leevena

Doubt if this can be done, if I understand the process as explained by Lori. Money for qualified expenses can be paid for via the HSA. But in this example, if the employee fails, the money paid from the HSA to the employer has already been spent, and on a non-qualified expense. If the employee "wins", the money paid is now refunded, and never spent on a qualifed expense.

I'am confused. Entry fee is charged and then returned if goals met. How is this related to the HSA? HSA money belongs to the insured, not the company.

The IRS is very clear on what is, and what is not eligible, for reimbursement via the HSA plan. These are available to you in Publication 502 at the IRS. If MDVIP does provide you with a global billing, it would be very difficult for you to prove to the IRS that the expense was eligible. If however, you do recieve an itemized billing, and that billing shows eligible expenses, then that part of the bill would be eligible. As a test, why don't you submit the bill to the carrier, or the HSA administrator (if you have one) and see what they send back. Remember, the HSA is a personal issue between the individual and the IRS.

No idea, but either read your plan documents or call your carrier. It makes no difference if your AM is out, someone there should be able to look up your plan information.

Check under "Health Plans in General, Including COBRA and HIPAA" for a similar question and answers. As for the appropriate differential, you may want to ask an actuary.

My background is health benefits, not retirement, but I do believe that the PGA Tour retirement plan is a deferred comp plan with some bonuses kicked in for certain goals that the players must meet. As for the jockey plan, they would like to structure it as a $15,000 yearly contribution to spend on a variety of plans (retirement, medical, life, dental, etc.). The medical is where I see the problem. It will be very difficult to find a carrier willing to cover such a small number of lives in such a "group".

Chaz...can you be more specific about which parts of ADA and HIPAA you are referring to?

Rules for the association are set at the state level. The key to an association is usually the definition of who can join and what size they must be. Don't know if the old plan was a veba, but my guess is no. As I suggested earlier, try working backwards with your group carrier reps, they may be able to point you in the right direction.

I would stay away from this type of rating. There are a couple of issues that arise, including; 1) how do you determine the additional amount to be charged for the smoker, 2) how do you define a "smoker", i.e., they quit, then smoke again, quit, etc., 3) how do you find out which of your employees are smokers, and 4) how do you determine the dependents that smoke. Additionally, how do you handle the fall-out from this? You will start to see a schism in the employee group, with some hard feelings developing. From this you will surely see calls for surcharges on other activities that contribute to health care costs, for example, overweight people, people who engage in risky behavior, people who don't take good physicial care of themselves, etc. This could become a hugh nightmare for you. This surcharge concept is good in the individiual policy world, but very difficult in the group.

There are a couple of options available to you, but I am not sure that they may fit perfectly what you are trying to do. I agree with the suggestion to research other race tracks for possible other models from which to work from. Depending on your state, an association plan may or may not work. My initial reaction is that since this is a single site group of jockey's, you may not have enough to qualify as an association. Another option would be to find an association, with benefits, that they may be eligible to join. I would work with the local carriers in the area and see if they have any leads. Keep in mind though, that your regular "group rep" may not be fully aware of what other types of plans are available, even from their own company. For example, I am in San Diego, and very few of the street "group reps" know that their carriers cover prevailing wage groups with special plans. Another option to explore is if the casino health plan could abosrb them. Even though they are not employees of the casino, similar situations exist. For example, often times companies will extend benefits to their BOD or towns that extend coverage to their very part-time council people. You will need to explore this with the casino and their carrier or plan administrator.

Again, I am not familiar with your state and it's laws, but I doubt very very much that carriers are required to provide individual coverage. Same suggestion, go to state or your broker. Hope this answers your question.

