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This Month's Topic: Insurance
Did you know?
Pennsylvania employers with fewer than 20 employees are generally required to offer employees, their spouses, and their dependent children mini-COBRA coverage.

Find general information on Pennsylvania mini-COBRA requirements in the chart below: 
Which employers must offer mini-COBRA under Pennsylvania law?   
Employers with  fewer than 20 employees  who offer a group health insurance plan to their employees.  
Who is eligible for mini-COBRA, and when?
 
  • Employees are generally eligible if, after being enrolled in the plan for at least 3 months, they lose group coverage due to termination of employment (other than for gross misconduct) or a reduction in hours of employment.
  • Spouses are generally eligible if, after being enrolled in the plan for at least 3 months, they lose group coverage due to the employee's termination of employment (other than for gross misconduct), reduction in hours of employment, eligibility for Medicare, divorce, or death.
  • Dependent children are generally eligible if, after being enrolled in the plan for at least 3 months, they lose group coverage due to the employee's termination of employment (other than for gross misconduct), reduction in hours of employment, eligibility for Medicare, divorce, or death, or if they lose dependent child status under the plan.  
Who pays for mini-COBRA coverage?
Who pays for mini-COBRA coverage? In general, the employee, employee's spouse, or employee's dependent child.  
For how long are the employee, the employee’s spouse, and the employee’s dependent child generally entitled to mini-COBRA?
9 months. 
Who administers mini-COBRA?
Employers are legally responsible for mini-COBRA administration. However, many employers choose to contract administration out to a third-party administrator (TPA).
How much can the plan charge for mini-COBRA coverage?
Up to 105% of the total premium.
Is there a notice requirement?
Yes. Employers must notify their plan administrator, the covered employee, and the insurer of a mini-COBRA-qualifying event within 30 days of the event. Notice to the covered employee must include information on electing mini-COBRA. In addition, the administrator must inform the insurer of the employee’s, spouse’s, or dependent child’s mini-COBRA election within 14 days. 
Additional requirements may apply. For more information, please contact the Pennsylvania Insurance Department. 
Dependent Status and Health Insurance
Under the federal Patient Protection and Affordable Care Act (Health Care Reform), group health plans that offer dependent coverage must make the coverage available until a child reaches the age of 26. 

Individual states may have requirements that are more favorable to plan participants. For information about your state, please click here and contact your state insurance department for guidance.

Please Note : The state laws summaries featured on this site are for general informational purposes only. In addition to state law, certain municipalities may enact legislation that imposes different requirements. State and local laws change frequently and, as such, we cannot guarantee the accuracy or completeness of the information featured in the State Laws section. For more detailed information regarding state or local laws, please contact your state labor department or the appropriate local government agency.
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Section 125 – Do you have yours?

A cafeteria plan is a separate written plan maintained by an employer for employees that meets the specific requirements of and regulations of section 125 of the Internal Revenue Code. It provides participants an opportunity to receive certain benefits on a pretax basis. Participants in a cafeteria plan must be permitted to choose among at least one taxable benefit (such as cash) and one qualified benefit.

A qualified benefit is a benefit that does not defer compensation and is excludable from an employee's gross income under a specific provision of the Code, without being subject to the principles of constructive receipt. Qualified benefits include:
  • Accident and health benefits (but not Archer medical savings accounts or long-term care insurance);
  • Adoption assistance;
  • Dependent care assistance;
  • Group-term life insurance coverage;
  • Health savings accounts, including distributions to pay long-term care services.

The written plan must specifically describe all benefits and establish rules for eligibility and elections.

A section 125 plan is the only means by which an employer can offer employees a choice between taxable and nontaxable benefits without the choice causing the benefits to become taxable. A plan offering only a choice between taxable benefits is not a section 125 plan.

If you do not have a section 125 and would like more information, please email pvmaAssure@FocusHRO.com for more information.
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