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Q&As: Mom and Pop Medical Insurance, In Network ER, and Bonus’s for Salaried Employees
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Manage episode 202157288 series 2129768
2 Person Group Insurance
Question: Is a small owner-only business eligible for group medical insurance? At this time, our company is comprised of the owner and his wife. There are no other employees yet, but we plan to hire employees in the future. Can we buy a group policy now or do we have to wait until we have other employees?
Answer: The question of whether a “mom and pop” business can purchase medical coverage as a group often comes up. Each state’s insurance laws control the type of policies that can be sold in that state and also defines who is a “group.” Insurance laws vary from state to state, but generally a husband/wife business does not qualify as a group if there are no other employees. There must be at least one W-2 employee who is not an owner or business partner (or spouse of an owner or partner). In the meantime, the owner may apply for an individual policy to cover himself and spouse (and eligible children, if any).
Lastly, there is a small handful of states that continue to allow mom and pop businesses meeting certain criteria to qualify as a group. Carriers and brokers licensed in the state can provide specific information about the respective state’s rules.
Health Care Benefits and “Emergency Services”
Question: The Affordable Care Act (ACA) requires our medical plan to cover out-of-network emergency services at the in-network benefit level. Does that apply just to the emergency room charges, or also to follow-up care?
Answer: According to the ACA regulations, the definition of emergency services includes:
- The initial evaluation or treatment in the emergency room or similar setting;
- Related ancillary services; and
- Further treatment if needed to stabilize the condition.
The plan cannot impose a time limit during which the emergency services are provided.
For instance, if the patient was treated in the emergency room and from there admitted to the hospital for surgery, it appears the emergency room services, hospitalization, and surgery are all within the ACA’s definition of emergency services.
Extra Comp for FLSA Exempt Employees
Question: May I provide an exempt employee with additional compensation for working longer hours on a time-sensitive project without losing the exemption?
Answer: Yes. If you have a position that is classified as exempt—meaning the position is exempt from minimum wage requirements and overtime pay as determined by the Fair Labor Standards Act (FLSA)—that does not prevent you from providing that employee with additional compensation to express appreciation when the employee works more hours than expected.
163 episodes
Archived series ("Inactive feed" status)
When? This feed was archived on July 28, 2021 16:09 (). Last successful fetch was on September 22, 2020 17:28 ()
Why? Inactive feed status. Our servers were unable to retrieve a valid podcast feed for a sustained period.
What now? You might be able to find a more up-to-date version using the search function. This series will no longer be checked for updates. If you believe this to be in error, please check if the publisher's feed link below is valid and contact support to request the feed be restored or if you have any other concerns about this.
Manage episode 202157288 series 2129768
2 Person Group Insurance
Question: Is a small owner-only business eligible for group medical insurance? At this time, our company is comprised of the owner and his wife. There are no other employees yet, but we plan to hire employees in the future. Can we buy a group policy now or do we have to wait until we have other employees?
Answer: The question of whether a “mom and pop” business can purchase medical coverage as a group often comes up. Each state’s insurance laws control the type of policies that can be sold in that state and also defines who is a “group.” Insurance laws vary from state to state, but generally a husband/wife business does not qualify as a group if there are no other employees. There must be at least one W-2 employee who is not an owner or business partner (or spouse of an owner or partner). In the meantime, the owner may apply for an individual policy to cover himself and spouse (and eligible children, if any).
Lastly, there is a small handful of states that continue to allow mom and pop businesses meeting certain criteria to qualify as a group. Carriers and brokers licensed in the state can provide specific information about the respective state’s rules.
Health Care Benefits and “Emergency Services”
Question: The Affordable Care Act (ACA) requires our medical plan to cover out-of-network emergency services at the in-network benefit level. Does that apply just to the emergency room charges, or also to follow-up care?
Answer: According to the ACA regulations, the definition of emergency services includes:
- The initial evaluation or treatment in the emergency room or similar setting;
- Related ancillary services; and
- Further treatment if needed to stabilize the condition.
The plan cannot impose a time limit during which the emergency services are provided.
For instance, if the patient was treated in the emergency room and from there admitted to the hospital for surgery, it appears the emergency room services, hospitalization, and surgery are all within the ACA’s definition of emergency services.
Extra Comp for FLSA Exempt Employees
Question: May I provide an exempt employee with additional compensation for working longer hours on a time-sensitive project without losing the exemption?
Answer: Yes. If you have a position that is classified as exempt—meaning the position is exempt from minimum wage requirements and overtime pay as determined by the Fair Labor Standards Act (FLSA)—that does not prevent you from providing that employee with additional compensation to express appreciation when the employee works more hours than expected.
163 episodes
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