FAQs, because we all have questions

This is health insurance made available to individuals and families rather than through an employer group. 

Maternity/pregnancy is an option on some individual policies. If maternity/pregnancy is offered, generally there is usually a waiting period before benefits are made available. 

Ultimately, you are responsible for accurately completing the medical history portion of the application. If you aren’t sure, you may want to review past claims or make an appointment with your health providers to review you records. 

No. Insurance companies will underwrite the applications before the policy is issued. This is an investigation of your medical history and a verification of all information included on your application. During this underwriting process, the company will evaluate many different items such as age, health status, and even dangerous occupations. Once this is complete, the company can offer the policy as applied for, issue the policy with any exclusion(s), issue the policy with a higher premium, or decline the policy. Insurance companies will not sell you a policy if they think you pose a high risk. 

No. Each state can process individual health insurance applications differently. 

It can vary. Sometimes the exclusion is for the entire life of the policy and other times it may be a period of time. 

Pre-existing health conditions can be any illness, injury, or symptom you received or were recommended medical advice, consultation, diagnosis, care and/or treatment. (For example, if you received treatment or saw a doctor for allergies one year before the effective date of coverage; allergies would be considered a pre-existing condition). 

Pre-existing waiting periods vary in length. If your policy has a pre-existing waiting period, no benefits are available for any pre-existing conditions for a certain amount of time listed on your policy. The pre-existing waiting period can be up to one year. 

You can request any date after the application date, however, the insurance company will need time to process your application. This can vary according to the extent of underwriting needed. Sometimes the company may order your medical records which can slow down the process. Typically, the application process takes about 30-60 days. 

Yes, another carrier may offer you coverage. Each insurance carrier has their underwriting guidelines and may differ. 

The company is allowed to exclude benefits related to pre-existing conditions whether they were listed on your application or not for the first two years after the effective date of the policy. The company can look back and investigate during the first two years of your policy to determine if a claim was related to a pre-existing condition. 

The law permits the individual health insurance policies to have a two-year incontestability period. The insurance policy was issued based on information contained on your application. If the information was not provided completely and accurately, it will affect how the policy is issued. The company may have issued the policy with an exclusionary rider, higher premium, or it may have been declined. 

If the company finds an error or omission on your application that may have affected their offer of coverage, the company will take action. They may rescind the policy. When the policy is rescinded, the policy will be null and void from the beginning. It is most important to fill out your application accurately and completely to avoid a rescission. 

A temporary or short-term policy is a policy that covers you for a short and specified amount of time (a common one is 3 months). It can be used for someone that is in between jobs needing coverage until the new employer policy is active. 

When your term is expiring, you will need to complete a new application. Based on your health at that time, the company can either issue the policy or deny the policy. 

Federal law requires all employers to send employees W-2 statements for all wages earned. These W-2 statements can be sent in either paper or digital form. Hard copies must be postmarked no later than January 31, and digital copies must be available to employees by January 31 of the following year. 

The Family and Medical Leave Act (FMLA) is a federal law requiring covered employers to provide employees with job-protected and unpaid leave for qualified medical and family reasons. Qualified medical and family reasons include: personal or family illness, family military leave, pregnancy, adoption, or the foster care placement of a child. 

An FMLA eligible employee is an employee who has been employed with their current employer for at least 12 months, has worked at least 1,250 hours over the past 12 months, and works at a location where the company employs 50 or more employees within 75 miles. 

The Fair Labor Standards Act (FLSA) does not require employers to provide payment for time not worked, such as vacation. These are additional benefits that an employer can provide. However, some local employment laws do require employers provide paid sick leave. It is best to check the laws in your area. 

Unemployment insurance is a state-operated insurance program that provides unemployment benefits to eligible workers who are unemployed through no fault of their own and meet other eligibility requirements of state law. Please visit your specific state unemployment website for more information. 

An Employee Assistance Program (EAP) is an employee benefit program that assists employees with counseling and work-life balance, legal and financial resources. Many EAPs also provide learning and development opportunities as well. Resources are geared toward both professional and personal matters. The EAP is confidential (your employer will not know which employees have used the EAP) and available 24/7. 

The U.S. Citizenship and Immigration Services’ website has a complete list of acceptable documents for completing Section 2 of the Form I-9. Click here to go to this website. 

You may be required to complete an application even though you already submitted your resume, because information that is required to complete a background check is typically missing from your resume. 

Performance management involves ongoing conversations between a manager and an employee to help ensure goals are being met and the individual is performing to the standards of the job. At times, an employee may be asked to sign a warning/corrective action form. The signature does not mean that the individual agrees with the content on the warning but is acknowledging that the conversation took place and the employee is receiving a copy of the document. 

To qualify for exempt status on a Form W-4, you must have had no tax liability for the previous year and must expect to have no tax liability for the current year. The exempt status is only valid for the calendar year in which the employee filed. 

The Department of Labor requires employers retain payroll records for three years. Payroll tax records should be retained for four years. Some states, such as California and New York, require records to be retained for six years. Check your specific state laws. 

