leevena

Gburns is correct. As for the HIPAA documents, this is because there will be Personal Health Information being exchanged/discussed. There should be no issue with the HSA either.

You are correct, they cannot restrict your choice of banks.

Excuse my confusion about the answer...I may be re-stating this. The most significant difference between a FSA that your employer should consider is how the left-over funds flow. In an FSA you have a use it or lose it rule at the employee level. The funds are kept in the plan. With the HRA the employer gets to keep the unused amounts. Also, as a side note, the employer does not even need to fund the HRA until the expense comes due. Personally, I would take the HRA route.

Can you be more specific about your request or the reason for the question? For example, are you asking for a generic definition, such as G Burns provided or something more specific? Insured plans will have pooling points and self-funded plans have attachment points, which each play a role in shock claims.

I was right...I was wrong! COBRA is relatively simply because it is a "pass-along" concept. When the loss of coverage occurs those dependents currently covered will be offered continuation coverage. In this situation the child was not yet born, so he/she could not be defined as a dependent. If the spouse is a dependent she could elect continuation of coverage. Once covered, if the spouse has a child, then the child is covered under the contract.

I hate to be the first to speak up...usually I am wrong, but I do not see this being a problem for a group health plan. This case was concerned with a dependent wanting to receive survivor benefits, which were denied because their needed to be a "inheritance" right. But under the "dependent" definition of a group health plan all that needs to be satisfied is that the child/dependent is from the mother. So, did I miss something? Feel like this is 8th grade and I walked into a pop quiz.LOL

The key is "for care" types of expense. Would the "care" be there if there were no nanny cam? The answer is yes and thus does not meet the threshold.

No way, not an eligible expense.

I'm really asking whether the Purchaser can limit COBRA participants to one of the options. Oh, sorry but I can be a little slow on the uptake. Hate to be somewhat vauge, but the employer may or may not be able to do what you are describing. Employers can restrict enrollment into certain health plan but it has to be done legally. If you differentiate between groups of similarly situated employees for the health plan, it must be based on legally defined employement-based classifications. These include part time, full time, doh's, lenght of services, geo areas, etc. Now, if this employer can structure these people (which I doubt from what you have said so far) they can limit the plan offerings. My guess is that the employer cannot, so you will need to offer all.

Asssuming none of these plans are closed to new enrollment, the purchaser can offer all of them.

The buyer is required to make available it's their current plan to the cobra population. They are not required to develop or obtain something new for them. As for setting up a new and separate plan, not sure why they would want to do this, unless there is a very large amount. Doubt very much if you could obtain a fully-insured quote, so self-funding would be the way to go if you could find the reinsurance and the size made sense.

I agree with QDROphile. But as a further suggestion, could it have something to do with the location (tribal nation) not being a legal part of US?

Healthcare providers can, and do this all the time. It can be done via insured or self-funded.

Generally speaking any plan that delivers a benefit to employees other than wages is subject to ERISA. If the employer is involved in this "offering" to their employees, it is covered by ERISA.

I don't disagree with your comment, but if I read the question correctly they will be legally closing the company. I don't not believe it is just changing name and tax ID. But I could be wrong, so keep the ketchup handy.

I am 99.9% sure that COBRA is not required in this situation. When a business is closed, there is no group health plan in effect, let alone something for the cobra people to continue. If I am wrong, please make the eggs for my face scrambled with a little ketchup!

Can't say for sure about the studies, but your question seems to be strange. If you add any new dependents to a health plan (self-funded or fully insured), your claims have the possibility of going up. Whether you have added a same-sex or not, there is now an additional participant who may or may not incur a claim. Was there something you were looking for in particular?

SLuskin...quick question. If the employer does decide to distribute do they distribute based on some type of formula based on employee contributions or is it just divided evenly between all the participants? Thanks.

Why not? (Assuming it's at-will employment.) at will has nothing to do with it. The employer could require participation and cost contribution if it's part of an employement contract only. If there is no contract, there can be no forced enrollment/payment.

No, no, and no!

Employer cannot require employee to pay for anything. The employer can require premiums paid by the employee run their contributions through a POP.

To be tax free, it needs to meet Section 7702 of the IRS code cash value accumulation test, shifting of risk, and pooling. If done it would meet the test for no tax. If you did not structure this properly, it would become income.

HIPAA defines as PHI; information regarding enrollment status, coverage eligibility, payment for plan, all of which it sounds like these people have access to. So yes.

i believe all participants are owners (let me know if that makes a difference). And I'm not certain what the additional charges are for, but I believe to cover admin expenses. (again, let me know if you think it makes a difference.) If all are owners, they are just taking money from one pocket and putting it into another pocket. Cannnot understand what the rational is for doing something like this.

Adverse benefit determination is required by health care reform. It requires a notification of why a benefit for a treatment/service is being denied. Part of the reporting requires a reason, and the denial codes provide that reason.