

pocket accum umulat ulator

• rs.

If you have e any further er ques esti tions ns or concern erns, , please e contac tact t Saveon veonSP SP at 1-800-683-1074 Monday - Thursda day 8:00 a.m. -8:0 :00 p.m. . Eastern rn and Frida day 8:0 :00 a.m.-6:0 :00 p.m. . Eastern, n, or contac act. t. Sincer erely ely, , SaveonSP

• nSP

Qu Quest estio ions ns

Thank You