Module 6 - Employee Group Benefits Flashcards
Contributory Plan
Employee pays some portion of the premium
Noncontributory Plan
Employer pays entire premium cost
Employee Contributions Taxability Life Insurance
Employees pay for group life insurance with after-tax dollars, unless the coverage is part of a cafeteria (section 125) plan.
Types of Group Life Insurance Coverage
Group Term Life
Accidental Death and Dismemberment
Group Ordinary/Group Paid-Up
Group Universal
Group Term Life (7)
- Premiums are deductible as a business expense
- absence of medical exam requirement
- tax-free first $50,000 of coverage
- Coverage must be based on a formula that applies uniformly to all plan participants
- low-cost and tax advantaged
- simple administration
- premium waiver
Section 79
Four requirements to qualify as group term insurance:
- Coverage must provide a general benefit.
- Coverage must be provided to a group (all employees of an employer) of employees as a part of their compensation for services rendered as an employee
- Insurance policy provided must be a master policy or a group of individual policies
- The amount of insurance provided to each employee must be consistent with no individual selection
Section 79 “General Benefit” Definition
Accidental death and dismemberment insurance, travel insurance, and health and accident insurance are not considered to provide a general benefit since such policies pay a benefit in only certain circumstances
Section 79 “Group of employees” Definition
All the employees of an employer - or fewer if individual selection does not define the group. Can cover a class. A self-employed individual, partner of 2% owner of an S Corp is not an employee for this purpose. Life insurance does not qualify as group term life insurance if provided to fewer than 10 employees.
Section 79 rules for Group Term Life - if the employer has less than 10 employees
- coverage is provided for all full-time employees
- the amount of insurance is based on a uniform percentage of compensation
- the amount of insurance on an employee is based on brackets of coverage - with no brackets exceeding the bracket below by more than 2.5 times - and the insurance amount on an employee in the lowers bracket is at least 10% of that provided in the top bracket; and
- evidence of insurability may be requrested via a medical questionnaire completed by the employee, but may not be based on a physical examination and additional voluntary information may not serve as a basis for determining premium rates.
IRC Section 416(i) “Key Employees”
- an officer of the employer with annual compensation from the employer exceeding 185k
- a greater-than 5% owner of employer
- a greater-than-1% owner of the employer, having annual compensation from the employer in excess of $150,000
IRC Section 416(i) “Nondiscriminatory” for Group Life Insurance toward Key Employees (one of four)
- at least 70% of all employees benefit from the plan (or any group term plan through the employer)
- at least 85% of participating employees are not key employees (of all group term participants)
- the plan benefits a non discriminatory employee classification, and
- the plan is part of a cafeteria plan and coverage complies with the Section 125 nondiscrimination requirements
IRC Section 416(i) Employees not to be counted in the plan’s compliance of requirements
- less than three years of service
- part-time and seasonal
- employees excluded because they are covered by a collective bargaining agreement and group term life was the subject of good-faith bargaining
- certain nonresident aliens
Accidental Death and Dismemberment (AD&D Policies) Definition
provide a lump-sum benefit for loss of life or body parts due to an accident. May be included in a group life insurance policy or in a group health policy. Often the benefit is a percentage of group term life coverage.
Two types of AD&D Policies
Business Travel Insurance - provides specified classes of employees only while they are traveling for business purposes
Voluntary Accident Insurance - covers accidents related to any activity, either personal or business.
Group Ordinary or Paid Up Policy
A policy that includes “permanent benefits” (provides an economic value that extends beyond one policy year). The permanent portion of total coverage grows as the employee approaches retirement. At retirement, the policy can be converted to an individual policy at a more reasonable cost than if it had been a pure term policy converted at the same age.
- Dividends on a permanent group policy may be taxable to the employee depending on how much the employee puts towards buying the insurance.
Group Ordinary or Paid Up Requirements
TERM REQUIREMENTS PLUS:
- the amount of the death benefit considered part of the group term plan mus be specified in writing by the employer or stated in the policy
- the amount of the death benefit designated as group term must comply with a formula in the regulations.
Group Paid-Up
Employee makes an after-tax contribution that is allocated to purchase whole life insurance. The employer purchases sufficient group term life insurance to provide the scheduled total amount of insurance coverage to the employee.
Group Ordinary
- Section 79 plan offers employees the opportunity to participate in ordinary whole life insurance funded by employee and employer contributions. There plans are not common because of earlier abuses, the permanent portion needs to be entirely supported by the employee.
Group Universal
GULP, premiums usually employee paid. The only underwriting requirement is that the employee be actively at work. An important advantage of the GULP plan is the portability provided, the insurance is usually transferrable and the employee can continue to pay premiums to the insurance company, although the premium may change.
