Module 4.2B: Benefits Flashcards
What is indirect compensation?
Non-monetary benefits provided to employees in addition to their salaries.
The US federal government requires the following:
- social security/Medicare
- unemployment insurance
- worker’s compensation insurance
- COBRA
- FMLA
- PPACA
What is FMLA?
employees that have worked for at least one year at an organization and at least 1250 hours during that leave are eligible to take unpaid leave for family or medical reasons and have job protection while they are out.
Protects employees from losing their jobs if they need to care for a family member.
Parents - 12 weeks of unpaid leave and continued healthcare benefits after birth or adoption of child.
The same applies to employees who need to care for a sick parent, spouse, or dependent.
An employee caring for a family member injured during active military duty can take up to 26 weeks.
What is ERISA?
Employee Retirement Income Security Act (ERISA) includes many protections for pension and health plan participants and their dependents.
ERISA requirement is a summary plan description that includes policies, eligibility rules, plan sponsors, claim procedures, and more. ERISA also defines vesting, funding, and payout rules.
What is COBRA?
The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows employees to keep their health insurance for a period of time (18 months) after they lose or quit their jobs or lose eligibility because of reduced hours. They continue to pay the premiums, up to 102%.
What is PPACA?
Affordable Care Act (ACA) or Obamacare, the Patient Protection and Affordable Care Act (PPACA) includes rules about offering affordable plans and covering pre-existing conditions and preventive care. Legal challenges to the law are on-going, so HR staff will need to remain vigilant about compliance.
What is Mental Health Parity Act?
legislation in 2008, healthcare providers must provide coverage and cannot make annual limits for mental health coverage higher than any other medical or surgical limits
requires health plans to treat mental illnesses the same as physical illnesses. That means that copays should be the same or lower, while dollar and treatment limits for mental health should be the same or higher.
What is HIPPA?
Health Insurance Portability and Accountability Act (HIPAA) requires employers and healthcare providers to protect patients’ private health information. It also prohibits discrimination because of an employee’s health status.
In cases where benefits laws conflict with one another, an employer should honor the:
statute most beneficial to the employee
Which of the following employees are covered by FMLA after 1 year of employment?
Temporary employees who have worked more than 1250 hours
Continuation of coverage under COBRA should be extended to employees who:
lose coverage due to a personal LOA
What are nondiscretionary benefits?
Benefits mandated by law
What is HMO?
Health Maintenance Organization - network of physicians paid per patient rather than for treatments and visits. Employees cannot go out of network for coverage
It is a relatively low cost and doesn’t require claims paperwork.
What is PPO?
Preferred Provider Organization - network of healthcare providers that negotiate discounted fees with employers and employers guarantee certain number of patients. Rates are cheaper than if employees go outside of network.
It is a relatively low cost and doesn’t require claims paperwork.
managed-care plans that aim to provide cost-effective, medically necessary services.
more choices because members can elect in-network providers and facilities at a discount or out-of-network providers for a higher cost.
What are consumer-directed care?
Health reimbursement accounts (HRA) and health savings accounts (HSA) allow employees to use special savings accounts to pay for medical expenses.
HRA plans, the employer sets aside pretax dollars to pay for employee healthcare.
HSAs, it’s employees who fund and own the savings accounts, which are federal tax exempt, and they must be enrolled in high-deductible health plans.
What is drug, dental, and vision?
vary widely in their coverage and costs. For example, some prescription drug plans might cover only generic or formulary drugs or limit pharmacy choices.
What is EAP?
Employee assistance programs offer confidential counseling options for both personal and professional concerns.
include legal or financial advice, marriage and family counseling, stress management, and other mental health care.
What are cafeteria plans?
Benefits program employees choose from array of healthcare benefits that are most important to them and their families and pay for them with benefit credits