Health Plan Contribution Report
ERISA rules require that Employers track, and the Unitarian U niversalist Association (UUA) report, separately, the amount of Unitarian Universalist (UU) HEALTH PLAN premium funded by an Employer and the amount paid by Employees for themselves and their dependents. Our Health Plan auditors review this information and may request detailed payroll documentation from non-reporting Employers in order to satisfy Department of Labor filing requirements.
We have simplified our reporting format to allow you to enter, online, the monthly split between your Employer contributions for Health Insurance and the contributions made by your employees. This replaces the previous paper "splits" form.
Secure Online Form
Use the secure online form.
Only include amounts for UU Heath Plan insurance premiums. Do not report any premiums associated with Life, Dental or Disability coverage. Show only the dollar amount that the Employer contributed, and the dollar amount each Employee contributed for UU Heath Plan premiums.
Report monthly, as you have in the past.
- You cannot save the online form and return to it later. The form must be completed and submitted in one sitting.
- Before hitting "Submit", please print a copy for your records
- Complete the online form monthly.
- Complete the online form for UU Health Plan premium contributions only.
- Do not include any information for Life, Dental or Disability payments.
- The total for each Employee should match the amount billed for the month for the UU Health Plan.
- Check the YES box if you are on COBRA or billed as a self-employed person.
For more information contact firstname.lastname@example.org.