Supplemental Insurance Coverages
Group Survivor Income
Dependents’s Group Life
Supplemental Group Term Life
Group Carve Out
Group Survivor Income
- no lump sum payment option
- spouse and children beneficiaries only
- benefits will be paid only if there is an eligible survivor
- not considered life insurance
- monthly payment schedule for given number of years
Dependents’ Group Life
Employers can offer group life insurance coverage for the spouse and any children up to age 26.
- coverage cannot exceed 50% of the insurance for the employee
- if the coverage ends for any dependent of a covered employee, the dependent has the option to convert to an individual policy without evidence of insurability
- Coverage amount. limited to $2,000
Supplemental Group Term Life
Such coverage cannot be offered to just a few individuals, but it can be provided to a class of employees, such as salaried employees. But the members can choose to participate to buy more group term life insurance. Often, the insurance company will require evidence of insurability, since there is a greater risk of adverse selection. Paid for after-tax by the employee.
Group Carve Out
- discriminatory benefits
The employer can make enhanced benefits available to a group of executives by providing them with $50k of group term coverage and carve out the executives from the group life term insurance for any amount over $50k. This excess coverage is commonly provided by permanent insurance.
Tax-Free Death Benefits
Death Benefits paid to beneficiaries are not subject to income tax, note that a group survivor income policy may not be considered life insurance because of it’s conditions.
Tax Consequences of Group Term Insurance
An employer can provide up to $50k of group term life insurance coverage on the life of an employee without tax consequences to the employee if the group term coverage meets the requirements of IRA Section 79. The cost of anything in excess of that is taxable to the employee, based on the cost per thousand each month. Dependent coverage in excess of $2k is fully taxable to the employee.
- entire premium is deductible for the business
When is it nontaxable income to the employee above $50k?
- disable or retired, under certain conditions
- individuals who have designated the employer or a charitable organization as beneficiary.
- the economic benefits of the full amount of insurance coverage is taxable if the insurance is provided under a qualified plan
Retired Lives Reserve
a plan that prefunds the cost of post-retirement group life insurance coverage.
- may be either an insurance companies separate account or a trust account providing group term life for retired employees.
- Non taxable to the preretirement employee, upon retirement the employee is taxed on the cost of coverage
- employer can deduct contributions
Tax Consequences of Permanent Insurance
- The cost of employer-provided perm life insurance is reportable income
- Dividends from permanent insurance may be taxable to employee depending on who is contributing to the coverage
- Deductible to employer if employee is being taxed on it
Key Employee Taxes on Group Life
If the key employee is being discriminated for in the group life policy then he will have the entire premium on his gross income.
ACA Highlights
- Immediate access to insurance for uninsured individuals with pre-existing conditions
- Eliminating pre-existing condition exclusions
- Rescissions prohibited
- Eliminating Annual and Lifetime Limits
- Preventive Health Care Coverage
- Increased age for coverage of young adults
- Discounts in the Part D “donut hole”
- Increased additional tax for nonqualified medical expenses
- FSA contribution limit deduction
- Additional Hospital Insurance for High-Wage Workers
- Additional tax on net investment income for high-wage workers
- Mandatory Employer Coverage
ACA - “Increased additional tax for nonqualified medical expenses”
- Applying to HSAs and MSAs, the penalty for withdrawals prior to age 65 for nonqualified medical expenses increases to 20%.
ACA - “Additional Hospital Insurance (HI) for high-wage workers”
The HI (medicare tax) will increase by .9% on single earning over $200k and married earning of $250k
ACA - “additional tax on net investment income for high-wage workers”
A new 3.8% tax will be levied on the net investment income of high-wage workers
ACA - “Mandatory employer coverage”
Employers with 50 or more employees must offer coverage to their employees or be subject to fines.
Group Health Insurance Providers
- an insurance company, HMO or a self-funded plan
Group Health Insurance Premiums
- employees may be required to contribute some portion of the premium cost for the coverage
Group Health Insurance Rates
- risk is presented by the characteristics of the group and the plan as a whole. Once the group plan is in force, premiums are based on the experience of the group and can change at each renewal.
Comprehensive Expense Plan Benefits
diagnostics, medical, hospital, and surgical services.
- Deductible then coinsurance
- MOOP
Small-Business Health Care Tax Credit Requirements
- No more than 25 full-time employees (2 half-time = 1 full-time)
- Pay an average wage of less than $50k per year
- Self-employed ind, 2% shareholders of an S Corporation and 5% owners of the employer are not treated as employees