robs477
Now an Angel in heaven
- Joined
- Aug 15, 2014
- Messages
- 1,227
I didn't think about picking on that scab again either, but WTH, it cant hurt to ask, will send another email...THXS!!
I Have Another Insurance Question?
- Thread starter robs477
- Start date
I didn't think about picking on that scab again either, but WTH, it cant hurt to ask, will send another email...THXS!!
robs477
Now an Angel in heaven
- Joined
- Aug 15, 2014
- Messages
- 1,227
Thank you mam. I do hope your feeling better
I am...I can actually feel my upper teeth again!
http://www.irs.gov/uac/Newsroom/Que...lity-Provisions-Under-the-Affordable-Care-Act
However, http://www.gpo.gov/fdsys/pkg/FR-2014-02-12/pdf/2014-03082.pdf
The final definition in the law:
I don't know what the definition of your granddaughter is in view of these rules. If she is a dependent AND she is not considered a "foster child," which I suspect means something specific about who is legally responsible (i.e., the state), and since your court order making you the managing conservators states that YOU are supposed to provide her insurance, then it appears that she is not a "foster child" under those rules, and that your employer is obligated to provide (because they are not expressly excused from providing) insurance coverage to your DEPENDENT.
Digging deeper: 152(b)(3) is an exclusion for non-citizens, unless the child is adopted. So that doesn't apply. So digging deeper into 152(f)(1) (Note: 26 U.S. Code § 152 - Dependent defined):
So, because the ACA rules exempt stepkids and foster kids, that would seem to exempt your granddaughter from coverage. Except, 152(c) says:
So I don't get whether your granddaughter is an exempted "foster child" ("an individual who is placed with the taxpayer by an authorized placement agency or by judgment, decree, or other order of any court of competent jurisdiction") or is a descendent of your child who is a "qualifying child." You might need to contact the IRS to get that clarified, in particular because according to your court order, YOU are responsible for obtaining insurance for her - even though you can legally (if not practically) get reimbursed by the parent(s) for the premium.
1. What are the Employer Shared Responsibility provisions?
For 2015 and after, employers employing at least a certain number of employees (generally 50 full-time employees or a combination of full-time and part-time employees that is equivalent to 50 full-time employees) will be subject to the Employer Shared Responsibility provisions under section 4980H of the Internal Revenue Code (added to the Code by the Affordable Care Act). As defined by the statute, a full-time employee is an individual employed on average at least 30 hours of service per week. An employer that meets the 50 full-time employee threshold is referred to as an applicable large employer.
Under the Employer Shared Responsibility provisions, if these employers do not offer affordable health coverage that provides a minimum level of coverage to their full-time employees (and their dependents), the employer may be subject to an Employer Shared Responsibility payment if at least one of its full-time employees receives a premium tax credit for purchasing individual coverage on one of the new Affordable Insurance Exchanges, also called a Health Insurance Marketplace (Marketplace).
For 2015 and after, employers employing at least a certain number of employees (generally 50 full-time employees or a combination of full-time and part-time employees that is equivalent to 50 full-time employees) will be subject to the Employer Shared Responsibility provisions under section 4980H of the Internal Revenue Code (added to the Code by the Affordable Care Act). As defined by the statute, a full-time employee is an individual employed on average at least 30 hours of service per week. An employer that meets the 50 full-time employee threshold is referred to as an applicable large employer.
Under the Employer Shared Responsibility provisions, if these employers do not offer affordable health coverage that provides a minimum level of coverage to their full-time employees (and their dependents), the employer may be subject to an Employer Shared Responsibility payment if at least one of its full-time employees receives a premium tax credit for purchasing individual coverage on one of the new Affordable Insurance Exchanges, also called a Health Insurance Marketplace (Marketplace).