1099’s are considered contractors hired to assist with designated work. A 1099 has the ability to designate their own schedule, refuse certain jobs, finish assignments using their own methods, and use their own tools. Once the job is completed for the 1099, the contract is ended and no further work is needed. An employee is one who reports to a supervisor, is designated to be at the office at a required time, training is provided by the company, and benefits are offered. 

Depending on your annual gross salary, tax wage base limits start over again at the first of the year. For example, the wage base limit for Social Security in 2021 is $142,800. Once an employee has earned this much in gross pay for the year, Social Security taxes are no longer withheld. 

The unemployment rate change means the state has updated the taxable rate for state unemployment tax. These rate changes are sent out each November. Forward to your payroll provider for accurate state unemployment tax withholdings. 

Pretax deductions are deductions taken out of your pay before tax is calculated on your gross wages. Types of pre-tax deductions include Flexible Spending Accounts (FSA), Health Savings Accounts (HSA), retirement contributions, and health insurance. Post-tax deductions are deductions taken after tax is calculated on gross pay including uniform deductions, Roth 401(k), Post-Tax health insurance, and garnishments. 

Payroll taxes that are the employee’s responsibility include state taxes, federal taxes, local taxes (where applicable), the employee’s portion of Social Security tax, and the employee’s portion of Medicare. Employer payroll taxes include Federal Unemployment tax (FUTA), State Unemployment tax (SUTA), the employer’s portion of Social Security tax, and the employer’s portion of Medicare. 

Employees can report employers that do not pay on time to the Department of Labor to request an investigation. 

Forms required to be filed for payroll include 941 (Employers Quarterly Federal Tax Return), state unemployment returns (quarterly filing), and state income tax returns (quarterly filing). Forms W-2 (Employee Tax Statement), W-3 (Employer Tax Statement) and 940 (Federal Unemployment Return) should be filed annually. 

Payroll companies are not regulated by any agency. The reporting of taxes is mandated by the IRS and the reporting of employee wages is mandated by the Department of Labor. 

Federal and state laws require employees to be paid at regular intervals. For example, you cannot pay an employee biweekly one month and then monthly the next. Some states do mandate the frequency of payroll. For example, in Arizona an employee is required to be paid every 16 days and Minnesota requires every 15 days. Check your own state’s regulations.

Payroll taxes due dates depend on your depositor type. If you are a monthly depositor, taxes are due on the 15th of the following month. If you are considered to be a semi-weekly depositor, taxes for payrolls paid on Saturday, Sunday, Monday, or Tuesday are due by the following Friday. Taxes for payrolls paid on Wednesday, Thursday, or Friday are due on the following Wednesday. If you have a tax liability of over $100,000 for a pay period, then it is due the following day regardless of your deposit type. If you are normally a monthly depositor, but have a $100,000 liability, your deposit frequency will change to semi-weekly. 

Outsourcing payroll can save a company time and money. Instead of manually tracking time, ensuring tax deposits are paid timely, and keeping up with the latest payroll laws, some organizations choose to outsource this administration. These outsource resources assist with gathering employee’s information, obtaining timesheet information, calculating pay for each employee, and issuing payments to the employees. Additionally, they will handle the creation and distribution of Form W-2 and deposit your payroll taxes to the government. 

Employers can offer to pay their employees in the form of check, pay card, or direct deposit. There are specific states, such as Arizona, which mandate payment of direct deposit. Check your specific state laws. 

According to the IRS, bonuses are considered supplemental wages. Bonuses can be taxed by using either the percentage method or the aggregate method. The percentage method is a flat supplemental rate of 25%, while the aggregate method is used when the employer pays the bonus with your regular rate of pay. The percentage of tax withheld is determined by the IRS withholding tables. 

A 401(k) plan is an employer-sponsored retirement savings plan that allows employees to contribute a portion of their paychecks into an investment account. There are certain tax advantages to contributing to a 401(k) plan.

Pre-tax 401(k) contributions reduce an employee’s taxable income in the year they are contributed, whereas Roth 401(k) contributions do not reduce the employee’s taxable income in the year they are contributed.  On the reverse side, Pre-tax 401(k) contributions, and the gains on those contributions, increase the employee’s taxable income in the year the money is withdrawn from the 401(k) account.  Roth 401(k) contributions, and the gains on those contributions, do not increase the employee’s taxable income in the year the money is withdrawn from the 401(k) account. 

A Multiple Employer 401(k) plan allows a number of unrelated employers to adopt to a single 401(k) plan. This method provides a cost-effective way of managing risks related to sponsoring a 401(k) plan. This also provides the adopting employers with access to advantageous pricing on investments and administrative services. 

Fiduciaries act on the behalf of the 401(k) participants and their beneficiaries. As such, they have strict standards and important responsibilities. These responsibilities include: following the plan documents; diversifying plan investments; acting solely in the interest of plan participants to provide benefits; paying only reasonable plan expenses; and carrying out their duties prudently. 

The information provided on this website is for informational purposes only and should not be construed as legal advice. Consult your legal counsel and HR partner in all business compliance matters.