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Recent Medical Reimbursement questions
On november 2, 2015 i found out about a benefit i was
on november 2, 2015 i found out about a benefit i was unaware of filed a claim for that year but when i tried to get the back years paid i am being denied. this is for medical reimbursement. is this something i should or can fight? i have filed all the appeals with them. please advise
I have a contract, from my employer, stating that I will
I have a contract, from my employer, stating that I will receive a quarterly bonus. This bonus will be paid no later than the last day of the month following the quarter.Unfortunately, I did not receive $10,797.00 owed to me from the 1st quarter of 2015; I was told that will be paid out in the second quarter of this year. I have not yet received that money nor have I received the 2nd quarter's estimated bonus amount. My employer has not completed the financials which was due by 6/30/15 and so, the amount owed can't be calculated until that information has been done. I am owed approximately $50,000.00 for the 2nd quarter in addition to the $10,797.00 previously owed to me from the 1st quarter.I have copied, below, my contract.EMPLOYMENT AGREEMENT for Chief Operating Officer 12-18-14This Agreement is made between Remodel Works Bath and Kitchen ("Employer"), located at***** Ste B, Poway, Ca. 92064, and David Shultz ("Employee"). -The goal of the owner Joe Christenson is to semi-retire from the daily operation. The goal is to work the second week of every month. Those days will be used for staff meetings, review all financial reports budget reviews capital and staffmg needs.DUTIES1) PERSONNEL- Establish department goals and objectives- Establish and implement and keep current departmental policies, goals and procedures- Determine all staffing requirements- Set up goals for Managers and Staff- Oversee the interviewing, hiring and training of new employees- Oversee the management of the installation staff and schedules to meet goals- Set up checks and balances to ensure policies and procedures are enforced- Continually review performance evaluations- Implement coaching techniques and performance measures to make improvements2) SALES AND MARKETING- Implement marketing and advertising plans with measured results.- Determine goods and services that will be offered- Set prices and credit terms based on forecasts of customer demand3) MANAGEMENT- Develop and update business plan yearly by the second week of October- Manage cash flows by reviewir1'g forecasts and AIR- Direct all financial and budget activities to fund operations including distribution of excess funds- Review financial statements, sales reports, and other performance data- Oversee and approve the purchase of all capital improvements and support equipment- Identify opportunities to reduce costs and maximize department efficiency- Oversee and direct all necessary reporting activity to government and insurance agenciesTRADE SECRETSall information relating to the projects of Employer and its business dealings are to be considered trade secrets of Employer. If required by Employer, Employee agrees to sign and abide by a non-disclosure agreement regarding the use and confidentiality of this information. Violation ofthe non-disclosure may, at the sole option of Employer, result in immediate termination of employment under this Agreement.NON COMPETITIONEmployee agrees that upon termination of employment, whether voluntary or involuntary, he will not engage in business activity that could reasonably be construed as being in competition with Employer for a period of 2 years from the final date of employment and termination of this Agreement.GOALAttain Income goal of$10,500,000 as per the budget for 2015. Set a goal of total overhead not to exceed 20%PAYMENTIn consideration of the foregoing, Company agrees to pay to Employee the amount of $150,000 dollars base salary per year, paid out in 26 pay periods.Paid employee medical benefits at the base level of other employeesA quarterly bonus paid no later than the last day of the month following the quarter. The Bonus is paid as follows:15% of the net profit when the profit equals or exceeds 18% of the gross sale10% of the net profit when the profit is between15% and 17.99% of the gross sale5% of the net profit when the profit is between 12%-14.99% of the gross sales.0% if the net profit is less than 12%The Owner's Salary, Travel, Meals & Entertainment and Medical Reimbursement and auto payment will be shown as "Add Backs" to the profit to calculate the % of profit for the Bonus.Total compensation not to exceed $300,000If Income totals don't exceed $9,500,000 the bonus will be calculated at 90% If Income totals don't exceed $8,500,000 the bonus will be calculated at 80% Calculations for the Bonus will start January 1 2015The bonus plan will be reviewed on or before for any changes on or before July15th 2015EFFECTIVE DATEThis contract shall become effective on January 1 2015 and remain in effect until it is terminated by either party. Either party may terminate this agreement by providing the other party with 2 week written notice of hisor their intention. Should this agreement be terminated by either party, Employee agrees that the payment of full salary to the date of termination all fully satisfy all claims against Company under this agreement.Employee understands and agrees that employment is terminable at will by employer and shall not be considered an employment contract for any specified term or minimum time period. If terminated a severance payment will be paid equal to one month of salary for every full year of employment. The severance payment will be voided for any deemed Illegal or Unethical either by law or the company policies and proceduresGENERAL PROVISIONSIn any action or suit to enforce any right or remedy under this Agreement or to interpret any provision of thisAgreement, the prevailing party shall be entitled to recover its costs, including reasonable attorney's fees. IN WITNESS WHEREOF, the parties have executed this agreement on.I have 2 questions for youFirst question, can I resign effective immediately, without given two weeks' notice as required in my contract. My employer has not met his terms of our contract since April and so, I feel that I don't have to comply with the two weeks' notice. In addition, the main reason that I want to leave immediately, without notice, is that work has become intolerable and in fact, I would even call it a hostile work environment. After three years, my employer is now asking me to hold on future growth of our company and, says he wants to change my contract so that I am capped on what I can make per quarter. If I am not growing the company, I will not get any more bonuses and I will lose money. I was solely hired to grow the company which, I did. I brought it from 3.7 million in 2012 to 10.8 million by year end.My second question is if I leave, do I legally l have an avenue to collect the money owed to me if my employer decides that since I am leaving, he will not honor the contract which is to pay me what I have earned up to this point.
