leevena

Yes, medicare premiums can be paid with HSA dollars as can out-of-pocket expenses such as medicare deductibles, co-insurance, etc. HSA dollars cannot pay for gap policy though.

I am sorry. My posting was not clear and I apologize. I did not intend to my response to insinuate that you were looking for clients at this site. Rather, I was stating that a forum like this is good for short and quick answers, not a good vehicle for developing a plan. Sorry for any confusion I may have caused.

Your question about how to find business is the most important thing about opening a business. Finding clients can be done in a variety of ways, but cannot be done in this forum. You should get some thoughts and ideas from people, but I suggest doing an indepth analysis of your market. Often times a marketing and sales plan becomes very apparant. Pricing can become a moving target for you. As I mentioned above, your market analysis should give you a good overview of what the competition charges. This should be a good start for your pricing development. Often times a new company will discount their costs in an effort to get clients, which help to bring credibility to you. Good luck.

Assuming that your plan is subject to COBRA, your time period is 60 days. As for your second question, "What would happen if my original coverage were to lapse before I had filled out a COBRA application and to require treatment?", that is more difficult to answer. It depends on the dates between the loss of coverage and the expense date. The key is you have 60 days to get coverage, so my advice is to get it right away. This link should give you a complete overview of what you need to know. Good luck. http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html

Marcy...I am sorry, but I still do not know what type of plan you are referring to in your post. The establishment of a plan usually follows one of the IRS rules, but you do not make mention of which one. My best suggestion is to find the paperwork and read it, this should give us some help.

THORFABIO...I am curious about the enrollment form you used to enroll this woman. When you completed the form, what category did you check for her? Did you use spouse or some other?

What I meant by stealing has nothing to do with you paying. You were paying, whether it is one month or 20 years because you had an ineligible dependent on your plan. I have been in the benefits industry for 25 years and have never seen a health plan that allows an employee to add a dependent such as yours. I am sure that there is probably one or two out there, but they are rare.

THORFABIO...I can certainly understand your frustration and feelings about what you perceive as discrimination towards your particular status. As you may know, much of this extension of benefits to same sex partners has been driven by politics. What strikes me though is your tone and "WTF" attitude. As I see it, you have been stealing benefits for 20 years. What you did is illegal. Just my two cents.

Sorry for the ignorance, but what is an "internal benefit account?" You say it is pre-HSA/FSA, but could you be more specific as to how it was set-up and what it was for?

JD698...you may want to try this link to help you with some of your questions. Since the notice of termination date is so close to the change in carrier date, there may be some particulars that are unknown to us at this post. Try this link and see if it helps you. http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html

The amount being reduced through the 125 plan, not the employer contributions.

I suggest you go to the health plan contract and read it's provision. Usually they will not allow a change in enrollment because a physician left a network.

I am not an expert on this subject, but I do believe we need to know a few more pieces of information before someone can give you an opinion. FMLA is not an automatic benefit. And it does not apply to all employers and employees. 1. What was the declination reasons before? 2. Is your employer subject to FMLA? 3. Are you eligible for FMLA, as an employee have you met your hours?

Can you be a little more specific with your term "fees?" Do you mean consulting fees? Do you mean fees for other types of services? I am guessing you mean consulting, but cannot be sure.

John and Don. Thanks for the reply. It is strange that the IRS document I found did not allow for ex-employees. By the way, John, are you the John Simmons from Deland Fl?

Don: I could not find the document you cited above, but I did find a tax publication that does not allow former employees to participate. It allows for three categories: 1. A current common-law employee (see section 2 in Publication 15, (Circular E), for more information). 2. A full-time life insurance agent who is a current statutory employee. 3. A leased employee who has provided services to you on a substantially full-time basis for at least a year if the services are performed under your primary direction or control. As I mentioned in my reply, I am not 100% confident of my reply, so learning something new would be of help to me. The link is as follows: http://www.irs.gov/publications/p15b/ar02.html

I am uncomfortable with the scenario you explained, but that being said, I do not know enough of the specifics to comment confidently. To begin with, a Flexible Spending Account is not portable, and cannot be maintained for an ex-employee. Secondly, these plans are "payroll reduction plans", which indicate employement and compensation. So, if the employee is truly an "ex" employee, there is a problem. Your last comment about receiving severence pay equates to being an employee may or may not be true. Was the employee terminated and then paid for one year? If this is true, then they are clearly not an employee. Or is the employee doing some kind of work for the employer in exchange for the one year salary? If this is the situation, there may be some legitimacy to the claim that they are still an employee. My guess is that the employee was severed completely and is receiving a payout.

Your situation is not all that different from other groups that self-fund or partially self-fund. The process of developing a budget can be very difficult, especially for smaller sized groups where credibility is lower. You last posting stated that the employer is trying to make sure that they do not get caught having to pay more money than expected claims. This is a legitimate concern. Why don't you consider funding at a higher level of claim cost, maybe 90% of the maximum, or worst-case scenario, figure? You have developed a solution to the higher than expected cost and if the claims are lower, any extra funds can be reserved for the following plan year. A word of caution, and I do not know your situation, but your original posting lead me to believe that you are part of a decision making team at the employer. If this is the case, you should be able to get this type of advice from the person (broker, sales rep., etc) recommending this plan. If your employer is not already getting this type of advice from the sales person, I would be leary of the sales persons ability.

I cannot comment on the 401(k). As for the health plan, the usual answer is no, you cannot waive the waiting period. Check you plan documents for eligibility definition. What you can do for this person is pay the cost of his/her health insurance until they do become eligible.

COBRA applies to the health insurance plan, not to the HSA fund. The calculation for the cost of the COBRA coverage is still the "health insurance premium+allowable administrative cost." If the employer wants to fund some of that cost for the ex-participant, that is up to them. There will need to be administrative issues that need to be addressed, but the employer can do it.

I cannot answer all of your questions, but I can address a few. Yes, the employer could refund, but I would not suggest it. Think of the amount of work that would be needed to identify each employee, how much they contributed, finding ex-participants, and then issuing checks. Could the employer ask for the extra dollars if the costs exceeded expected, I do not know the legal answer. But from a practical standpoint, it would be very difficult to actually do this. Similar to the refund scenario above, think of the work needed to identify people, communicate, and more importantly collect the money, especially the ex-participants. And, do you really want a situation where employees are now being asked to pay additional dollars, after the fact, for what would be perceived as an employer mistake. My suggestion would be to change the employee contribution at the new plan year. For example, if the plan costs were low, decrease their contributions. If the costs were higher, increase their contributions. This also has pros and cons, but seems to be better than their plan. Good luck.

J Simmons is correct. This person does not qualify for COBRA. If you need something in writing, follow this link. http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html Good luck.

My responses have been tongue in cheek, for the most part. I can't believe someone would actually try to have the 125 plan cover something like this. But, as for the price, it depends on the type of plugs you buy. There are the cheap ones you buy, like for swimming, and then there are the custom ones that cost much more.

Still won't go. This is preventive.

Doubt very much if ear plugs would be covered for this situation. However, I do have a suggestion. Since a the 125 plan is giving him a tax deduction, why not deduct the cost of the ear plugs as a business expense? I am assuming that he gets paid as a band member.