Updating Your Employee Handbook  for Benefit Provisions

Updating Your Employee Handbook for Benefit Provisions

Employee Handbook Update

Updating Your Employee Handbook  for Benefit Provisions

Alex Miller | Millennium Medical Solutions | (855) 667-4621 | alexm@medicalsolutionscorp.com. 

Have you updated  your Employee Handbook  for Benefit Provisions? Handbooks are important for many reasons such as informing employees of their rights and duties, communicating available resources, and outlining paid time off policies. With respect to health and welfare benefits, here are a few things to consider:

1. Does your handbook go too far?

Handbooks cannot change the terms of governing benefit documents such as summary plan descriptions (“SPDs”). Handbook provisions should mirror plan terms and/or refer

to plan documents. Any provisions purporting to amend plan documents are ineffective. However, handbooks may ­ll in the blanks where the plan documents are silent or refer to outside policies. For example, an SPD may indicate that certain eligibility criteria is determined by the employer. In this case, that criteria may be explained elsewhere such as a handbook or benefit booklet.

2. Are all handbook provisions current?

A handbook should reflect current, compliant provisions such as those addressing benefits, eligibility, and termination.

          • Does your handbook exclude certain employee groups from benefits (e.g., temporary employees or interns)? If so, be aware of potential exposureunder the Employer Penalty which defines a “full-time employee” as any employee who works at least 30 hours per week. There are no exclusions of categories of employees. However, if using the look back measurement method, part-time employees,seasonal employees, and variable hour employees can be asked to wait up to 13+ months to determine full-time employee status without penalty.
          •  Does the handbook contain an outdated waiting period (e.g., indicating that plan entry is the ­first day of the month following 90 days of continuous service?
          • Does the handbook contain conflicting eligibility terms? For example, does the handbook indicate that an employee must work at least 40 hours per week to be eligible for benefits when an employee must only work at least 30 hours per week?
          • If the look back measurement method rules are being used, are those referenced or outlined?
          • Does the handbook indicate that same-sex spouses are excluded from benefit eligibility? Excluding same-sex spouses is not advisable due to recent court cases and EEOC  discrimination inquiries and likely conflicts with plan terms. It may also conflict with the company anti-discrimination workplace policy.
          • 3. Does the handbook demonstrate that an offer of coverage was made?

            Under the Employer Penalty rules, an employee must be offered an effective opportunity to accept coverage at least once with respect to the plan year. Final regulations do not apply any specific rules for demonstrating that an offer of coverage was made.

            Many employers require an affirmative waiver of medical benefits. This is the best method to prove an offer was made, provided that a waiver can be collected from every single employee waiving. Otherwise, any waiver not returned by the employee arguably proves that he was never made the offer.

            When an affirmative waiver is not required, otherwise documenting information regarding the election process is key. An employer will want to show that employees received sufficient information about the offer so that they must have known medical coverage was available.A widely-distributed handbook with clear information about the offer and its terms can be a valuable part of an employer’s distribution of information as well as benefit booklets, email correspondence, posters, mandatory meetings, etc., as applicable.

            If you need assistance with creating or modifying your handbook, please contact us and we can help you with a solution.

            NOTE: This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional.



Filling a Liability Claim

Filling a Liability Claim


Filling a Liability Claim after Storm Sandy

The most effective way to file a claim is to contact your carrier directly. We have compiled a list of our companies and their respective claim department numbers that you can conveniently reference below.

Claim Department Contact Numbers (By Insurance Carrier)
ACE Ins. Co.: 1-800-778-1629
Adirondack: 1-877-365-8693
Chartis Private Client Group: 1-888-760-9195
Chubb Ins. Co.: 1-800-252-4670
CNA Commercial Ins.: 1-877-262-2727
Encompass Ins.: 1-800-340-3016
Farmer’s Group: 1-800-435-7764
Foremost: 1-800-527-3907
Foremost Auto Claims: 1-800-274-7865
GMAC Ins. Co.: 1-800-325-1088
Guard Ins. Group: 1-888-639-2567
Hanover Ins. Co.: 1-800-628-0250
Harleysville Flood: 1-800-421-3535
Harleysville Ins. Co.: 1-800-892-8877
Hartford Flood: 1-800-759-8656
Hartford Ins. Co.: 1-800-243-5860
Kemper Ins. Co.: 1-866-536-7376
Lancaster Ins. Co.: 1-800-521-6155
Main Street America Group: 1-877-425-2467
Metropolitan Ins. Co.: 1-800-854-6011
New York Central Mutual Ins. Co.: 1-800-234-6926
One Beacon: 1-877-248-3455
Peerless Ins. Co.: 1-800-522-7152
Penn Millers Ins. Co.: 800-233-8347
Progressive Ins. Co.: 1-800-274-4499
QBE Ins. Co.: 1-888-737-8256
Safeco Ins. Co.: 1-800-332-3226
Selective Ins. Co.: 1-866-455-9969
Seneca Ins. Co.: 212-277-3490
Sterling Ins. Co.: 1-800-462-4661
Tower Group Cos.: (Pers.) 1(888) 856-5522
Tower Group Cos.: (Comm.) 1-888-856-5522
Traveler’s Ins. Co.: (Pers.) 1-800-252-4633
Traveler’s Ins. Co.: (Comm.) 1-800-238-6225
USLI Ins. Co.: 1-888-875-5231
Utica First Ins. Co.: 1-800-456-4545
Utica National Ins. Co.: (Pers.) 1-800-216-1420
Utica National Ins. Co.: (Comm.) 1-800-216-1420
Zurich Ins. Co.: 1-800-987-3373

Once again, we hope you and your family are recovering from the storm in good health and safety!