However, http://www.gpo.gov/fdsys/pkg/FR-2014-02-12/pdf/2014-03082.pdf
B. Foster Children and Stepchildren
By incorporating section 152(f)(1), the definition of dependent in the proposed regulations includes biological children, stepchildren, adopted children, and foster children. Commenters requested that foster children and stepchildren be removed from the definition of dependent for purposes of section 4980H. With respect to foster children, commenters noted that the government entities responsible for a foster system typically provide health benefits for the foster child, so that employer-provided coverage would be duplicative and difficult to administer. With respect to stepchildren, commenters noted that in the case of a stepchild, the child in most cases will have two parents who are not stepparents both of whom potentially would be able to provide for the child’s coverage and both of whose employers potentially could be subject to section 4980H for failing to offer coverage to that child. These commenters suggested that applying section 4980H to an employee’s stepchildren would in many cases be duplicative and that, for this reason, many employers currently do not extend offers of coverage to stepchildren of an employee. In light of these considerations, the final regulations exclude both foster children and stepchildren from the definition of dependent for purposes of section 4980H only.
By incorporating section 152(f)(1), the definition of dependent in the proposed regulations includes biological children, stepchildren, adopted children, and foster children. Commenters requested that foster children and stepchildren be removed from the definition of dependent for purposes of section 4980H. With respect to foster children, commenters noted that the government entities responsible for a foster system typically provide health benefits for the foster child, so that employer-provided coverage would be duplicative and difficult to administer. With respect to stepchildren, commenters noted that in the case of a stepchild, the child in most cases will have two parents who are not stepparents both of whom potentially would be able to provide for the child’s coverage and both of whose employers potentially could be subject to section 4980H for failing to offer coverage to that child. These commenters suggested that applying section 4980H to an employee’s stepchildren would in many cases be duplicative and that, for this reason, many employers currently do not extend offers of coverage to stepchildren of an employee. In light of these considerations, the final regulations exclude both foster children and stepchildren from the definition of dependent for purposes of section 4980H only.
The final definition in the law:
(12) Dependent. The term dependent means a child (as defined in section 152(f)(1) but excluding a stepson, stepdaughter or an eligible foster child (and excluding any individual who is excluded from the definition of dependent under section 152 by operation of section 152(b)(3))) of an employee who has not attained age 26. A child attains age 26 on the 26th anniversary of the date the child was born. A child is a dependent for purposes of section 4980H for the entire calendar month during which he or she attains age 26. Absent knowledge to the contrary, applicable large employer members may rely on an employee’s representation about that employee’s children and the ages of those children. The term dependent does not include the spouse of an employee.
I don't know what the definition of your granddaughter is in view of these rules. If she is a dependent AND she is not considered a "foster child," which I suspect means something specific about who is legally responsible (i.e., the state), and since your court order making you the managing conservators states that YOU are supposed to provide her insurance, then it appears that she is not a "foster child" under those rules, and that your employer is obligated to provide (because they are not expressly excused from providing) insurance coverage to your DEPENDENT.
Digging deeper: 152(b)(3) is an exclusion for non-citizens, unless the child is adopted. So that doesn't apply. So digging deeper into 152(f)(1) (Note: 26 U.S. Code § 152 - Dependent defined):
(f)Other definitions and rules
For purposes of this section—
(1) Child defined
For purposes of this section—
(1) Child defined
(A) In general
The term “child” means an individual who is—
In determining whether any of the relationships specified in subparagraph (A)(i) or paragraph (4) exists, a legally adopted individual of the taxpayer, or an individual who is lawfully placed with the taxpayer for legal adoption by the taxpayer, shall be treated as a child of such individual by blood.
(C) Eligible foster child
For purposes of subparagraph (A)(ii), the term “eligible foster child” means an individual who is placed with the taxpayer by an authorized placement agency or by judgment, decree, or other order of any court of competent jurisdiction.
The term “child” means an individual who is—
(i) a son, daughter, stepson, or stepdaughter of the taxpayer, or
(ii) an eligible foster child of the taxpayer.
(B) Adopted child(ii) an eligible foster child of the taxpayer.
In determining whether any of the relationships specified in subparagraph (A)(i) or paragraph (4) exists, a legally adopted individual of the taxpayer, or an individual who is lawfully placed with the taxpayer for legal adoption by the taxpayer, shall be treated as a child of such individual by blood.
