Spousal surcharge compliance affidavit

    • [PDF File]BENEFITS

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_f7976b.html

      Compliance: o Enrollment in ... If you are enrolling a spouse in the medical plan, be sure to complete the Spousal Surcharge Affidavit section during the ULTIPRO enrollment process. If an employee's spouse has other group medical coverage available and chooses not to enroll in that coverage, you will be charged a Spousal Surcharge.

    • [PDF File]Tobacco Surcharges Legal Rules - Cowden Associates

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_51f415.html

      For compliance purposes, HIPAA divides wellness programs into two categories—participatory wellness programs and health-contingent wellness programs. A smoking cessation program that offers a tobacco surcharge will fall under one of these categories, depending on how the program’s surcharge is designed.

    • [PDF File]SPOUSAL SURCHARGES AND DEPENDENT ELIGIBILITY AUDITS ...

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_f3dde7.html

      SPOUSAL SURCHARGE COMPLIANCE CONSIDERATIONS Compliance item Comments Affordable Care Act • The ACA does not prohibit spousal surcharges or eligibility restrictions • A spousal surcharge could cause loss of grandfathered status • Simplified reporting options for ACA reporting on the 1095-C/1094-C are only available if spouses are offered ...

    • [PDF File]Dependent Eligibility Verification Should Be a Part of ...

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_f75627.html

      Compliance Protection for You and Your Employees Experience, People ... SPOUSAL SURCHARGE. 10/09/2013 5 Audit and Reporting About the Dependent Eligibility Verification ... • Affidavit Samples: Overage Dependent DomesticPartner Reminder Packet • Same as initial

    • [PDF File]OPENENROLLMENT

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_32c1bd.html

      If you are covering a spouse on a medical plan, you MUST submit a 2020 Spousal Affidavit to the Department of Employee Benefits by November 1, 2019. o If your spouse has access under another employer’s plan, but you elect to cover him/her, you will be subject to the surcharge ($25 per pay period equating to $500 per year).

    • [PDF File]Affadavit - Spousal Surcharge - CBE Companies

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_f22dc8.html

      Affidavit of Spousal Surcharge Compliance We, _____, and _____ Employee Eligible Spouse Certify that the following are true. Please place an “X” next to the one that applies to you: 1. _____ Named spouse is not employed or is self-employed and does not have access to an

    • [PDF File]2022 Appvion Spousal Surcharge Affidavit/Waiver Form

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_abb5ee.html

      2022 Appvion Spousal Surcharge Affidavit/Waiver Form Employee Last Name: Employee First Name: MI: SSN #: Spousal Surcharge Employees may choose to have their spouse covered under the Medical Plan; however, there is a $250 monthly additional charge (a surcharge) if your spouse is eligible for medical coverage through his or her employer, but has

    • [PDF File]Morehead State University AFFIDAVIT OF SPOUSAL SURCHARGE ...

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_a992d2.html

      AFFIDAVIT OF SPOUSAL SURCHARGE COMPLIANCE Open Enrollment for 2022 Benefits To be completed if you are enrolling your spouse in Morehead State University’s medical. If you are NOT enrolling your spouse in your employer medical plan this form is not needed. If you fail to complete this

    • [PDF File]SPOUSE MEDICAL PLAN SURCHARGE AFFIDAVIT

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_2a140b.html

      Surcharge Affidavit attesting to your spouse’s access to employer medical plan coverage through his/her employer, regardless if he/she enrolled in that coverage. If you are newly-hired and you enroll a spouse in your employer medical plan, you must turn in the Spouse Medical Plan Surcharge Affidavit within 14 days of your hire date.

    • [PDF File]Complete this form if you have a spouse/partner enrolled ...

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_9781fe.html

      Affidavit of Spousal Surcharge Compliance We_____, and_____ Employee Eligible Spouse/Partner Certify that the following are true. Please place an “X” next to the one that applies to you: 1. _____ Named spouse is not employed and does not have access to an employer-sponsored health ...

    • [PDF File]Working Spouse Affidavit

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_30fe1d.html

      surcharge will apply. Eligibility will not be guided by the cost in any way but Simply that the spouse is eligible to be on their employer's plan. Compliance will be by a signed affidavit annually. Effective 1-1-2013 6. Medical premiums will increase . 5% . effective August . 1, 2012. Dental premiums will increase effective August . 1,2012 . as ...

    • [PDF File]2022 Benefits

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_2f5d69.html

      Compliance: o Enrollment in ... If you are enrolling a spouse in the medical plan, be sure to complete the Spousal Surcharge Affidavit section during the ULTIPRO enrollment process. If an employee's spouse has other group medical coverage available and chooses not to enroll in that coverage, you will be charged a Spousal Surcharge.

    • [PDF File]Spousal Carve-Outs and Surcharges

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_264040.html

      Spousal carve-out or surcharge strategies can be an effective way to reduce plan costs, but employers should first carefully consider the different approaches and make sure compliance related issues are properly addressed.

    • [PDF File]YOUR TOTAL REWARDS

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_7569c3.html

      compliance cannot be re-enrolled until the next Open Enrollment or unless there is a qualified life event. EMPLOYED SPOUSE MEDICAL CONTRIBUTION VERIFICATION All caregivers covering a spouse under medical coverage are required to complete the Affidavit of Spousal Health Care Coverage when newly enrolling a spouse and annually during Open Enrollment.

    • [PDF File]Affidavit of Spousal Eligibility for Health Care

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_5c8831.html

      Affidavit of Spousal Eligibility for Health Care. I wish to update the status regarding my spouse’s eligibility for health care benefits. By signing below, I certify that my spouse is no longer eligible for an employer’s active or retiree health care coverage effective _____; and that all attached supporting documentation is accurate.

    • [PDF File]ACA Reporting Requirements, Expanded Spousal Benefits ...

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_e4c828.html

      COMPLIANCE & RISK MITIGATION 2016 OPEN ENROLLMENT COMPLIANCE CHECKLIST ... Assess Spousal Affidavit Options (Employee Attestation) in Offering Coverage to Legal Spouses Evaluate Spousal Surcharge and/or Carve Out Options to Avoid Offering a Non-Competitive “Magnet” Plan

    • [PDF File]Carveouts Surcharges v2 Feb2018 - Kinney Pike

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_10e08f.html

      Federal Compliance Considerations Spouses ... This is generally accomplished through use of an employee affidavit, by performing periodic eligibility ... March 23, 2010. If the imposition of a spousal surcharge reduces the employer contribution below that level, the

    • STATE OF NEW YORK

      support, spousal support, maintenance or alimony.” The levy shows a total amount due of $79,635.66 and requires the garnishee to transfer to the Division property of the petitioner to satisfy the amount due. 3. In support of its motion the Division submitted, in part, the following: (i) a Notice of

    • [PDF File]BEST IN CLASS SOLUTIONS SPOUSAL CARVE-OUT / WAIVER

      https://info.5y1.org/spousal-surcharge-compliance-affidavit_1_315471.html

      Many medical plans are implementing either spousal carve out or spousal surcharge plans in an attempt to control health plan costs. There are some design considerations that should be reviewed before putting one of these into your health plan. Some considerations are: † Which type of program to implement: spousal carve out v. spousal surcharge.

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