Category / Regulations

by Medcon Benefit Systems Group, Inc.

Legislative Brief: What is an ERISA Plan?

What is an ERISA Plan in the group health plan environment? ERISA has been amended many times over the years, expanding the protections available to welfare benefit plan participants and beneficiaries. ERISA violations can have serious and costly consequences for employers that sponsor welfare benefit plans, either through DOL enforcement actions and penalty assessments or through participant lawsuits.
ERISA applies to virtually all private-sector employers that maintain welfare benefit plans for their employees, regardless of the size of the employer. This includes corporations, partnerships, limited liability companies, sole proprietorships and nonprofit organizations. They exempt two types, those maintained by Governmental Employers and Church Plans.
ERISA generally applies to the following common employee benefits, regardless of whether they are insured or self funded:

  • Medical
  • Dental
  • Vision
  • RX
  • HRA’s
  • FSA’s
  • Group Life and AD&D Benefits
  • EAP’s
  • Short and Long Term Disability Benefits
  • Disease-specific Coverage (for example, cancer policies)

ALL Group health plans subject to ERISA are required to provide participants with a summary plan description (SPD). An SPD must be written in a manner calculated to be understood by the average plan participant and must be sufficiently comprehensive to inform the participant of his or her rights and obligations under the plan.

For additional information, please feel free to contact us at 214/739-5215.

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by Medcon Benefit Systems Group, Inc.

FMLA Part III: Notice and Certification

Eligible employees using FMLA leave must provide a 30-day advance notice to take FMLA leave when the need is foreseeable, otherwise notice is to be provided as soon as practicable. An adequate amount of information must be provided in order for the employer to determine whether the FMLA applies to the leave request. If the employee is applying for FMLA leave for the first time, the employee is not required to assert FMLA rights or even mention the FMLA. If the employee has previously been provided FMLA-protected leave, the employee must specify the qualifying reason or need for FMLA leave.

As an employer, you have some important responsibilities in order to remain compliant and avoid costly fees. A notice approved by the Secretary of Labor explaining rights and responsibilities under FMLA must be posted and included in the employee handbook or written guidance concerning employee benefits. The FMLA poster provided by the Department of Labor here is available for use by employers.

Once the employee requests FMLA leave or it is determined the leave is for FMLA purpose, the employer is responsible for notifying the employee of the rights and responsibilities under the FMLA and explain that the leave will be designated and counted as FMLA leave. Optional forms WH-381 and WH-382 are also provided on the Department of Labor website for employer use.

Employers can require certification from a health care provider when FMLA leave is requested, as well as a certification that they are fit to resume work upon their return. The Department of Labor has also provided forms WH-380E and WH-380F for employer use regarding certification.

As always, along with our sister company, ERA, we welcome the opportunity to assist you with any of your compliance needs. Please do not hesitate to contact us to find out how we can be of valuable service to you.

*This article is intended to provide general guidance and should not be considered legal advice.

by Medcon Benefit Systems Group, Inc.

FMLA Part II: Leave Entitlement

According to the United States Department of Labor, employees who are eligible under FMLA may take up to 12 work weeks of unpaid leave during a 12 month period due to one or more of the following reasons:

  • For the birth and care of a newborn child of the employee
  • For the placement with the employee of a son or daughter for adoption or foster care
  • To care for a spouse, son, daughter or parent with a serious health condition
  • To take medical leave when the employee is unable to work because of a serious health condition
  • For qualifying exigencies arising out of the fact that the employee’s spouse, son, daughter or parent is on active duty or call to active duty status as a member of the National Guard or Reserves in support of a contingency operation

A serious health condition is defined as an illness, injury, impairment or physical or mental condition that involves inpatient care or continuing treatment by a health care provider for a condition that prevents the employee or the qualified family member from performing the functions of their job. Employees can also take leave in blocks on a “reduced leave schedule” when medically necessary with reasonable efforts to schedule the leave so as not to disrupt the employer’s operations. Additionally, during FMLA leave, the employer must maintain the employee’s health coverage under any group health plan on the same terms as if the employee had continued to work. When the employee returns to work, they are to be restored their original job, or to an equivalent job with equivalent pay, benefits and other terms and conditions of employment.

To view the full code of federal regulations regarding the FMLA, please click here.

The final post in the series will discuss appropriate notice and certification under FMLA.

*This article is intended to provide general guidance and should not be considered legal advice.

by Medcon Benefit Systems Group, Inc.

FMLA Part I: Who Is Eligible?

During our many years of service to our clients, the regulation that brings the most questions is the Family Medical Leave Act (FMLA). In a concentrated effort to answer questions and bring clarity to the Act, we are going to divide the FMLA information into three distinct parts and actually give you links to appropriate forms directly from the Department of Labor website.

The FMLA allows employees to take up to 12 work weeks, consecutive or intermittent, depending on the circumstances, unpaid, job-protected leave in a 12-month period for specified family and medical reasons. Employees are eligible if they:

  • Work for a covered employer
  • Have worked for the employer for a total of 12 months
  • Have worked at least 1,250 hours over the previous 12 months
  • Work in the United States where at least 50 employees are employed by the employer within 75 miles.

There are a few exceptions related to military service. If an employee had a break in service during the 12 month employment requirement or 1,250 hour requirement due to fulfillment of the employee’s National Guard or Reserve military service obligation, the time performing the military services counts in determining whether the employee has been employed for at least 12 months or 1,250 hours. Additionally, there are military family leave entitlements, including military caregiver leave and qualifying exigency leave. Military caregiver leave allows eligible employees up to to 26 weeks (in a single 12 month period) unpaid leave to care for a service member with a serious illness or injury that is the employee’s spouse, son, daughter, parent or next of kin. To find out more details on military caregiver leave and what is classified as a “qualifying exigency,” click here to be directed to the Department of Labor website.

Our next post in the series will discuss leave entitlement.

*This article is intended to provide general guidance and should not be considered legal advice.