(C) Eligible foster child
For purposes of subparagraph (A)(ii), the term “eligible foster child” means an individual who is placed with the taxpayer by an authorized placement agency or by judgment, decree, or other order of any court of competent jurisdiction.
So, because the ACA rules exempt stepkids and foster kids, that would seem to exempt your granddaughter from coverage. Except, 152(c) says:
(c)Qualifying child
For purposes of this section—
For purposes of this section—
(1)In general
The term “qualifying child” means, with respect to any taxpayer for any taxable year, an individual—
For purposes of paragraph (1)(A), an individual bears a relationship to the taxpayer described in this paragraph if such individual is—
The term “qualifying child” means, with respect to any taxpayer for any taxable year, an individual—
(A) who bears a relationship to the taxpayer described in paragraph (2),
(B) who has the same principal place of abode as the taxpayer for more than one-half of such taxable year,
(C) who meets the age requirements of paragraph (3),
(D) who has not provided over one-half of such individual’s own support for the calendar year in which the taxable year of the taxpayer begins, and
(E) who has not filed a joint return (other than only for a claim of refund) with the individual’s spouse under section
6013 for the taxable year beginning in the calendar year in which the taxable year of the taxpayer begins.
(2) Relationship(B) who has the same principal place of abode as the taxpayer for more than one-half of such taxable year,
(C) who meets the age requirements of paragraph (3),
(D) who has not provided over one-half of such individual’s own support for the calendar year in which the taxable year of the taxpayer begins, and
(E) who has not filed a joint return (other than only for a claim of refund) with the individual’s spouse under section
6013 for the taxable year beginning in the calendar year in which the taxable year of the taxpayer begins.
For purposes of paragraph (1)(A), an individual bears a relationship to the taxpayer described in this paragraph if such individual is—
(A) a child of the taxpayer or a descendant of such a child, or
(B) a brother, sister, stepbrother, or stepsister of the taxpayer or a descendant of any such relative.
(B) a brother, sister, stepbrother, or stepsister of the taxpayer or a descendant of any such relative.
So I don't get whether your granddaughter is an exempted "foster child" ("an individual who is placed with the taxpayer by an authorized placement agency or by judgment, decree, or other order of any court of competent jurisdiction") or is a descendent of your child who is a "qualifying child." You might need to contact the IRS to get that clarified, in particular because according to your court order, YOU are responsible for obtaining insurance for her - even though you can legally (if not practically) get reimbursed by the parent(s) for the premium.
Last edited:
robs477
Now an Angel in heaven
- Joined
- Aug 15, 2014
- Messages
- 1,227
Diana, Yeah, I was completely in shock when my Company rejected her as a dependent. It is clearly written in the Court order, there is no gray. My company is basing their decision on the non-surrendering of the birth parents parental rights. By default, they abandoned their parental rights through abandonment as I tried to explain. I appealed, I lost, that was in 2011. The policy stills says
the same thing. I could try it again, but it might be one of those things where you win the battle but lose the war?? You will be able to tell after reading this that it is a very fragile scab I am hesitant to re-open...lol I tried everything short of filing litigation.
Here are some of most pertinent paragraphs (cut & paste), from our court order:
IT IS ORDERED that (My Wife and I) are appointed Joint Managing Conservators of the following child: (Granddaughter). IT IS FURTHER ORDERED that (Birth Father) and (Birth Mother) are appointed possessory conservators of the minor child.
IT IS ORDERED that (My Wife and I), as a nonparent joint managing conservators, shall have the following exclusive rights and duty:
1. the exclusive right to designate the primary residence of the child without regard to geographic location;
2. the exclusive right to consent to medical, dental, and surgical treatment involving invasive procedures;
3. the exclusive right to consent to psychiatric and psychological treatment of the child;
4. the exclusive right to receive and give receipt for periodic payments for the support of the child and to hold or disburse these funds for the benefit of the child;
5. the exclusive right to represent the child in legal action and to make other decisions of substantial legal significance concerning the child;
6. the independent right to consent to marriage and to enlistment in the armed forces of the United States;
7. the exclusive right to make decisions concerning the child's education;
8. except as provided by section 264.0111 of the Texas Family Code, the independent right to the services and earnings of the child;
9. except when a guardian of the child's estate or a guardian or attorney ad litem has been appointed for the child, the independent right to act as an agent of the child in relation to the child's estate if the child's action is required by a state, the United States, or a foreign government; and
10. the independent duty to manage the estate of the child to the extent the estate has been created by the joint property of the conservators.
