--- name: employee_benefits_administration description: Design and run employee benefits and leave for a small team: choose health and retirement plans the team can afford using a cost model on a real census, set leave policy per work location from official rules, run renewal checks 90 to 120 days out, run an enrolment window that closes clean, handle mid year qualifying life events, and keep the monthly, quarterly and yearly admin calendar that stops cover from lapsing. Use when setting up benefits, renewing a health plan, pricing a benefits change, writing or fixing leave policy, running open enrolment, or checking which benefits rules apply at a given headcount. --- # Employee Benefits Administration ## Purpose Give a small team real benefits without losing cover, money or a deadline to loose administration. Most benefits failures are not plan failures. They are calendar failures: a renewal priced on a stale census, an enrolment that never got reconciled to payroll, a leave case decided from a policy written for a different state, a threshold crossed last year that nobody noticed. This skill covers the full admin job: choosing the package with a cost model, setting leave policy location by location, renewing on time, enrolling people cleanly, handling mid year changes, and running the recurring calendar. United States federal rules are worked in full because they set the thresholds small teams trip over. The method is built to travel: every rule figure is verified against the official source for the place and the year before it is used, the same way the leave worksheet is filled per location. It does not give legal, tax or insurance advice, and it does not replace a broker. Contested leave cases, discrimination or retaliation claims, and plan document drafting go to a qualified adviser in that jurisdiction, with the records from this skill as the brief. ## Workflow ### 1. Start from the census, not the brochure - Build the census first: every person with work location, hours, pay, start date, current tier and dependents covered. Check it against payroll. Every quote, model run and eligibility call in this skill uses this census and no other list. - Count what the thresholds count. Full time equivalents for the ACA test are full time staff plus total part time hours in a month divided by 120. Write the three US threshold lines down for the team: COBRA at 20 employees in the prior year, ACA applicable large employer at 50 full time equivalents averaged over the prior calendar year, FMLA coverage at 50 employees with a per employee worksite test. The cost model prints these checks on every run. - Record what the team has now, in money: premium by tier, employer share by tier, enrolment by tier, retirement formula, and admin fees. A renewal decision made without the current cost written down is a guess. ### 2. Price the package with the cost model - Run each option through `scripts/benefits_cost.py` on the same census. It takes premiums, shares and rates as inputs, so it works for any carrier quote and any year. ``` python3 scripts/benefits_cost.py scripts/examples/small-team.json python3 scripts/benefits_cost.py --self-test ``` - Worked example, from the file above: 12 staff, average pay $52,000, payroll $624,000. Seven people on employee only cover at $650 a month with the employer paying 75 percent, three on family cover at $1,450 a month at 50 percent, dental and vision for 10 at $45 a month at 50 percent, and a SIMPLE IRA match capped at 3 percent of pay with 75 percent of staff taking part. Result: health $67,050, dental and vision $2,700, retirement $14,040, admin $2,400, total $86,190 a year. That is $7,182.50 per person and 13.81 percent of payroll, on top of pay. The self test covers this case, a 2 percent nonelective case, a 55 full time equivalent case that crosses the ACA line, and a bad plan name that must fail. All four pass. - Compare options on three numbers only at first: total employer cost, cost per person, and benefits as a percent of payroll. Then look at what the employee pays per pay period, starting with the lowest paid full time worker. A package the lowest paid cannot afford to join is not a benefit. - Choose the health design with the trade named: premium, deductible, network fit for where people actually live, and the employer share. In the United States, check the Small Business Health Care Tax Credit before signing if the team is under 25 full time equivalents: the credit can cover up to 50 percent of premiums paid (35 percent for tax exempt employers) for up to two years, if the employer pays at least 50 percent of employee only premium, meets the average wage test for the tax year, and buys SHOP coverage. - Choose the retirement design the team will actually run. For 2026 in the United States, a 401(k) allows $24,500 per person in employee deferrals, and a SIMPLE IRA allows $17,000, with catch up amounts on top for staff aged 50 and over. A SIMPLE IRA employer must either match deferrals dollar for dollar up to 3 percent of pay or contribute 2 percent of pay for everyone eligible. A health savings account paired with a high deductible plan has 2026 limits of $4,400 for self only cover and $8,750 for family cover. Verify every limit against the IRS notice for the plan year before using it in a decision. ### 3. Set leave policy per location with the worksheet - Fill `references/leave-policy-worksheet.md` once per work location. Where a person works sets the rules that cover them. - In the United States, test the federal baseline first: FMLA covers private employers with 50 or more employees, and an eligible employee has 12 months of service, at least 1,250 hours in the prior 12 months, and a worksite with 50 or more employees within 75 miles. Eligible leave is up to 12 workweeks of unpaid, job protected leave in 12 months, and up to 26 workweeks for military caregiver leave. Health cover continues during FMLA leave, and the employer must tell the employee whether they are eligible within five business days. - Then add the state layer for that location. State family leave laws can cover much smaller employers, and state paid family and medical leave programs pay part of the wage while the federal leave does not. Programs paying benefits in 2026 include California, Colorado, Connecticut, Massachusetts, New Jersey, New York, Oregon, Rhode Island, Washington and the District of Columbia, with Delaware, Maine and Minnesota starting benefits in 2026. Write the weeks, the pay percent and who pays the contribution from the state program site, not from a summary article. - Then add company leave on top, with the order written down: how paid time off, company paid parental leave, the state program and statutory leave run together, and what happens to health cover, retirement contributions and accruals during each leave type. - Walk the last real leave case through the finished worksheet before calling the policy done. Fix any line that would have given the wrong eligibility, length or pay answer. ### 4. Run renewal as a dated project - Follow `references/renewal-checklist.md`, starting 120 to 90 days before the plan year ends. Carriers send renewal material 60 to 120 days out, which is