oriecat

This information is even on the DOL website FAQ on COBRA. http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html What's important to remember is that "entitled" actually means eligible and enrolled.

My understanding is that the employee must be entitled and enrolled in Medicare following the COBRA election in order for you to be able to cancel their COBRA coverage due to other coverage. If they only became entitled and didn't actually enroll then no you can't cancel them.

I could be way off here, so take these thoughts with the knowledge that I might not know what I'm talking about... Sec 129 provides an exclusion from income of the amounts paid by the employER for dependent care assistance. Sec 125 then comes in and takes the employEE amounts and makes them employER amounts through the choice of cash or benefits. So I do not see how you could do a plan without section 125 unless the employER wants to provide these benefits themselves.

This is all new to me, and I am interested in seeing any responses you get on this. Would this be another way of looking at it? 1. EE elects $1200 for the year 2. EE has contributed $600 so far 3. EE has QSC and then changes election to $600 for the year 4. Since EE has already paid her $600 for the year, she no longer has to contribute but is still covered for the full year at the $600 Is that how it works?

We moved to a PTO system back in 97 I believe. I am very happy with it. It just seems to be more fair to me, because before you would have employees who take their 3 weeks of vacation and then call in sick all the time using up weeks of sick leave too, so they end up getting paid not to work for 5 weeks, while a good employee who is always at work only gets paid not to work for their 3 weeks of vacation. We also instituted what we call Long Term Leave, which accrues up to a max of 480 hours (12 weeks). It can only be used once you have zero PTO, and can only be used in FMLA situations. At the transfer, we moved up to 48 hours of old sick time to the vacation time to make the new PTO time. Any sick hours after the 48 were then made into the LTL Bank. One thing to consider could be the difference in your workers comp premium, because generally to my knowledge (at least under our policy!) vacation pay is excludable from taxable wages, but PTO, since it is not differentiated between sick and vacation, is not excludable.

Yeah, I wasn't sure on that, that's why I formed it as a question. However, my thinking was along the lines of that once the spouse's coverage ends, she will get a HIPAA Creditable Coverage Cert, and those don't generally say why the coverage ended, in my experience anyway, so if she just took that to the employer, they wouldn't know it was a voluntary waiving, unless they were inclined to dig deeper. I would think most er's would just take the cert and use it as a HIPAA event. How do others handle that?

Sounds to me like the wife IS currently covered, but is now choosing to drop her coverage during open enrollment. But I agree that waiving coverage is not a qualifying event for COBRA. However wouldn't the loss of coverage, due to the waiving, then be a HIPAA Special Enrollments events for her employers plan? So she shouldn't have to wait until April?

We are now in our open enrollment period. Active employees must take both medical and dental, they are bundled. However for COBRA we unbundled and the COBRA enrollees can take whichever they need. A medical COBRA enrollee asked me today if she can now add dental since it is open enrollment, or since she did not elect COBRA for dental at her initial enrollment, is that now not available to her? I know with COBRA she has to have the same rights as similarly situated non-COBRA participants, but that doesn't really apply here since they all have to have both. Thoughts?

I know this isn't your question, but are you aware that filing a W-2 and a 1099 on the same individual is a big red flag to the IRS that employment taxes are being evaded? You might need to evaluate these employees and make sure they are being properly classified.

Well I don't see why condoms shouldn't be a covered expense, altho I fully admit to not brushing up on what all the regs say. If I, as a female, choose to use condoms for birth control, as opposed to the pill, why should one be reimburseable but not the other? Both are for the prevention of the medical condition of pregnancy. Now if you've got men buying the condoms, I can see where that gets a little trickier, since they aren't preventing their own pregnancies, but you do have the disease control issue...

I agree. If you are prorating the coverage for the month of the termination, then you should prorate the premium for that month as well.

I'd be inclined to say no. Under our plans, changing from one to the other can only occur at open enrollment, unless the employee moves out of the service area.

Yeah, that sounds like a messy deal to me too. I don't think it would be wise to get into a situation where some parttimers have coverage as an active employee and others don't. However, I think one way to get around that would be to terminate their coverage, send them COBRA information, tell them to sign up and that the company will pay the premiums for them for the 18 months. Of course, then 18 months down the line, if they are still there and still part time, then you again have the same problem of how to deal with them.

I don't believe so, although our HR director always says the same thing, so I am interested in seeing if anyone else has any thoughts about that. Under ERISA, notice of a material reduction in covered services or benefits, which I believe a premium increase would fall into, has to be provided within 60 days after the date of the adoption of the change.

I am reading a 2003 report on trend that our broker sent to us. At the end, there are ideas for different cost management strategies. Under Plan Management, it says "Provide coverage incentives for support services and complementary care to motivate employees to improve their health". What do you think that means? Examples? Thank you.

No, the question I answered was the second half "or is the COBRA ending an ok event to allow the employee to elect coverage under the employer's insurance in this situation?"

Yes, the ending of the COBRA period provides special enrollment rights under HIPAA. See the following from the HIPAA FAQs at HHS. http://cms.hhs.gov/hipaa/online/Group/hipa...p?record=540061

Yes, I believe so. It would have to be prescribed by a physician to treat a specific illness or injury.

Yes, I agree.

I am working on our wrap SPD. How much COBRA information is required under ERISA to be in there? Is it ok to give a brief explanation and reference to the Initial Notice that is also provided separately? If the info is fully explained in the booklets provided with the wrap, is it necessary at all? Thank you!

I've kinda been wondering the same thing. My impression based on the new DOL Model Election Notice is no, as it says "If employees might be eligible for trade adjustment assistance, the following information may be added:" Emphasis mine. Makes it sound like nothing is required. But I could be wrong...

Agreed. Here is how my matrix defines the allowed change for when a Spouse Gains Employment: "May drop or decrease coverage for employee, spouse, and/or dependents who become eligible for and elect coverage under spouse's plan". New employment itself is not a qualifying event. As to how to handle your situation, I am not sure, because I do not understand why they would require a signed letter on letterhead, etc. I would think just getting a copy of the new enrollment form would suffice. I also don't understand why they would only mail it and it would take 4-6 weeks. It would take 2 minutes to print out a letter real quick showing that information. Have you tried contacting the insurance carrier directly to see if they have processed the enrollment yet and if they could fax a letter showing the coverage?

Here's another quote, from one of the various Treasury Regs relating to Cafeteria Plans http://www.irs.gov/pub/irs-utl/tres_reg-1125-2.pdf Page 6, Question 7 "A health FSA will not qualify for tax-favored treatment under sections 105 and 106 of the Code if the effect of the reimbursement arrangement eliminates all, or substantially all, risk of loss to the employer maintaining the plan or other insurer."

This isn't going to make sense since I haven't been able to think too clearly about this all, but in reading through some of the stuff in my HIPAA implementation checklist, it just starts to boggle me about how the plan can't release info to the employer, but when you are one and the same person how do you differentiate between when you are working in one capacity and when you are in the other, and how are you supposed to keep yourself from knowing information that the employer isn't supposed to know without authorization, when you already know it, because you do the work for the plan?! I must be missing something...

I think that you have to go not by either of those dates, but by the date that she lost coverage under the plan. His enrollment would then be governed by the terms of his plan doc, such as in my plan, it would be the first of the month following application to enroll.