3. Obligations of (My Wife and I) are ORDERED to include and maintain the child in either of Petitioner’s health insurance available through either employer no later than 60 days after the Court signs this order.
IT IS FURTHER ORDERED that (Birth Father) reimburse 100% of the actual cost of the health insurance coverage in the amount of _______ provided by (My Wife and I).
Here is the rejection letter in 2011 from my Company:
The legal documentation does not meet the requirements for coverage under the Group Health Care Plan (“GHCP”). The document does not appoint you as permanent legal guardian of the minor child nor does it state that the parents of the minor child relinquish their parental rights.
The Plan specifically states:
“Eligible dependents include your spouse (i.e. your husband or wife as recognized under the laws of the state in which you live) and your eligible dependent children. Eligible dependent children are your child(ren) under age 26, including:
Basically you are telling us that any employees that have LEGAL dependents and have a LEGAL Court ordered Guardianship of a child cannot get health insurance from my employer even if it states that in a Court order? Surrendering parental rights of the Biological parents has NOTHING to do with this standalone Court order and our responsibilities of legal Guardianship to provide medical insurance and are a separate subject and a separate cause of action altogether.
Guardianship/Conservatorship (Texas Probate Code - Section 693) is a standalone responsibility if ordered by the Court and is NOT dependent or contingent on the surrendering of Parental rights (Family Code §§ 161.001; 161.003(a) to be enforced. In accordance with Texas law those are two completely separate and two different causes of actions, standings and petitions that are separable and NON dependent on each other for enactment.
As you can see on page (1) of the Court Order, both birth Parents are listed as being in “Default” judgment for never appearing in Court. They have not had any involvement in her Life since she was abandoned by them at 2 years old and she is now 8 years and 9 months old and therefore have legally surrendered their “Parental Rights” by abandonment.
the same thing. I could try it again, but it might be one of those things where you win the battle but lose the war?? You will be able to tell after reading this that it is a very fragile scab I am hesitant to re-open...lol I tried everything short of filing litigation.
Here are some of most pertinent paragraphs (cut & paste), from our court order:
IT IS ORDERED that (My Wife and I) are appointed Joint Managing Conservators of the following child: (Granddaughter). IT IS FURTHER ORDERED that (Birth Father) and (Birth Mother) are appointed possessory conservators of the minor child.
IT IS ORDERED that (My Wife and I), as a nonparent joint managing conservators, shall have the following exclusive rights and duty:
1. the exclusive right to designate the primary residence of the child without regard to geographic location;
2. the exclusive right to consent to medical, dental, and surgical treatment involving invasive procedures;
3. the exclusive right to consent to psychiatric and psychological treatment of the child;
4. the exclusive right to receive and give receipt for periodic payments for the support of the child and to hold or disburse these funds for the benefit of the child;
5. the exclusive right to represent the child in legal action and to make other decisions of substantial legal significance concerning the child;
6. the independent right to consent to marriage and to enlistment in the armed forces of the United States;
7. the exclusive right to make decisions concerning the child's education;
8. except as provided by section 264.0111 of the Texas Family Code, the independent right to the services and earnings of the child;
9. except when a guardian of the child's estate or a guardian or attorney ad litem has been appointed for the child, the independent right to act as an agent of the child in relation to the child's estate if the child's action is required by a state, the United States, or a foreign government; and
10. the independent duty to manage the estate of the child to the extent the estate has been created by the joint property of the conservators.
3. Obligations of (My Wife and I) are ORDERED to include and maintain the child in either of Petitioner’s health insurance available through either employer no later than 60 days after the Court signs this order.
IT IS FURTHER ORDERED that (Birth Father) reimburse 100% of the actual cost of the health insurance coverage in the amount of _______ provided by (My Wife and I).
