A self funded health plan has been asked to

preauthorize a bone marrow transplant scheduled

for next week. The plan specifically INCLUDES

bone marrow as one of the covered transplant

procedures. However, it EXCLUDES experimental

procedures.

The participant is included in a clinical study

at a major hospital. While the FDA has apparently

given its approval to the basic procedure, our

TPA has said that it is still considered experimental

in nature. They recommend we deny the preauthorization.

So, problem #1 is the conflict in plan language, but

to further complicate this issue, our TPA has said that

the stop-loss carrier will not pay on the claim....(if

it is deemed experimental.)

How is this best handled? My initial reaction is to

deny the preauthorization and contact the participant

to let him know of the problem and the appeal rights.

In a perfect world the participant would back out

of the clinical trials, and undergo the normal procedures...

or the stop loss carrier would agree to treat the procedure

as a normal bone marrow transplant.

Suggestions??

For a plan I work on, there are several 1099's that were produced for normal distributions taken.

I also have several other participants that will need 1099's filed related to their PS 58 Cost.

Side note - I am not that familiar with the 1099 process. I believe that there is a 1096 that would be provided which would be a total of the 1099's produced.

My question is: Since I have 1099's for 2 different reasons (dist's & PS 58 cost), will I need to submit separate 1096's, or can I just combine them?

From what I hear, this could be a big issue if done incorrectly.

Thanks in advance!

For the year in which the employee enters the plan, plan defines compensation from date the employee became a participant. However, employer has allocated 2003 contributions based on such employee's comp. for the entire plan year. Correction - forfeit the excess amount contributed (plan reduces)? Any possibility of an amendment changing the comp. period to the entire year for first year of participation?

Plans merged as of 12/31/02 should a final 5500 be filed for the MP plan?

I have a DB plan that excludes highly compensated employees. It has a plan year from 2/1 to 1/31. Currently, I use the 12 month period preceding the plan year for the look back year for purposes of determining who is an HCE and thus excludable from the plan. However, I would like to elect to use the calendar year data election (in Notice 97-45), which provides that the look back is the "calendar year beginning with or within the look-back year." My problem is, if I elect the calendar year data election, then I won't know who to exclude from the Plan until almost the end of the applicable Plan year. Is there a way around this problem?

Plan's definition of compensation has no exclusions, however the employer has been excluding bonuses for all contribution and allocation purposes. Understand that the employer should make a QNEC (and earnings) to adjust for the incorrect deferral, but does a QNEC have to be made for the missed employer contributions? Q & A 133 from the Correcting Plan Defects Column states the missed employer contributions need to be made but not in the form of a QNEC. Q & A 135 expands but not sure if it is saying the missed employer contributions must be in the form of a QNEC? Does Rev. Proc. 2003-44 require a QNEC or just make up the missed employer contributions with earnings and put in the regular PS or Match source?

Can you please tell me how you would handle the following situation, and any supporting cite or references?

Participant fails to make loan payment in June 2003, loan should have been deemed at the end of the cure period, which would have been Oct 1, 2003.

Participant terminated in December and requests distribution.

Would you deem the loan and then process the distribution request, or would you offset the loan and then process the distribution request.

The participant now has a distributable event, can you deem it at distribution because it should have been deemed, but never was? Or, does the distributable event now not allow you to deem?

Is there anyway to be warned of duplicat personal information in a DCM import. We've got a few plans that never enter rehires as a rehire, but rather a new hire. If I enter census info. by hand I will get a warning if duplicate information is on the system; thus I know the rehires. If I use the DCM import, I don't get that warning, is there anyway to get that warning using DCM? I've pretty much given up on the client to enter rehires correctly & they have several rehires each year so it is difficult to catch everyone.

Thanks in advance for any guidance.

We have a case involving a 401k plan asset "custodian" demanding documentation

that I feel only the plan "Trustee" is responsible for verifying.

The situation is that the Trustee submitted a request for payment to be made to the

spouse of a deceased plan participant. This request was submitted on the custodian's

distribution request form. This spouse was previously paid out the major portion of

the account by a prior custodian when this was a Money Purchase Account with no

trouble. The balance is some residual earnings.

The new custodian is taking the position that they cannot make the distribution

without being provided the deceased participant's beneficiary designation and death

certificate. They say they must have this documentation for their SAS 70 audit.

Please advise I can further argue this with the new custodian and how .

