leevena

You maybe correct, but it depends on your employees and their expectations. My usual suggestion is for the employer to notifiy employees of the document on the intranet and let them decide for themselves if they want a copy, some will not want to get one. In your notification you may decide "NOT" to offer a paper copy, which will cut down on the number of ee's requesting a copy just for the heck of it.

I understand this question to be "the employer is not forwarding premiums for 120 days after due date", is that correct? If so, I have seen situations like this in the past, where larger companies needed longer time frames to process their payments...or so they say. We at the health plan had to make a buisness decision about this practice. It usually had to do with the size of the account and the amount of revenue/profit the group was contributing. In these situations we would adjust our policy towards these groups. We never had more than 2-3 ever at any time. Hope this helps.

You are not speaking out of turn, but thanks. Maybe I was not clear about it in my response, but I asked him/her to check the plan documents.

There are two issues here, one is the ability to disenroll from the health plan, the second is disenrolling from the Section 125 plan. Remember, these are two different plans. The health plan provides the coverage, while the 125 plan is nothing more than the vehicle by which an employee pays for the coverage. The health plan usually does not care if someone is dropping their coverage. However, the IRS regs for 125 plan has specific guidelines that allow participants election changes mid-year for specific events occur, such as marriage, divorce, birth/adoption, death of dep, change in cost/coverage of health insurance, change in spouse employment, change in residence, etc. Additionally, these are guidelines, the employer 125 plan document is the place for you to look for the actual answer. It does not appear that this situation meets the IRS regs for change. So the result appears to be that the employee can drop the coverage from the health plan, but still needs to have the deductions continue until the next open enrollment period. And by the way, this is nothing new. Admittedly, most people don't realize it when the enroll.

I don't know enough about the type of plan you have, so I will make some general statements for you. 1. Your comment about "we will get hammered with a single high claim" makes me believe that your plan is experience rated, to some degree. I would ask the carrier what credibility factor they will be using and at what point do the large claim write-offs begin. At 115 lives, I do not believe that the credibility factor will be high, you may only be at 25-50% credibility. Both of these would act as a hedge against the large claim impacting your experience rating. 2. The cost difference between unlimited and a fixed amount ($2 or 5 million) should be very small, say 1-2% savings. This is because very few people (statistically) will ever reach 2, let alone 5 million. 3. To go from "unlimited " to some specific dollar amount appeals to me, but what is your company philosophy towards the employee? If you are a "maternal" type, a "unlimited" amount offers a level of comfort and safety. If you have another, such as the 2 or 5, you will get some people who will question it. No matter how logical you present the idea that the chance of them reaching it is very slim, some will still be concerned. 4. At your size, the carrier may have pre-packaged plans that leave little to customization. Ask the carrier first if they have different levels. Hope this helps.

You can fund the hsa this way if you want. As for whether you should do it that way, it depends. The issue I see is how couples view their finances. Some couples split their finances, maintaning seperate accounts, expenses, etc., while others don't. If you and your spouse are comfortable with the larger sums going into your account, go ahead and do it.

Thanks to the both of you for your replies, I appreciate your thoughts. JSimmons, sorry I never got a chance to stop by your office, this all happened so quick. My mother in law was diagnosed and died 4 weeks later. My wife left immediatly when diagnosed, and I stayed behind to finish up work and sell the house. You are right about checking last year, but we were assured that the advisor was doing a good job. Take care.

Check out this website, it should be very helpful to you. http://www.cms.hhs.gov/healthinsreformforc...thparityact.asp

My background has been life/health and would like some guidance on a general quesiton regarding retirment. It involves a relative who is now incapable of making decisions and needs 24 hour care. My wife and I have relocated from west coast to east coast to care for him, living in his home. Another sibling has power of attorny. Background is a 80 year old male, widowed, health is somewhat fragile (but no immediate threat to death), has $130k for investments, a house worth about $180k (paid off), SS income of $1,100 per month, and life insurance of $32k. We do not the exact amount, but the $130k was substantially higher prior to the market crash. We do not know what types of investments were involved. Current cash needs are about $2,000 per month, but could go down somewhat as we get a better understanding of his expenses and can trim some of them. Our guess is that the expenses could go down a few hundred per month, but no real figures yet. Our concern is that the cash be preserved. We are looking for professional help from financial planners as what to do. My question concerns the allocation mix that we are beginning to hear from these planners. Is there a certain type of mix we should be aiming for? One in particular proposed a mix of 25% cash, 30% fixed, and 45% equities. I was a little shocked to hear the mix contained equities at 45%. Any thoughts or ideas would be greatly appreciated.