Here is the rejection letter in 2011 from my Company:
The legal documentation does not meet the requirements for coverage under the Group Health Care Plan (“GHCP”). The document does not appoint you as permanent legal guardian of the minor child nor does it state that the parents of the minor child relinquish their parental rights.
The Plan specifically states:
“Eligible dependents include your spouse (i.e. your husband or wife as recognized under the laws of the state in which you live) and your eligible dependent children. Eligible dependent children are your child(ren) under age 26, including:
- birth children;
- stepchildren who live in your home and are supported by you;
- legally-adopted children who live in your home, or children legally placed for adoption in your home; and
- children placed under your exclusive legal guardianship who live in your home, are supported by you and whose parents have given up their rights as parents.”
Basically you are telling us that any employees that have LEGAL dependents and have a LEGAL Court ordered Guardianship of a child cannot get health insurance from my employer even if it states that in a Court order? Surrendering parental rights of the Biological parents has NOTHING to do with this standalone Court order and our responsibilities of legal Guardianship to provide medical insurance and are a separate subject and a separate cause of action altogether.
Guardianship/Conservatorship (Texas Probate Code - Section 693) is a standalone responsibility if ordered by the Court and is NOT dependent or contingent on the surrendering of Parental rights (Family Code §§ 161.001; 161.003(a) to be enforced. In accordance with Texas law those are two completely separate and two different causes of actions, standings and petitions that are separable and NON dependent on each other for enactment.
As you can see on page (1) of the Court Order, both birth Parents are listed as being in “Default” judgment for never appearing in Court. They have not had any involvement in her Life since she was abandoned by them at 2 years old and she is now 8 years and 9 months old and therefore have legally surrendered their “Parental Rights” by abandonment.
robs477
Now an Angel in heaven
- Joined
- Aug 15, 2014
- Messages
- 1,227
Yes, it is self funded, didn't think about that either. They have a lot more latitude that way huh? That also kind of worries me about them having to pay for two bariatric procedures in the same year. I'll probably get put on some kind of disposal list.
Well crap - self-funded means some of the ACA protections don't apply (yet - I don't know when the grandfathered self-funded plans have to come into full compliance).
But I found this: http://www.ahatpa.com/pdfs/news/health_care_reform/hcr_employer_guide.pdf (A Guide for Self-Funded Plans)
I still think you have an argument,
But I found this: http://www.ahatpa.com/pdfs/news/health_care_reform/hcr_employer_guide.pdf (A Guide for Self-Funded Plans)
If a large employer offers health coverage, it must meet all three criteria to be considered in compliance:
▪ Minimum value standard. The plan pays 60 percent or more, on average, of total allowed costs of benefits
provided under a group health plan or health insurance plan.
The Department of Health Human Services (HHS) provides an online tool to help calculate whether or not a
plan meets the Minimum Value standard. There are also instructions for using the calculator tool.
▪ Affordability. The employee’s contribution to the plan’s cost for
“self-only” coverage cannot exceed 9.5 percent of employee household
income.
Safe Harbor: Since most employers do not know an employee’s household
income, the IRS has created three Safe Harbors for determining
affordability. In each Safe Harbor test outlined below, the employee’s
contribution for the lowest-cost, self-only coverage cannot exceed 9.5
percent of:
– the employee’s W-2 income as reported in Box 1;
– the employee’s hourly rate multiplied by 130 or monthly income for
salaried employees;
– the Federal Poverty Level (FPL).
▪ Offer coverage for substantially all full-time active employees. “Substantially all” has been defined as 95
percent or more of full-time active employees in 2014. In 2015, coverage must be offered to employees and
dependents (children).
A full-time employee is defined as someone who averages at least 30 hours of work per week or 130 hours per
month.
If the coverage offered does not meet these requirements or if the employer chooses not to offer any health
coverage, they may be subject to penalties.
▪ Minimum value standard. The plan pays 60 percent or more, on average, of total allowed costs of benefits
provided under a group health plan or health insurance plan.
The Department of Health Human Services (HHS) provides an online tool to help calculate whether or not a
plan meets the Minimum Value standard. There are also instructions for using the calculator tool.
