oriecat

Thanks for that, Christine, that is helpful., even if it just solidifies that the issue with the general notice going to everyone is really stupid.

The way they set up the model notices is really confusing. They are saying to send a new notice to everyone who had a QE since 9/1/08, but then the model notice that they put out clearly says it is for people who haven't received a notice yet at all. Well most of the people from that time frame got a notice long ago.

Nope, it can apply to both. See the new FAQs here: http://www.dol.gov/ebsa/faqs/faq-cobra-pre...eductionER.html

http://www.dol.gov/ebsa/COBRAmodelnotice.html

Haven't seen anything from the DOL yet. I think they have two more days...

As the employer, we will end up fronting the 65%. If premiums are due on the 1st to the carrier, we have to pay the bill. We cannot cancel someone's COBRA until they are more than 30 days past due, which means we can be out the whole premium for over a month. We will not be allowed to take the credit off the payroll taxes until the 35% premium is received. So if someone mails their 35% on the 30th day and you get it a couple days later, you've been in the hole for that premium for over a month, and then cannot take the credit until you happen to pay taxes next. It's a nightmare and as both payroll and benefits administrator, dealing with the notices/enrollment side and the payroll tax side, I just want to rip my hair out.

This is now shown on the DOL COBRA website. http://www.dol.gov/ebsa/newsroom/fsCOBRApr...mreduction.html "Those who are eligible for other group health coverage (such as a spouse's plan) or Medicare are not eligible for the premium reduction." So, yes I agree.

http://www.cms.hhs.gov/EmployerServices/05...erexception.asp "The small employer exception provision of the MSP statue can be found at 42 U.S.C.1395y(b)(1)(A)(iii) and 42 CFR 411.172(b)." http://assembler.law.cornell.edu/uscode/ht...95---y000-.html http://edocket.access.gpo.gov/cfr_2006/oct...2cfr411.172.htm

This is not what the website Janet linked to says. It says Cal-COBRA gives an additional 18 months after the federal COBRA, even for those coming from a large employer.

I doubt there is a regulation that says that since not all plans are on a calendar year basis. Here is the wording from the most recent proposed regulations: (f) Run-out period. A cafeteria plan is permitted to contain a run-out period as designated by the employer. A run-out period is a period after the end of the plan year (or grace period) during which a participant can submit a claim for reimbursement for a qualified benefit incurred during the plan year (or grace period). Thus, a plan is also permitted to provide a deadline on or after the end of the plan year (or grace period) for submitting a claim for reimbursement for the plan year. Any run-out period must be provided on a uniform and consistent basis with respect to all participants.

Maybe I am not properly understanding what you're asking about here, but it very much seems like what you are saying would make the entire 125 regs irrelevant, because anyone could at any time just say, stop my premiums and call it a cessation. In my mind, cessation would mean that the insurer no longer required them, not that someone just said to stop paying them. That would be a significant premium rate change which would qualify as a status change.

That's our government for ya...

Section (b)(2) of the reg describes the Individuals Eligible for Special Enrollment. It does not talk about prior dependents, only new dependents. (vi) Current employee, spouse, and a new dependent. A current employee, the employee's spouse, and the employee's dependent are described in this paragraph (b)(2)(vi) if the dependent becomes a dependent of the employee through marriage, birth, adoption, or placement for adoption. Here is the full regulation

I don't think that is correct. This example is straight from the 54.9801-6 regulations: Example 1. (i) Facts. An employer maintains a group health plan that offers all employees employee-only coverage, employee-plus-spouse coverage, or family coverage. Under the terms of the plan, any employee may elect to enroll when first hired (with coverage beginning on the date of hire) or during an annual open enrollment period held each December (with coverage beginning the following January 1). Employee A is hired on September 3. A is married to B, and they have no children. On March 15 in the following year a child C is born to A and B. Before that date, A and B have not been enrolled in the plan. (ii) Conclusion. In this Example 1, the conditions for special enrollment of an employee with a spouse and new dependent under paragraph (b)(2)(vi) of this section are satisfied. If A satisfies the conditions of paragraph (b)(3) of this section for requesting enrollment timely, the plan will satisfy this paragraph (b) if it allows A to enroll either with employee-only coverage, with employee-plus-spouse coverage (for A and B), or with family coverage (for A, B, and C). The plan must allow whatever coverage is chosen to begin on March 15, the date of C's birth.

This is what the DOL website says: It only talks about new dependents, not old dependents.

Is it this? http://www.moss-barnett.com/CM/Articles/no...2007_90_rev.pdf

I believe she is talking about expenses of the deceased participant? So basically can someone who is not the participant submit claims on their behalf when the participant has died, so that the eligible expenses can be reimbursed to the estate?

There is also an entire forum here dedicated to them. http://benefitslink.com/boards/index.php?showforum=89

yeah, I'm not thinking about COBRA rules at all, I am more thinking of Sec 125 status change rules, so maybe I should have put this in the Cafeteria plan forum...

An employee of mine waived our group coverage in order to take her husbands family plan. He was laid off, and their coverage ended Jan 31st for that plan. So we talked about bringing them back onto our plan Feb 1st due to loss of other coverage, but they decided to stick with that plan through the COBRA coverage. Now 2 months later, they are significantly increasing their COBRA rates, so she is wondering if she can come onto our plan now. And I can't think today, so I'm not sure if that rate change would be a qualifying event. Thanks for any thoughts.

They've been out on medical leave for 8 years and you didn't put them on COBRA yet?

(Note I am no expert on this stuff, these are just some of my thoughts...) Wouldn't the old plan document show the old, now non-existent company as the plan sponsor? If so, they would need a new document to show a current sponsor. Also how could a company that doesn't exist anymore sponsor anything? So yeah I would agree with you.

You're welcome. So I'm still curious if becoming a partner would equate to a termination of employment. They would still be on the payroll, wouldn't they?

Those both say "during a period of COBRA continuation coverage". Those are allowable changes to the coverage once you are on COBRA, but they are not initial qualifying events.

Our dental plan summary says: Temporomandibular Joint treatment (TMJ) limited to treatment for pain, muscular or skeletal disorders to $1,000 maximum per Calendar Year. Any benefits applied to this maximum will also be applied to the annual maximum.