I am not familiar with each state and their laws, but, since you dropped to 1 life, you no longer have a group. Most states recognize a group as 2 or more. You should check with your broker, or go directly to the state department responsible for this and find out. You might be able to go back to the carrier and see if they will keep the group if you meet the minimum enrollment, which may be all four for you group. Good luck

An employee can drop their coverage ( I am assuming you mean health insurance ) anytime they would like. Even if their employer offers free health insurance, they can still decline to enroll. Or, are you asking about a 125 plan and it's requirements? Am I missing something in this question? Your last line asks "Can employee A drop her current coverage or does she have to continue to maintain coverage for herself with C and B going on to B's insurance. Thanks!

It seems like your question is still about the money the person wants, so my suggestion would be to pay it and get it over with.

Your post was a little long and confusing, so let me make sure that I understand the facts. The employee (cobra) was covered under the plan terminating on 5/31. The cobra participant paid the May premium. The PEO sent them a form enrolling them for 5/1. Why did the PEO enroll the person for 5/1 when the old carrier was covering them till 5/31? As to whether the carrier can decline to refund the money...who cares (my opinion)? My recommendation is for the company and/or PEO to pay the cobra participant the amount and make sure that the new plan has accepted them. All things considered, this is a small price to pay to avoid some headaches.

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. Oops, I stand corrected. You are correct Oriecat, I forgot about the ability for some employees to purchase cal-cobra on their own.

This is not exactly true. The law does apply to employers. The employer is responsible for administering the cal-cobra premiums, or must find an administrator. Payment from the cal-cobra participant is paid to the administrator and then to the carrier.

Cal-Cobra applies to all groups that are not subject to the Fed Cobra laws, meaning groups under 20 employees. Since Google has well over 20, and probably self-funded, they are not subject to the law. You are not eligible.

No, it does not violate ERISA. What the plan should be do is tell you what specific expenses would be covered, without referring to your particular situation. Let me give you an example. If you call and ask if a certain expense is an eligible expense, the plan administrator can look at the spd and determine yes or no. Let's assume that the expense is an eligible expense. Now you say to them, "I am having that expense incurred, is it covered? They can answer "we cannot tell you if it is covered until after" and still be within the law. The reason is they have no way of knowing if it meets other requirements, such as necessity, appropriate provider, etc. I know it sounds strange, but it is a legitimate answer to give.

Actually, most plans will answer the same way, (We can't tell you if it will be covered until afterwards."), or at least they should. They are being cautious because they do not want to get into a "he said, she said" situation with members. The focus is on "necessary" expense. The best thing to do is read your plan documents and see if root canal is a covered expense. Forget about the ERISA issue, it is not the point with their response.

MERPs, or Medical Reimbursement Plans have been around for decades, and are commonly referred to as Section 105 plans. They are nothing more than a high deductible (say $1500) and the employer gives back some of the savings to help the employee (say $500). Variations include HSA and Health Reimbursement Arrangement plans. I would check with the various carriers in your state to find out if they have a high deductible plan available. After that, you will need help with administration, contract, etc. for the side funds. Good luck.

Your plan document should address this issue. Most plans allow for coverage through the end of the month, but a few don't.

You are essentially correct. One word of caution, regarding the family deductible. There are two different types of deductibles for non-singles. Using your example, under the first deductible option the family deductible must be met before any expenses are paid at 100%. That includes expenses for one person. Under the second option, this is not required. Let me use an example. You and your wife are covered. You incur a $10,000 expense. Under the first deductible option you will pay $3,000 (becuase you need to satisfy the family deductible). Under the second option your OOP is $1,500. As for the second part of your question, that being the reduction in cost, it does seem possible. I am in CA, and BS of CA tells us that the average CA runs up $500 per year in medical expenses. So a reduction of 40% does not seem to far out of possibility. I have seen many proposals such as yours.

I find myself agreeing with the comments that your posting was inappropriate. While you may not get paid from the other forum, it appears that the forum is part of your business. Your website does invite brokers to purchase your services. So it seems like you may be prospecting for business on this forum.

Yes, assuming they still meet the requirements of your plan, you must add them back.