oriecat

To change the EIN on a welfare plan, is it necessary to terminate one plan and start a new one, or can that be adopted through a plan amendment?

Sounds like it might be a good idea, especially if they are still in their election period, so they could elect coverage to get that claim paid.

I believe all of those benefits are covered by ERISA, unless it is a government or church plan. Do you provide SPDs? Do you file a 5500 form?

I don't really know, but I just have some thoughts on this - what does the SPD or certificate of insurance say about termination of benefits? Does it clearly specify that coverage will end on the day after termination or the end of the month or ?? Wouldn't that documentation in the plan take precedence over what the COBRA notice itself said? Also, what do the HIPAA certs say as when coverage terminated? Are you actually dealing with a claim issue where the ex-employee is trying to get claims paid past the termination date because the COBRA notice date was different?

Since I just got back from an ERISA compliance seminar, I'll take a stab here. An ERISA plan would be one that: Is a plan, fund, or program Maintained by the Employer (or an employee organization) To Provide to Participants or Beneficiaries Certain Listed Benefits Through insurance or otherwise What kind of benefit are these premiums for?

Reading some more on this, I really don't think the Group Insurance Arrangement applies, as there is no trust that holds the insurance contracts or serves as a conduit for the premium payments. So then I am looking more at the multiemployer and multiple employer definitions, and they seem to say that due to common control, we would actually be a single employer plan, even though I have two distinct EINs, because of common control, which would be the fact that the owner is the 100% shareholder for both companies. Would that be correct or am I missing something?

I don't think so. I don't recall ever seeing anything about there being one. It would certainly be extremely wise of the plan to state a cap though. Ours is $3000.

I agree with that, and I realize where the confusion comes in, because I edited my message and took out a question I had. It sounds to me like the employee wants the unborn child to be covered as a dependent. What I was trying to say was that the unborn child can only be covered if the mother is covered. Maybe I misunderstood the question though, but to me that seemed to be what the employee wanted to do. Of course adding the child after birth would not be a problem, if the plan allows dependent coverage. It's just that the unborn baby cannot be seen as a dependent, therefore the mother would have to be covered at this point, IMO. (That's why I put "child" instead of child. The employee views the unborn baby as it's child, but legally it is not yet a dependent. I had the same question once actually. I told him no, they would have to get married and cover the spouse. They were doing that anyway, so it worked out.)

The only way for the "child" to have coverage is if the mother has coverage. If he wants coverage, then he needs to comply with the plan and put her on as a spouse, or domestic partner, however the plan is set up. If he refuses to do that, then I don't see any way to give coverage to the child until it is born, when he could then add the newborn child to the plan. Editing because I forgot you said self-insured. Does the plan document say anything about separate dependent coverage for unborn children? (I wouldn't think so!) Just go by what the plan doc says. He can't expect more than that.

Thanks!

On our previous 5500 forms, (our accountants filed them for us), they were filed as a DFE, using code G. Can someone explain to me exactly what that means? I read the sections in the 5500 form instruction booklet from the IRS, but I am just not understanding it. We have two companies and the plan includes them both, but filed under only one of their EIN. I don't know if that's where it comes from, since it isn't a single employer plan. And I still have yet to understand the difference between multiple employer plan and multiemployer plan. Thank you.

Based on where the comma is, it just sounds like a) incapacity due to pregnancy or b) for prenatal care. Not a) incapacity due to pregnancy or b) incapacity due to prenatal care. If it was incapacity of both then I don't think there should be a comma there. So based on that, it just sounds to me like prenatal care itself is FMLA qualifying. I fully admit that I could be reading wrong!

As long as I've been involved with the insurance plans, our plan year has been 11/1 to 10/31. But our 5500 shows the plan year as 10/1 to 9/30, except some of the Sch A's show the right year. I was told that at some point in the past, the plan year actually was 10/1 to 9/30, but since it isn't anymore, is there anything we can do to fix this so it's all correct in the future? I am thinking that if it had been done properly back when the plan actually changed then a short plan year 5500 could have been filed for the one month, and then changed to the correct plan year from then on. But how do we do that now, since the change happened so long ago?

Actually, pregnancy IS a serious health condition. See 29CFR825.114 (a) For purposes of FMLA, ``serious health condition'' entitling an employee to FMLA leave means an illness, injury, impairment, or physical or mental condition that involves: ... (2) Continuing treatment by a health care provider. A serious health condition involving continuing treatment by a health care provider includes any one or more of the following: ... (ii) Any period of incapacity due to pregnancy, or for prenatal care.

Yeah, I emailed them last week. I thought I would see if anyone here knew anything while I waited.

We have a self-insured dental plan. We are in Oregon. Am I correct that no portability options are required after the exhaustion of COBRA? Thank you.

I am trying to figure some stuff out regarding our welfare plans. 1. Without a ‘wrap-around’ plan document to bundle any/all of the plans into one “Plan”, are separate 5500 filings required? (We have previously filed one 5500 for the medical, dental, life plan and one for the Section 125 plan. We do not seem to have a wrap-around document bundling the plans. We only have a very old SPD that lists the benefits as one plan, but it is no longer current with ERISA SPD requirements.) 2. Are there any possible consequences if a single 5500 has been filed, but there is no wrap-around document, or if it is lost or out of date? 3. If plans are not bundled, can enrollment in one plan be contingent upon enrollment in a separate plan? For example, we require employees to elect both medical and dental coverage. If they are not bundled together, can that be required? Thank you!!

Based on my matrix and my reading of the pages of Pub 502, I'd say no. It says the amounts must be primarily for, and essential to, medical care. If the patient isn't the one traveling, I fail to see how the travel is essential to the medical care.

How long do you have to/should you keep them?

Can anyone help with my questions in this thread? http://benefitslink.com/boards/index.php?showtopic=18840 There doesn't seem to be anyone in that other forum lately. Thanks.

Thanks for pointing that out. I was just going by what I could find in my matrix. I will have to look into this more.

In December we started a voluntary disability program for employees, through Baltimore Life. I am not real familiar with ERISA at this point (I am working on it!) but what I read in a mini ERISA book I have is that this would only be non-ERISA if we did not in any way sponsor or endorse the product. I think we very much are endorsing it, it's not like we are just letting a salesperson come in and sell it, we send out the enrollment info, I have sent claim forms to people, etc. Am I correct in my thinking? We do not have a plan document, so I asked if we would be receiving one, and they replied that since it is a voluntary product, that ERISA doesn't apply.

Sounds like COBRA would apply to me, provided that they are big enough. Did they provide any justification for why they think it doesn't?

I have to agree that there is no status change, and therefore no change can be made. In my status change matrix, the closest option was "Visiting relative's ability to provide dependent care" - No change allowed. I think that the ee choosing to change providers, whether paid or unpaid, is not a qualifying status change.

The only problem I see, if I understand correctly, is that you are listing the 401k deferral as based on the FICA/FUTA pay, instead of the gross pay. That could be correct under your 401k plan document, but it just seems odd to me.