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Washington Quarterly Statement of Supplemental Benefits Paid For Self Insured Employers

State:
Washington
Control #:
WA-SKU-3248
Format:
PDF
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Quarterly Statement of Supplemental Benefits Paid For Self Insured Employers

The Washington Quarterly Statement of Supplemental Benefits Paid for Self Insured Employers is a financial report that employers in the state of Washington who self-insure their employees must submit to the state. This report provides an overview of the supplemental benefits that have been paid on behalf of the employer’s covered employees for the respective quarter. The report includes the name of the employer, the date of the report, the total amount of supplemental benefits paid during the quarter, and a breakdown of the benefits by type, such as medical, dental, vision, and mental health. The Washington Quarterly Statement of Supplemental Benefits Paid for Self Insured Employers is issued in two different formats: a paper form and an electronic form. The paper form must be submitted to the Washington State Department of Labor & Industries each quarter, while the electronic form must be submitted through the Washington State Department of Labor & Industries website.

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FAQ

L&I maintains a list of self-insured employers. Your employer or their representative handles your paperwork and pays for the claim. They will give you a Self?Insurer Accident Report (SIF?2) form. Fill out the form completely and return it to your employer or their representative.

To be exempt, officers of a non-public corporation must meet all of the following criteria: They must be a bona fide officer. To be considered a bona fide officer: The individual must be voluntarily elected, or appointed to the position, of their own free will and with their express knowledge, and.

Supplemental benefits include accident, critical illness, hospital indemnity, disability, cancer, life, vision and dental insurance. These are designed to complement medical insurance, which can run out in the event of an accident or illness and leave insureds to pay out-of-pocket for treatments and other costs.

Employers purchase coverage through the Department of Labor & Industries (L&I). L&I manages all claims and pays benefits out of an insurance pool called the Washington State Fund. The fund is financed by premiums paid by employers and employees, not by general revenue taxes.

Here's how L&I calculates the premium rate for each of the business's risk classifications: Multiplying the business's experience factor by the sum of the Accident Fund, Medical Aid Fund, and Stay at Work base rates, and then. Adding the base rate for the Supplemental Pension Fund.

A supplemental benefit is a payment from an employer to an employee to make up the difference between their regular wage and the benefit paid by Paid Family and Medical Leave. This could be salary continuation, or paid time off (PTO).

A worker receives a percentage of wages based upon family status and number of dependents at the time of injury. A worker is entitled to 60% of their gross monthly wage. An additional 5% is added for a spouse and 2% for each dependent child, up to five children.

More info

Quarterly Report for Self-Insured Business (F207-006-000). Quarterly Statement of Supplemental Benefits Paid for Self-Insured Employers (F207-011-000).Stop Payment - Form 1003, This document is a PDF. (1) The total value of assessments collected from self-insured employers under this section must be credited to the fund. The surcharge and supplemental surcharge are collected quarterly from insurance carriers and self-insurers. Woman completing form. Browse Workers' Compensation forms and publications below. Who pays for unemployment benefits? The Kansas Employment Security Law requires employers to pay taxes to fund all eligible regular unemployment benefits. Complete Part A, Claimant's Statement, of the claim form.

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Washington Quarterly Statement of Supplemental Benefits Paid For Self Insured Employers