leevena

Good question. I have not found one, but I do have one for Medicaid. My guess (which you should not go by) is that DOL will utililze the same list...but then again who knows.

Moving them can be done. Can't say for sure if this group is doing it legally, but it can be done.

thanks for your reply. I wholesale alternative funding medical for small and medium size groups (under 15-500 lives) and often use a captive structure. Since these are small groups coming together in a cooperative risk sharing arrangement, the captive is very useful for us. Interesting difference though, we use rental arrangements for our medical. Thanks for your help.

Thank you.

Before you laugh, I am not a math genius...took my two years of high school math in three. My answer is that you lost 39% of the page.

As I said, I am somewhat confused, so please help us with an explanation.

I am a little confused by the discussion and why some believe that COBRA should be offered. Am I missing something? COBRA qualifying events for the employee are quite simple and clear; 1) Termination from employement and 2) reduction in hours, thus making the person ineligible for benefits. Neither of these two events has occured.

Yes, you are correct that there are two QE's; term of employment and reduction in hours. Since neither has occured, and assuming that the employer did not inititate the transfer as a way to avoid COBRA, there is no QE. As for authority, don't know how to prove something like this, sorry. There is nothing in the regs/law that explain every possible situation.

There are two issues with the transfer within a company and depending on the situation COBRA may or may not be available. If an Employee transfers "voluntarily" to a position that does not have a group plan (non-union to union as example) available to him/her, there is no qualifying event, and obviously no COBRA coverage is available. If an Employee is transferred by the Employer as a way for the Employer to avoid COBRA, then it is a qualifying event and COBRA is available. Hope this helps.

I agree with vebaguru if the ER pays the premiums it will be a welfare benefit plan covered by ERISA. ERISA does not however impose a nondiscrimination requirement. If the coverage purchased is through individual policies that impose pre-existing conditions, the group health plan might be in violation of HIPAA special enrollment rights. Under current Code section 106(a), the value of the coverage would be excluded from the employee's taxable income and under section 162 deductible by the ER (to the extent it does not cause total compensation package to be unreasonable). This is so whether such coverage is provided for all, there is varying coverage or only the highly compensated employees are recipients. There is currently no nondiscrimination rule. If the group health plan is subject to all of the new Health Care Reform (i.e., is not grandfathered passed portions), then there is a new nondiscrimination requirement imposed for group health coverages. It was supposed to take effect 1/1/2011, but it's implementation has been delayed by the IRS pending further notification (when the IRS gets a few rules sorted out). If an ER keeps its involvement down to a very minor level and lets EEs choose their individual coverage and pay for 100% of the premium through a bare bones cafeteria plan (IRC section 125), then it will not be either a welfare benefit plan for ERISA purposes nor a group health plan for HIPAA and new Health Care Reform purposes. The ER can then bonus extra money to the targeted employees so that they can afford to elect payroll reductions to pay for the individual coverage--or whatever else those employees, on an individual basis, may choose to do with the bonus money. This approach is like threading the needle, but there is that much of an opening if done right. John, I agree with your comments, but have a questions. If the employer is operating a 125 plan (which it does not appear so) wouldn't the 125 discrimination issue arise here? Or am I missing something. Thanks

after reading your last post regarding layoffs, now I am even more against your idea. From an arms length analysis, I look at a few things for a self-funded account (medical that is) and those are; 1) positive cash flow, 2) stable company (not layoffs), 3) internal staff that understands self-funded, 4) cash reserves. It does not sound like this group meets any of this, especially the "understanding of self-funded" piece. Also, you said the premium is $800 per month. Is your mgt lacking basic business skills? If your company is laying off people, presumably because there is a money issue, even if you get free life insurance, your savings is minimal. After you take your tax deduction how much is the true cost. Man, do I feel sorry for you.