A PA employer offered medical/dental/vision to full time employees
A PA employer offered medical/dental/vision to full time employees (40 hours a week), however, the group plan dissolved as of September 2011 because they only had 1 employee on the plan and the plan required 2 employees. The employee handbook stating full time eligible employees (40 hours per week) receive medical/dental/vision at 60% paid by employer/40% paid by employee was never changed and notification was never sent out to each employee, does the handbook have leverage? This handbook was given to each employee (part time and full time) and an acknowledgement was signed by each employee. A full time employee had a life changing event as of May 1, 2013 where the spouse no longer had medical/dental/vision benefits. The employee spoke to the employer and was told they would temporarily pay for 60% of the Cobra until they could find a group plan or individual plan for this employee. This employer has changed his mind and no longer wants to pay a portion of the Cobra or provide a group or individual plan for this employee. He states that he is not obligated because he is a small employer (3 part time, 1 full time and 1 full time owner). He also wants to code the portion of Cobra that he paid for in May and June as a loan. Nothing was in writing as a loan and it was not addressed as a loan initially during discussions. He has agreed to give an additional pay raise as a medical reimbursement for 1 year, however, that additional pay raise does not come close to the 60% of what the employer would pay if a group plan or individual plan was in place. Does this employer have the right to do this? Also, does the employee have the right to hold the manual as a "contract" of sorts?
I fell on 2/15/12 at a business. slamming my head into a vehicle.
I fell on 2/15/12 at a business. slamming my head into a vehicle. The results after MRI's, Xrays, chiropractic work and massage was I needed a cervical fusion which was successful, but left with severe TMJ, more MRI's and paid for a mouth guard-no help. I am on disability but work and own a small business. The company paid me for my out-of-pocket expenses only, $3000, half of which was NOT under insurance. Medicare wants to collect from me - what can I do and what can they make me pay?
I work full-time at Impeerium Peer Network/NAMI-CV, a small
I work full-time at Impeerium Peer Network/NAMI-CV, a small non-profit organization. As of January 2013, I opted to use the medical reimbursement program. In the policy, it states the following: “Reimbursement amount is 100% of eligible expenses, subject to a $3,600 limit for both qualified medical reimbursements and tuition refund. The combined total yearly benefit payable for both programs is $3,600, with no provision for carryover into the next calendar year. The annual limit is proportionately adjusted based on date of hire.” My question for you lies with the next scenario. On April 12, 2013, I had laser eye surgery at the out-of-pocket cost of $2700.00. I submitted the required paperwork for medical reimbursement and was told I can only receive $300.00 a month for it. When I asked why it was done that way when most other companies do not do it the same way, I was told by my Executive Director that if I quit tomorrow, they wouldn't pay me the rest of the medical reimbursement. It was like insurance. If I had health insurance through them, I wouldn't receive the health insurance after I quit. Is what they told me legal and right based on the laws and the policy given to me? When I asked for the summary plan description, I was given a copy of the policy which is “Eligible employees include all full time staff, effective 30 days from date of hire.Eligible expenses include all qualified medical expenses as defined by the IRS in Publication 502.An abbreviated listing effective July 2012 is attached. This is subject to change.The time period for incurring these expenses must fall within the employment period.All items must be submitted for reimbursement within 3 months of the date incurred.Only true "out-of-pocket" expenses are allowed. No reimbursement is allowed for itemscovered by other plans. Rembursement amount is 100% of eligible expenses, subject to a $3,600 limit for bothqualified medical reimbursements and tuition refund. The combined total yearly benefitpayable for both programs is $3,600, with no provision for carryover into the next calendar year.The annual limit is porportionately adjusted based on date of hire.Proof of expenses is required together with a completed Health Reimbursement Form.”Another notable fact is that I do not contribute any money to the medical reimbursement account. The full $3600.00 is contributed by my employer. I can be contacted [email protected] Thank you for your time and help.Thanks,Cassie King
Allen M., Esq.
JAG officer and former adjunct prof.
Juris Doctor, Cum Laude
I sent this question before I set up an account, so I guess
I sent this question before I set up an account, so I guess I better re-do it. I just retired as a manager of a medical/surgical practice for the past 14 years. Before I accepted the position I typed up a summary of the items that the doctors interviewing me and I discussed as the expectations on both parts. I asked them all to either sign off on it if it was correct and/or to change it. They signed off on it. One of the items stated that they would pay my medical and dental in full and that if I remained in the position for at least 10 years and ended up retiring from their practice they would continue to pay my medical and dental. I retired on 12/07/12. I sent them an invoice for the amount of the medical to be reimbursed to me. I received an envelope in today's mail which contained a letter stating that they have decided on my retirement package which consists of a gift certificate for $1500 for a cruise and have decided that they will only cover six months of secondary medical coverage for me not to exceed $2041.80. Do I have to accept this as all they will pay for my medical/dental or can I pursue this without it costing me more that I will receive?
I do payroll for a construction company (roofing). We recentlyView more employment law questions
I do payroll for a construction company (roofing). We recently got a subcontract on a prevailing wage job and I am trying to complete the payroll reporting form. Our employees do not get medical benefits or pension, etc. but as I understand on a prevailing wage job we have to pay fringe benefits no matter what. I did not realize this until after I already completed the pay checks for the job (we are cutting seperate checks just for this individual job). I thought it would just make things a lot less difficult to just pay the fringe benefits cash, but the owner of the company says no because then he would have to do a whole other reporting of that to workman's comp because he is not suppossed to pay cash. Would that really create an issue with workman's comp if the money getting paid cash is just the fringe benefits, not the hourly wage? Would it have to be reported anywhere else besides on the prevailing wage payroll reports?