too late to market a plan if the work starts when the letter arrives. - Split the renewal quote into rate change, plan change and fees before reacting to the headline number. Price the renewal and at least one alternative on the same census in the cost model. - If the employer is an applicable large employer, test affordability every renewal: the employee share for the lowest cost self only plan that meets minimum value must stay under the affordability percentage for the plan year, 9.96 percent of household income for plan years beginning in 2026 under IRS Revenue Procedure 2025-25, checked through the Form W-2, rate of pay or federal poverty line safe harbour. The mandate itself means offering minimum essential cover to at least 95 percent of full time staff and their dependents to age 26, where full time means 30 or more hours a week. - Sign the decision and record the rejected options with their modelled cost. Renewals that renew themselves by silence are how a team ends up paying for a network nobody can use. ### 5. Run the enrolment window so it closes clean - Follow the worked cycle in `references/enrolment-cycle.md`. Announce the window at least two weeks ahead with dates, what is changing, employee cost per pay period, and where to get help. A window of two to four weeks is the common working range. - Give each plan one page: premium by tier, employee cost per pay period, deductible, out of pocket maximum, how to check the network, and what changed from last year at the top. - Remind on day one, at the midpoint, and 48 hours before close. Track completion daily in the final week and speak to the last people directly. Close on the stated date. - After close, audit every election against its source form, send enrolments to the carrier and get receipt in writing, load payroll deductions, and reconcile deductions in the first pay run of the new plan year. Send each person a written confirmation of their elections and the date cover starts. A person who thinks they enrolled and did not is the worst outcome in this whole skill, and only this reconciliation prevents it. - Plan for new joiners outside the window: eligibility date, waiting period as written in the plan, enrolment deadline from start date, and the proof the carrier needs. Put the same steps in the onboarding packet so no joiner waits for the next open enrolment by mistake. ### 6. Handle mid year changes inside their windows - Treat qualifying life events as dated cases, not favours. In the United States under HIPAA special enrollment rules, loss of other cover, marriage, birth, adoption or placement for adoption gives the person a right to enrol if they ask within 30 days of the event. Losing Medicaid or CHIP cover, or gaining eligibility for a state premium assistance subsidy, gives 60 days. Birth, adoption and placement cover starts on the event date when the request is on time. - Ask for one proof document with a date, log the event date, the request date and the decision, and apply the plan rule the same way for everyone. A request outside the window waits for the next open enrolment, and the log is what proves the call was fair. - Run departures the same way: last day of cover as the plan states it, continuation offer where the law requires one, and the retirement account note the leaver needs. In the United States, COBRA generally covers group health plans of employers with 20 or more employees in the prior year, runs 18 months after termination or a cut in hours and 36 months after events such as divorce or a child losing dependent status, and the person can be charged up to 102 percent of the plan cost. Under 20 employees, check the state mini-COBRA rule instead of assuming no duty. ### 7. Keep the admin calendar - Monthly: reconcile the carrier bill to the enrolment record, check deductions for joiners, leavers and tier changes, process continuation notices and life event cases. - Quarterly: recount headcount against the 20, 50 full time equivalent and 50 employee thresholds, review open leave cases against the worksheet for each location, and confirm retirement money reached the provider on time each pay run. - Yearly: run the renewal project, refresh every legal figure used in the package from its official source for the new plan year, file the health and retirement forms the jurisdiction requires by the dates the authority sets for that year, and file the full packet: census, quotes, decision record, notices, elections, carrier confirmations, first reconciled bill and payroll. - Keep benefits records access tight. The census and enrolment files hold dates of birth, family details and pay. Store them where only the people who run benefits can open them. ## Output Contract For a setup or package change, deliver: - The census used, with its payroll check date. - The cost model output for the current package and each option considered: total cost, cost per person, benefits as a percent of payroll, and the threshold checks, with the inputs named so the run can be repeated. - The signed decision: plan, employer share by tier, retirement formula, and the rejected options with their cost. - The leave policy worksheet filled for each work location, each legal line with its official source and check date. For a renewal or enrolment run, deliver: - The completed renewal checklist with dates done. - The enrolment audit: elections as filed against elections as sent to the carrier, with differences fixed or named. - The first pay run reconciliation and the first carrier bill reconciliation for the new plan year. - The confirmations sent to staff, and the filed renewal packet. For a leave or life event case, deliver the case log line: event or leave type, eligibility call with the rule it rests on, dates, pay treatment, and the notice given to the employee. ## Operating Rules - No figure without a source and a year. Premiums come from a written quote on the current census, legal limits and thresholds from the official source for that plan year. A figure that cannot be verified blocks the decision, it does not get rounded into place. - One census, one model, same inputs for every option. Comparing plans priced on different headcounts is how bad renewals get signed. - The reconciliation is the job. Elections, carrier records and payroll deductions must match, in the first cycle, every cycle. A mismatch found later is fixed openly and logged with its cause. - Windows are windows. Enrolment deadlines and life event request periods apply the same way to everyone, including owners and managers. Exceptions made quietly become the real policy, and they do not survive an audit or a dispute. - Leave calls rest on the worksheet for that person location, never on what was done for someone in another state or country. When two laws cover the same leave, the person gets the more generous answer on each point, and the worksheet shows both lines. - This skill gives administration method, not legal, tax or insurance advice. Disputed eligibility, a denied claim, a penalty notice or a claim of unfair treatment stops the workflow and goes to a qualified adviser, with the packet as the brief. - No em dashes in any document this skill produces for people to read.