First, check your medical plan benefits for Mental Health benefits, just kidding...partially. Let me start be saying two things; 1) I am guessing that your employer is not a mega-size, and 2) I am a strong component of self-funding. Hard to imagine why any employer would want to self-fund this benefit. It is cheap, budgetable and easy to obtain. If you were to self-fund you would need to find a way to fund benefits immediatly should something happen and a few claims come in unexpectedly. But to answer your question more directly, you would need a few things; 1) actuarial assumptions/costs, 2) documents, 3) administration services, 4) probably a IRS determination, but ask an attorney, and 5) adoption within your organization/HR/Board. This is the best I can think of. Good luck.

This is interesting and I would like to ask a few questions. 1. is the life benefit self-funded or insured? 2. what other benefits would you put in a captive? 3. are you talking about creating a captive (inexpensive) or renting a cell? thanks.

Correct, but under the Elgibility Test heading, it lists 3 requirements to pass the eligibility test. On page 2, #3 says the same benefits in the same amounts must be offered to NHCEs and HCEs? Well it looks like I stand corrected. I was always under the assumption that as long as all were offered, there was no problem. Thanks for the help.

I don't know, maybe I am missing something. I am under the impression that if the ER allows all of the employees to participate in the POP plan, than the in fact have passed the eligibility test. Is there something different? I read the link that was provided and that document says the same thing.

You now know that I do not have great reading skills, so are you now testing my counting skills to see if I can find #4? LOL I did count twice just to make sure. Eligibility testing for the POP is the only test that needs to be satisfied. I just read your link, which by the way is one of the better written descriptions I have seen, and it confirms my position. Scroll down to the end of page 3 POP plans. It states that the POP only needs to pass the eligibilty test. Then scroll back up to Eligibility, where it states that the easiest way to make the plan pass this test is "to make all employees eligible." As I mentioned in my last post, I am assuming that this the POP is made available to all employees. If it is not, then there is a problem and I would agree with you.

I too read the question posted incorrectly. I did answered this from the perspective of a full blown 125. For a POP only (god, I am hoping I read this correctly this time or this will be really embarassing) the only test you need to satisfy is the eligibility. The eligibility testing essential says that the employer is making the plan available to enough of the non HCE's. If the POP is available to all employees, which it sounds like it is, then it passes the eligibility test.

Difficult to say without more information. All you have given us is the contribution amounts per unit. What is needed is an explanation of the total premium generated for each category along with the size of each group. For example, if you had 10 HCE's and 3 NHCE's in your group, good chance it will fail. If however you had 10 HCE's and 200 NHCE's there is a good chance it will not fail. Also, keep in mind you are testing for eligibility and contributions/benefits.

As with any law/regulation, the devil is in the details and interpretation/implementation. The Healthcare Reform legislation did not do away with these plans. The most obivous impact is; 1) the loss of OTC drugs as a qualified expense, 2) increase of non-qualified withdrawls penalty from 10% to 20%, and 3) loss of hardship withdrawl. What does concern me though is how HHS interprets and implements the provisions pertaining to actuarial value, MLR's, and essential benefits. The actuarial value (60% of costs to cover claims) is the one that worries me the most. Hope this explains.

Hard to say. I did not find anything that discussed that issue. I would go along with dependent child first.

Absent anything at your state level, you should continue the traditional practice of 1rst birthday in the calendar year.

29 wonderful years for me. Wouldn't trade her for anyone else. Have a good weekend.

There is always hope, but it does not always translate into reality. When I was young I had hoped for a wife just like mom...great cook, made meals that my dad liked, did my laundry, ironed my sheets, let me use two towels in the shower, and so on. What do you think happened? LOL All joking aside, if the carrier did charge less premium, then the cobra rates would be different. As for the ability to impact their claims cost, it would depend on how the group's costs were determined (pooled or experience rating) and if the number of smokers were large enough to appreciably decrease their claims.

If silent, then it appears that it can be done.

It is allowable, but what does the plan docs say.