▪ Affordability. The employee’s contribution to the plan’s cost for
“self-only” coverage cannot exceed 9.5 percent of employee household
income.
Safe Harbor: Since most employers do not know an employee’s household
income, the IRS has created three Safe Harbors for determining
affordability. In each Safe Harbor test outlined below, the employee’s
contribution for the lowest-cost, self-only coverage cannot exceed 9.5
percent of:
– the employee’s W-2 income as reported in Box 1;
– the employee’s hourly rate multiplied by 130 or monthly income for
salaried employees;
– the Federal Poverty Level (FPL).
▪ Offer coverage for substantially all full-time active employees. “Substantially all” has been defined as 95
percent or more of full-time active employees in 2014. In 2015, coverage must be offered to employees and
dependents (children).
A full-time employee is defined as someone who averages at least 30 hours of work per week or 130 hours per
month.
If the coverage offered does not meet these requirements or if the employer chooses not to offer any health
coverage, they may be subject to penalties.
I still think you have an argument,
Larra
Well-Known Member
- Joined
- Dec 31, 2013
- Messages
- 3,523
Robs, with the addition of your granddaughter to the mix, this has gone above my pay grade, so I will defer the rest to Diana. But I just wanted to tell you how much I admire you and your wife for taking on the responsibility for your granddaughter. She is very fortunate to have you in her life.
robs477
Now an Angel in heaven
- Joined
- Aug 15, 2014
- Messages
- 1,227
Thank you Larra, that is so sweet of you to say. Actually, she is my hero and gives us way more than we give. She is an incredibly stable and sweet little girl. I cant imagine how she must feel sometimes knowing that both of her birth parents didnt care enough to want her. I never had children of my own and I have been the only Dad she has known her whole life since she was two and she is almost twelve. I take her to all her softball games, volleyball, band choir etc. and sometimes it gets really hard being our age with a young child. That is my main driver for wanting to lose weight and get healthier, for her. Nothing I can do allows me to lose weight, so having the DS has so many implications for me. Again, thank you for the kind words and Diana...I'm speechless regarding how helpfull and smart you and Larra and many others on this site are. And dont forget, Larra, (I haven't), you are the one that invited me over here!!
robs477
Now an Angel in heaven
- Joined
- Aug 15, 2014
- Messages
- 1,227
Diana, I do too, but, again that may be one of those “win the battle, but loose the war” thingy’s. I may re-submit it just to see what they say since it’s been four years and because of the new ACA regs, still not sure. BUT, in the meantime I’m going to shop the public market for a policy for her as well for a backup plan, a “plan D”. Thank you again for your personal help!
Larra
Well-Known Member
- Joined
- Dec 31, 2013
- Messages
- 3,523
You are most welcome!
The weight loss and improved health will indeed make a big difference in your ability to be a great parent, esp as you get older. Carrying around that extra weight gets harder as we age (ask me how I know!), and your DS will allow you and your wife to continue to be great parents.
The weight loss and improved health will indeed make a big difference in your ability to be a great parent, esp as you get older. Carrying around that extra weight gets harder as we age (ask me how I know!), and your DS will allow you and your wife to continue to be great parents.
robs477
Now an Angel in heaven
- Joined
- Aug 15, 2014
- Messages
- 1,227
Ok, after sleeping on this....I decided to just add her and I just completed the add on. WTH, the worst they (my company) could do is reject it again, and as you said, the employer obligations have changed because of the ACA, so, we'll see what happens. I have until March 1, 2015 to provide "Supporting documentation", and I will wait until the last week in Feb to send it. That will buy us 3+ months to shop the private market as said, for back-up plan "D".
The only question I have left is, where the heck in San Jose do I send that nice flower arrangement? Sue, Larra, EN, Southernlady, somebody?....help me out here, PM me?
I'm NOT allowed to give it out...she would haunt me with gag gifts if I did and I have enough damned clutter in this house as it is.The only question I have left is, where the heck in San Jose do I send that nice flower arrangement?
Sue, Larra, EN, Southernlady, somebody?....help me out here, PM me?
Similar threads