what the?...Let me take the three issues seperate. 1. the standard disclaimer that "this is not a guarantee of benefits and only speaks to medical necessity", is essentially saying that the expense is covered, based on what they know at that time, because things can change, such as if you are still an enrolled in the plan. For example, if they ok the procedure on 12/1/08 and you disenroll on 12/31/08, and then have the procedure on 1/5/09, the expense would not be covered. The language is scary, but standard. 2. As for the difference between CIGNA and the fund office seems to be a different issue. I have not seen any of the documents/contracts etc between your employer and the vendors, so my answer is somewhat hedged. In a self-funded arrangement, the employer/fund etc., makes all the calls about what is covered, how it is covered, etc. It may be that the fund is beginning to think about changing how they view this type of procedure. If so, it would not be unusual for the precert folks to not know about this. They would be advised once the fund office makes a decision. 3. You comment about ERISA "It is my understanding that with ERISA they have to uniformly decide claims and can't apply a different decisions to the same claim without it being discrimination, so it seems that either they would have to retract all of them in order to deny me or if they leave the other claims stand then I would have to be approved." is basically correct. But the key with any of these types of procedures is the facts about each case, not the claim. There may be 5 people with a claim for gastric bypass, but it is possible that only 1 meets the standards for medical necessity. Hope this helps.

I cannot comment on the issue of the fund going back and reversing decisions, sorry. Also, under a self-funded plan, the employer has the ability to operate the plan as they see fit. Don't believe that ERISA would be of any help here either. You state in your question that "I followed all of the precertification requirements to get medical necessity determination" but, did you receive a written precertification for your procedure? This is very important. If you have gone through all of the precert process and was given a written precert, you should be ok.

I have a warning, and it's for you, if you don't mind. In my 25+ years in this business I have seen many things, but this one does seem to take the cake. This client seems to be blaming everyone but herself. 1. She and her husband run a small business, yet she claims to know nothing about the plan? She is both the co-owner and a participant, at some level she should have been made aware of the details. 2. A fire destroyed all the records? There are no copies anywhere, such as accountant, last tpa, etc.? 3. While I realize people/companies can make mistakes, I find it difficult to believe that Paycheck's is at fault here (I have no connection to them). I am not recommending that you abandon this client, but I would be very careful. Good luck.

Check out the DOL website, here is a link. http://www.dol.gov/dol/topic/health-plans/cobra.htm From what you have written, it sounds like there is no cobra available. As for notice, you should check with your state regs for loss of coverage notice requirements.

You are partially correct. A self-employed person can have a HSA, but cannot have "pre-tax employer contributions". You can take an above the line deduction for your HSA contributions and premiums that you pay. As for whether this is a good plan for you, it depends on your situation, both medically and financially. If you a relatively healthy, with the income to cover the higher deductible, and if you stay that way for a few years, you can find yourself with a sizeable hsa fund account. This will allow you to purchase an even higher deductible, and in the process, reduce your premium costs.

I would not be too concerned. To begin with, I doubt if anyone would want to answer your question without detailed, verifiable and 100% understanding of the type of coverage you are questioning. Secondly, many of these plans have been marketed as a companion to HSA's. I have been selling them like this for some years now. Good luck.

It is not the expenses that are an issue, it is the type of insurance contract that is the issue. Your comment in the last post (One big thing I would like to know is if outpatient surgery services are HSA compliant.) is irerelevant. The question is what type of contract is covering the expense. If it is a hospital indemnity, you are ok. If it is a group plan, it is not. Hope this helps.

Another suggestion that might be of help is to get a vendor who will provide you witht this service for free, or little cost. For example, a carrier or a local broker might be a source for these sources with little to no cost. I would try Colonial Life. Here is California they provide some of these services in return for the employer offering payroll deduction products.

Without seeing the actual plan or contract, I need to be careful, but hospital indemnity plans that you mention are allowed. The key to these type plans are that they are identified as a "limited-pay" program. Hope this helps.

I do not believe there is such a list that you could rely on. You can be covered by a HSA and also have a spefic disease/illness or an hospital indemnity plan. In fact, many employers who offer HSA's will also offer one of these plans as a way to fill in some of the gaps.

Employer contributions to an HSA are allowed. See : http://www.treasury.gov/offices/public-aff...-english-07.pdf I guess I'm confused- page 1 of attached pdf from treasury indicates employer money can go into the HSA as well Yes, employer contributions are definitely allowed. There is another document on that site,"All About HSA's", that also discussses employer contributions Sorry for the confusion, this is my fault. Yes, the employer can contribute. I had a brain freeze when responding earlier.

Employer cannot contribute directly into a HSA, only EE money can go directly. Once money is in the HSA, only the employee can use it. Are you sure that the product is an HSA and not a HRA?

You stated that the HSA was for 2007 and that he/she is withdrawing HSA dollars for 2008 incurred claims---this is not allowed. They can withdraw for expenses incurred in 2007 only. Otherwise, the dollars stay frozen.

GMK, thanks for the reply. I did not read the question very closely. I never saw the second reference to Family, only the first paragraph about a LOA.

If your employee was enrolled in your plan, then you must offer COBRA. Your question stated that you collected part of the premium, but does not state if the ee was enrolled.