oriecat

I am not sure if it is a legal requirement or just our plan requirement, but in our plan, the spouse must be the beneficiary unless a spousal consent is signed. I assume it is a legal requirement and would be interested to know where it comes from.

This is probably a stupid question, but anywoo... When distributing a SAR for a welfare plan, is it to be distributed to all participants for the year the SAR applies to, or all current participants? (I'm thinking an employee who went on the plan last month will not care about what happened in the plan last year. But then no one cares about SARs anyway....)

I'm confused by your question. Are you saying that you are not in Texas and want to know if any place else has similar mandates?

Moe, if you read the link I posted above that discusses the regulations on status changes, you will see that the consistency rule requires that "the election change is on account of and corresponds with a change in status". It is also stated that "the consistency rule in the final regulations requires that any employee who wishes to decrease or cancel coverage because he or she becomes eligible for coverage under a spouses or dependents plan due to a marital or employment change in status can do so only if he or she actually obtains coverage under that other plan."

So in your example, these are my assumptions and opinions, which can always be wrong.

EE got married 4/1/03. Under HIPAA special enrollment, she would have gone on the spouses coverage 4/1 or 5/1 probably. She then tells you 10/15 that she wants to drop coverage due to her other coverage? It's 5 months later! How does that at all correspond with the previous status change? To correspond with the status change, I believe that both changes would need to be made just about simultaneously. Adding coverage 5/1 and dropping other coverage 11/1 do not correspond in my book.

Now, if the ee did not go on the other coverage 5/1, but say 10/1 or 11/1 because of his open enrollment, then that's a different situation. Also perhaps if the other coverage had a pre-existing condition exclusion period that she was waiting out with dual coverage, that could change things too. I am not sure about that. Again this is all just my opinion.

They never made it out of committee.

http://thomas.loc.gov/cgi-bin/bdquery/z?d1...d107:h.r.00063:

http://thomas.loc.gov/cgi-bin/bdquery/z?d1...d107:h.r.00167:

Use it or lose it still applies at this time.

Yes, that's exactly the reason why we are not allowing our disability to be paid pre-tax.

I would disagree, Moe, since the plan has to follow its SPD, which doesn't have a time limit, but the plan also has to comply with the Sec 125 regs, which require that the plan only allow changes that comply with the consistency rule.

Accordingly, the spouse's ability to opt-out of her plan mid-year strictly depends on the extent to which her plan permits such changes, as permitted by the 125 rules.

Correct. I guess I should have mentioned that, however I just assumed that the plan in question does allow changes, otherwise Moe would have no reason to even ask the question.

Maybe I am stretching, but if HIPAA requires that special enrollment take place within 30 days, and Sec 125 requires that changes to cafeteria plans take place due to HIPAA status changes and be consistent with and due to the status changes, I fail to see how a plan could allow a 125 change much beyond the 30 day limit and still fall under the consistency rule. (Someone wanting to drop coverage now because they went on their new husbands insurance 3 months ago just doesn't seem consistent to me.)

Actually I guess the real question for Moe would be, what does the plan document say regarding changes? My plan document does specify that all changes must be within 30 days of the event.

HIPAA created the special enrollment rights, which must be exercised within 30 days of the status change. The cafeteria plan final regs were then changed to reflect the HIPAA enrollment rights, allowing corresponding changes to the sec 125 plans.

See Treas Reg 1-125-4

http://www.irs.gov/pub/irs-utl/tres_reg-1125-4.pdf

Yes, the COBRA admin fee is a maximum of 2%.

Is the dental plan sponsored by an employer, who is otherwise subject to COBRA? Or does the employer just allow someone to come in and sell the product, without endorsing it? Is there any mention of continuation in the plan booklet?

Thank you!!

While on an FML the employee must be given a notice 15 days prior to cancellation of coverage for non-payment.

Do you have a source on this? I don't remember seeing anything like that before and would like to look into it more.

I would personally think that any amount would need to be refunded, otherwise you are collecting more than the 102% that you are allowed under law (assuming that you are charging the full 102%).

Here it is.

Cobra_Initial_Notice__DOL_Model_2.doc

Either way, I think we need some sort of punishment for people who misspell HIPAA as HIPPA. Can we ban them for a week or something?

I already retyped the Initial (or General, I guess its called now) Notice from the Federal Register, but modified it with company specific info. If I get a chance I will back that out to the model form and post it up.

I got scooped!

This is only my opinion -

Scenario 1 - Yes, I think paying the appropriate amount ($200) is fine. You're not changing the claim amount, you're just paying the amount that is approved and denying the part that isn't.

Scenario 2 - No, I think you should pay only what was submitted for, and then approved. Sometimes people might want to leave funds in for a while to save for another occasion. I wouldn't make assumptions about their intent.

No, I have always heard that premiums are not eligible expenses for reimbursement. Unless there is some weird way around it that I don't know about.

Has anyone found a link to text version of the new COBRA model notices? It would be easier to update than to retype the whole thing from the Federal Register. But they show as image files in the text version so they don't show up.

Yes, he is entitled to COBRA for any coverage he is enrolled in on the day before the qualifying event date. It doesn't matter if he also has Medicare coverage. Only when someone enrolls in Medicare after electing COBRA can COBRA be terminated.

I agree too. The desired change in the DCAP is not consistent with the status change and a midyear change should not be warranted.

This is just my gut feeling, nothing to back it up. I would think that if someone had the capability and wanted to accept credit card payments, I do not see why it wouldn't be ok. But the law is specific that the most you can charge is 102% of the premium*, so you could not increase your premium to cover the visa fees, if you are already charging the max. If you're not charging the 102% then you could increase it to that, but it would have to be at your annual renewal, as COBRA rates have to be fixed for a 12 month period.

* - with the exception of the 150% for the disability extension.

I am not sure I understand your question.

The employer is required to continue the health coverage as though the employee was still working. The employee is still required to pay any required premium that they have to contribute.

I found this webpage last year when looking for info on the same. I thought it helped a bit in understanding the definitions n such.

http://www.stanton-group.com/services/fsa/...sting_rules.asp