leevena

No idea, but I would assume not often. I am on the wholesale side (42 years) of the group business, and since ACA I have quoted in excess of 5,000 groups. Believe I have seen it 2 or 3 times.

I agree with Brian that it is difficult but not impossible. 1. At enrollment, the employee is required to attest whether the dependents have access elsewhere. There is a warning about providing false info. 2. The employee with dependent coverage can be asked to provide proof that the dependent does not have access to coverage. A letter from the other employer is often used. 3. Check your COB information. I am sure there may be other ways, but these are what I am familiar with now.

Yes, it is fairly common. I cannot speak to others' incentives for choosing, but they should choose based on their perceived needs and OOPs. Some companies also have a policy that makes dependents ineligible if their dependent has access to coverage elsewhere.

You would be surprised to learn that many States take longer than the usual week or so. There are a variety of reasons why, including state regulations and backlog. NC, NJ, NY and a few others tend to take 8+ weeks.

I agree this probably happens, and it's best to consult an ERISA attorney. My initial reaction is that it probably does not constitute a MEWA. Consider the following. 1. MEWAs are a plan that provides benefits to employees of multiple employers. If this is a single employer (I assumed from the post), how would this be a MEWA? 2. Welfare plans provide for the employees and their beneficiaries. Since the payment is for the surrogate (assuming not a beneficiary), would this not constitute a MEWA? Curious what Brians' take is on this.

You are correct that a General-Purpose Health FSA are considered disqualifying coverage for HSA eligibility and that it would be difficult for the IRS to know. However, there are few things that could occur, leading to the IRS knowing. 1. Employer Records - employers track these contributions. If the employee is audited, the IRS could request these records. 2. HSA Contribution Form 5498-SA - the institution that holds the HSA funds report contributions to the IRS. 3. Dependent Care FSA information - is reported on W-2. 4. IRS Form 8889 - employees with HSA contributions must file form 8889. Part of this form is a certification for eligibility. 5. Random IRS audits.

Just some thoughts. 1. A written statement from the attending physician? 2. Police reports. 3. Autopsy report or other medical records. Good luck.

Employers generally cannot selectively offer traditional HRAs to employees who opt out. However, they could offer ICHRA, QSEHRA, or EBHRA to the others.

The answer depends on the measurement method your organization uses to determine full-time status. If you use the Look-Back method, the employee's FT status during the stability period is based on their hours worked during the preceding measurement period. If you use the Monthly Measurement method, eligibility is determined by the actual hours worked each month.

Lauren0507, I do not know what your relationship is with the group. I am from the wholesale side of group health, a TPA that administers self-funded medical plans. But I found this interesting. And BTW I agree with Brian that more than likely it is a welfare plan. $2,000 per year per employee appears to be excessive for what the group/employees will receive. A physician cannot assist in refills for someone who is not their patient. So, if the concierge physician cannot assist with refills for non-patient employees, and the concierge can easily and quickly refill a script for an employee who is already a patient, what is the value? As for the high or immediate scheduling priority, maybe some value can be given to that, but certainly not $2,000 per employee per year. Just my 2 cents.

Yes, we all do tend to get trapped sometimes in tunnel vision, if only it were of the Lincoln Tunnell I would be happy. Glad to be of help. Have a good day.

This sounds like a great deal. There is far too little information here for any of us to provide you with a complete explanation, but from what I see and know this is more than likely a legal plan. I am assuming that the union negotiated this on your behalf and is a collective bargained plan. Many unions are utilizing this as a way to fund post-retirement. What I cannot comment on is the specifics you discuss in your post, such as the amounts, the difficulty in use, denial of claims, etc., because I do not have access to the plan documents. You asked if this is unethical, but without any qualifier as to why. I believe not, and in fact I would say that this type of plan is very generous and somewhat unusual. Most Americans do not have an employer depositing money into a post-retirement account. While $130-$180k may sound small, when you consider what the eligible expenses are for this plan, that is a significant amount of money. Speaking for me alone, and I have been doing employee benefits for 42 years, this is a very generous plan. This type of plan allows for flexibility.

I am in my 42nd year and have never seen a fully insured or stop-loss carrier approve an extension of COBRA. Not saying that they have not, just never seen it before. The risk is not worth it to the carrier.

Brian is correct. I work on the carrier side, highly unlikely any fully insured carrier will allow it, and same for any self-funded group.

For what it is worth, since 1982 I have been on the wholesale side of the group business, working with many brokers of all types. I cannot recall anyone complaining during any of the shutdowns.

Bob The Swimmer, so true. I have been a carrier rep for 39 years and have been stunned by how many brokers sleep walk, not all, but many.

Bob the Swimmer is spot on. BTW, for transparency purposes, I am a group health carrier rep, not a broker. I would add a few things. First, depending on the size of your group, you should expect different services, and expertise, from the broker. From your posting, it appears to me that you may be at a larger group. There is a significant difference between the needs of a 50 life group, a 500 life group and a 5,000 life group. Secondly, there is no reason why you should not ask for an outline of services provided, arrive at an agreement, and memorialize it in a contract/MOU. Lastly, just as a group shops for coverage, you can also shop for brokers. Talking to 1 or 2 other brokers every few years is worth it. Keep in mind, your current broker may be doing a good job, but you may be missing out on other things/ideas. Good luck.

Brian, never would I have thought this would be allowed as an eligible expense. Thanks for posting.

Dave, I agree with the earlier comments too. But in particular for me, I have found this forum to be more professional. Some of the other forums I belong to come across as teenagers yelling at each other or at times providing useless information that they believe is accurate but is not. BTW, I am a group health guy so there is not as much for me here, but what is here does tend to be helpful.

My 2 cents is that the additional cost associated with adding flavor is not deductible. The addition of a flavor, and it's associated cost, is because the patient does not like the flavor of the drug. I see it as a non-medical ingredient and should not be allowed as an eligible expense. What would be next? If I do not like the taste of a certain drug, can I deduct the cost of a shot of whiskey I use to mask the flavor?

Ok, thanks so much for the clarification.

Luke, I have a question for you about your reply. If an employer is exempt from ERISA but adopts ERISA guidelines, does this automatically make it an ERISA group going forward?

I am a group rep for a carrier, and have not seen anything about the act impacting the SBC. I have attached a link to cms, with a good overview of interim final. Find reading this easier than going to the original releases. Good luck. https://www.cms.gov/newsroom/fact-sheets/requirements-related-surprise-billing-part-ii-interim-final-rule-comment-period

QSEHRA can’t be offered with a group dental plan. ICHRA can be offered with a group dental plan.

Question for Peter and Brian. Would it not be better to change the plan document wording to something along the lines of "A discretionary amount to be announced by the Employer at the beginning of each Coverage Period" and eliminate the specific number?