I am considering transferring an IRA to an account that will be actively managed by a financial advisor. The advisor charges a fee that is a percentage of assets and can be paid by check or by taking the fee out of the account. If I elect to have the fee taken out of the account, is this a taxable event (i.e. am I actually withdrawing funds from the IRA to pay the fee)? Or is just like a fee (non taxable)on a mutual fund?

Can an otherwise eligible employee elect not to participate in a 403(b) plan - i.e., not receive the employer contribution? I know there is a prohibition against irrevocable elections not to participate in standardized prototype 401(k) plans, but what is the rule with respect to 403(b)s?

Was the deadline for a calendar governmental plan to amend to final 401(a)(9) regs December 31, 2003?

Employee obtains stock through an ISO, employee divorces and transfers ISO stock to wife through a bona fide property settlement pursuant to the divorce, can the ex-wife qualify for non-recognition under 1042 if she sells the stock to the ESOP?

The third condition of the exemption from annual examinations by an IQPA states that the administrator must make available for examination, at the participants request, copies of each financial institutions statements and evidence of any required bond.

I interpret this to mean that if a Plan does not have a fidelity bond (even though they have been advised to purchase one many times) they cannot claim the exemption from an IQPA examination on line 4k of Schedule I because they would not be able to furnish proof of a bond that doesn't exist. Others in my office disagree. Wanted to see what others thought about this.

Do I have this right? A db plan that permits continued participation after normal retirement date must provide participants with a benefit equal to the greater of: (1) the age/service benefit or (2) the actuarially increased value of the normal retirement benefit when the participant ultimately retires, unless the plan provides participants a suspension of benefits notice at age 65, in which case the plan need only provide the age/service benefit. Also, if a plan opts to provide the notice, does the plan need to contain a statement that such a notice will be issued?

Can someone help me? I have a safe harbor 401k plan that has a safe harbor match as well as a discretionary match. The employer fully utilizes both matches; however with a last day and 1,000 hour requirement for the discretionary match - they fail ACP testing for the discretionary. To alleviate this problem we amended the plan to remove the accrual requirement for 2003, before the end of the year. Since this was a nonstandardized plan, with last day 1,000 hour requirement we could do this because we were not taking away a benefit from anyone.

My question is since we removed the accrual requirements for the discretionary match (anyone who defers receives a match), do we have to give a discretionary match contribution to any participant who deferred and were paid out prior to the date we amended the plan for 2003?

Since the amendment was not executed until late in the plan year, do I need to give a match to someone who terminated in January?

A healthcare employee is in the process of being terminated for " time theft" - Facts are as follows:

Employee X was working the nightshift at a Nursing Facility with three different locations A,B. and C. - Each night this employee would clock in at location "A", immediately leave "A"'s premises, drive over to, and clock in at location "B", then immediately leave "B", and do the same at location "C". The employee ended up collecting three times his true salary as a result of this fraudulent no show shuffle.

Criminal charges have been filed and are pending with the District Attorney. Question is as follows:

Assuming that the employee winds up convicted (which is certain), Can the Nursing Facility employer attach any employer monies that were contributed into a Qualified plan on behalf of this former employee - or does ERISA preempt any attachments whatsoever?

A Plan requires last day employment to receive matching contributions (no hour requirement). A number of participants terminate during the year so that the match now does not pass coverage. The Plan uses a Fail Safe to correct coverage. None of the participants added back under the Fail Safe rules made salary deferrals.

Is it just the number of participants added back that matters, or would a contribution (QNEC?) need to be made for the added back participants?

As always thanks for any insight.

Group has FSA with Premiums, Medical Reimbursement & Dependent Care Reimbursement categories.

If I do the discrimination test individually for each category they only pass 2 of 3

But, if I do TOTAL pre-tax benefit amounts then the the test passes.

(ex)

Premiums - Pass

Medical - Pass

DC - Fail

Total plan key ee amounts = $900.00

Total plan pre-tax amounts (all ee's including key) = $3800.00

900 / 3800 = 24%

Is it ok to use TOTAL BENEFITS OF THE PLAN???

Thanks!!!

I have a situation where a consulting firm was bought by another consulting firm. The buyer bought the business and the employees. As a result, it is business as usual since the same Enrolled Actuaries will be signing the Schedule B for teh same clients regardless of who they work for. The enrolled actuaries would include the new firm's name on the B.

Does this change necessitate disclosure on Schedule C where the entity that employs the Enrolled Actuaries has now changed? The sold consulting firm would no longer exist.

Thanks