1. The following are the players in a fully-insured group medical plan.

Association (the policyholder)

Member of the association (an employer)

Participants (employees of Member)

Insurance company

TPA (claims administrator ...hired by insurance company)

PPO

QUESTION: Which of the above is a fiduciary of the plan?

2. Another Question:

Participant received medical services. TPA processed the claim. TPA tells participant that TPA mailed an EOB to participant timely, but participant cliams that he never received the EOB in mail. Participant calls TPA and requests TPA to e-mail a copy of that EOB to participant. TPA says it can't e-mail a copy... but will mail it again. Participant never gets it in mail. Participant calls TPA again and TPA accuses participant of being rude and hangs up on him.

How in the world is participant suppose to get the EOB? Does DOL even require that he must be given an EOB? Who has jurisdiction over requiring that an EOB be furnished to participant .... (DOL, State Insurance Dept, ???)

Does a plan have to recoup fraudulently induced benefit payments when the plan cannot show damages (i.e., if the money that was paid out pursuant to a fraudulent QDRO had stayed in the plan, its value would have decreased significantly due to current market conditions)? Accordingly, the plan actually benefitted from the money not being in the plan. Does the plan still have to recoup such payments? Is full restitution always required even where the plan benefits from the fraudulent payments due to a precipitous market downturn?

Hi,

We are offering a new HSA program at work this year and Bank of America has not provided us with a Salary Reduction Form (for employees to complete authorizing contributions directly from his/her paycheck to their HSA).

Does anyone have a sample form that I could look at before I take a stab at creating my own?

Thanks so much.

We offer single and family coverage An employee is currently covered under his spouse's health plan along with his dependent (she is a currently a student at a local university). He wants to enroll himself and student dependent in one of our health plans during OE to be effective 1/09. On 2/09, he wants to delete his student dependent as she will be enrolling in a health plan at her university (I am assuming that the semester begins again in Feb). This seems to be a qualifying event but we don't specifically state this in any of our documents.

Is this going to be the nightmare I imagine?

A company with about 130 participants and about 750 employees over a calendar year pays weekly. (Obviously, they have a high turnover.) They Plan on uploading contributions to the Investment company weekly. The office manager wants to send me payroll data only quarterly or twice a year. The Plan has age 21 and 500 hours in six months eligibility. I use Relius software.

I am thinking that if I receive the hours and comp weekly, Relius will do a huge amount of the work automatically. If I get the date 2 or 4 times a year, I think I will have to force a lot. Does anyone have any experience with this on this large a scale? (I do this with some plans with 5 people now)

I have 2 plans.

The first is a medical insurance plan which is fully funded by the employer . We have 17 people on the plan.

The second plan is a medical reimbursement plan which is self insured.

Question do these plans need to have 5500 filed?

Question the medical reimbursement plan has 2 shareholders which are greater than 2% employees. From what I have researched they can be in the plan, however it is deducted as wages not subject to fica and medicare taxes.

Question Is this correct?

My question deals with a 401(k) profit sharing plan participant who died at age 58 while employed. He did not sign a beneficiary designation form, but the plan has a default provision making his wife the sole designated beneficiary. The normal form of benefit is a QPSA, and the plan allows for optional forms, including LSDs. The plan does not have a provision allowing the spouse to change the form of benefit after the participant’s death. It does, however, allow direct rollovers to eligible retirement plans of eligible rollover distributions. My understanding is the spouse can postpone distributions until the participant would have reached age 70 ½. Could she, during this intervening period, directly roll over the account to an IRA in her own name, even if the benefit is slated to be paid in a QPSA form in 12 or so years? One part of this theory is that it is not yet being paid in substantially equal payments over her lifetime.

My life would have been much easier if the P & S had just signed the BD form!!! Thanks for any help.

We (TPA) are taking over the administration of a calendar year 401(k) Profit Sharing Plan that has a fixed match formula of 50% of deferrals up to 4% of pay (per the plan document). Anyone that defers gets the match - there is no last day or hours requirement.

For 2009 we would like to modify the the plan to provide for a discretionary match instead of the fixed match. Are we able to modify this provision as long as we give prospective notice (say, by December 1, 2008 for an effective date of January 1, 2009) or would this be a cutback that would trigger 100% vesting? Or?

Any input would be greatly appreciated.

Thanks!!

A plan wants to terminate mid year and is a safe harbor matching 401(k) plan. The plan has always made deferrals and safe harbor match only. The plan is top-heavy and relies on the exemption from T-H status due to SH match.

Am I correct in the following

1. 30 day notice to employees is required to cancel the match.

2. The plan will be subject to ADP/ACP testing for the year of termination.

3. The sponsor will need to make top heavy minimum contributions for the year of termination (because the exemption no longer applies).

Is there an exception for terminating plans that I am missing where one or more of the above would not apply?

Thanks in advance for any thoughts.

I'm back at work, but it appears that my brain may still be snorkeling in Hawaii.... (Couldn't find Blinky, though.)

Plan sponsor signed documents mid-September for a new calendar year safe harbor plan effective in 2008. Deferral election forms were submitted by several employees before 9-30. Client has now decided that there is no way he can begin deferrals before 11-30 for anyone. Upon hearing that was not a viable option, he would like to "amend" the plan to become effective 1-1-09.

I'm thinking that they currently owe QNECs for the deferrals that didn't get made, and I've already nixed the proposed "amendment". What am I missing?

How long do we need to keep records for an old 401(k) account for a company that no longer exists (due to acquisistions) if the plan has been terminated and all funds distributed? What items, if any should be kept and what could be disposed of?

thanks!

Plan includes an EACA - default contribution percentage of 3%.

Effective 1-1-09 the Plan wants to amend to a QACA with the default contribution percentage set at 6%.

For those participants who were automatically enrolled under the EACA at 3% and have made no election to the contrary, must they be increased to 6% once the QACA becomes effective in 2009?

We have an employee who was hired in September at a level that is eligible for our deferred compensation plan. Due to an administrative reporting error, the HR department did not receive notice of this person until November. Under 409A, an initial deferral election must be made within 30 days of first becoming eligible to participate in the plan. I don't see anything in the 409A regs that allow for a correction of an administrative error such as this, and I don't think this error is covered by Notice 2007-100. Does anyone have any thoughts on this?

Ladies and Gentlemen, Florida has enacted a law effective October 1, 2008 about which there is little agreement among practitioners. What they do agree on is that sponsors of fully insured group health plans with a Florida situs must allow their covered employees to continue covering unmarried dependents without dependents of their own until age 30 as long as those unmarried dependents either reside in Florida or are students at accredited institutions of higher learning.

The age 30 mandate is further limited in that the unmarried dependents may not have any other healthcare coverage which includes Medicaid and Medicare. I would argue that the COBRA administrator should quote the same COBRA rate billed to a divorced spouse mandatorily or a domestic partner permissively as opposed to the single rate whichh has been the practice historically.

Please comment from the perspective of actuarial logic as there are no regulations on point to my knowledge.

I have a client that has an employee that is paid a salary once a month before service is credited:

For an example: The participant gets paid on October 30th for service credited in November.

Is this a qualified CODA? Oh...and the participant happens to be the owner's wife.

All other employees are paid twice a month AFTER their service is credited.

As 403(b) plan sponsors review the new regs and begin to consolidate vendors, install fidcuairy process and other ERISA related behaviors the question is arising as to whether these plans should elect 404©.

Is this safe harbor available to 403(b)s? If so, are there any different filing requirments on the Form 5500 other than indicating 2f?

Thanks

I have a plan sponsor who is having problems passing the coverage/discrimination tests for an early retirement window ("ERW") program to be implemented early next year. The sponsor acquired a division of a company this year (April), which will be the look back year for the HCE determination next year. Although many employees of the acquired division would be HCEs if their compensation were annualized, none of them will be HCE due to their partial year with the sponsor. (1) Is there any applicable relief for a year of acquisition? (2) Is the sponsor allowed to annualize compensation for the year of acquisition to determine HCE status?

Hi. Superintendent of a School Board has an employment contract. As part of his contract, there is a paragraph that states that the "School Board will make a contribution for the Superintendent's benefit to an arrangement invested in an annuity selected by the Superintendent and satisfying the requirements of Section 401(a) of the Internal Revenue Code, in the amount of $10,000 with Superintendent being vested immediately." The paragraph goes on to state that the School Board will make this contribution annually.

It appears to me that this paragraph is creating a governmental plan with one participant. I think this is permissible due to the governmental plan's exemption from the nondiscrimination and minimum participation rules of ERISA. But what about the plan document requirement?

Any thoughts?

An ER has 25 EEs, has a group health policy for the EEs, and is in the midst of annual renewal of the policy. Unbeknownst to the ER, the agent just found out that an EE laid off last week has been rated as a bad health risk and would spike the group premium considerably. So much so, it would be much less expensive for the ER to pay for an individual policy for the former EE for a year than it would be the extra group premium if that former EE elected COBRA and paid the group rate himself.

Is there a prohibition to offering an EE an inducement to forego COBRA, similar to the prohibition against inducing someone to forego ER provided health coverage and go on Medicare primarily?

Suppose a plan amendment is done that provides a year of past service (prior to the effective date of the amendment).

Also, suppose the amendment is written to only affect the benefit accrual (upward) for a one HCE - it does not change the benefits for any other participants. Overall, even with this higher benefit accrual, the general test under 401(a)(4) passes.

Is the amendment deemed to be nondiscriminatory? The past service provided did not exceed 5 years and the accruals do not appear to fail under 401(a)(4) testing.