leevena

There is no federal law, state law, or IRS reg., that mandates employee meetings on company time. The only situation I can even think of is in a barganing agreement. LRDG, I do not mean any disrespect, but you are wrong with your comment "it wouldn't be inapporpriate for the broker to refer to 'IRS rules'." Yes it would be. IRS does not require company time. As other responses have stated, employees need to be given information, support, etc., but never required at company expense.

Waid, I need some clarification. I am assuming that your insured plan was costing somewhere around $2000 per month (employee only cost). If that is so, and your employer is going to deposit that amount per month, or $24,000 per year. That means that all of the participants have a total of $24,000 per year to cover themselves with. You do not have insurance. I would even go as far as to say that this is not a self-funded plan because the amount of coverage would be so minimal. Can he do this plan design (and I say design with a tongue in my cheek)? Yes. Can he self administer the claims? Yes, but he would be a fool. I doubt if he has any idea about claims adjudication or privacy rules. Let me give you an example, one of your fellow employee turns in a claim for a sexually transmitted disease. Do you really believe it will stay confidential? TPA would cost money, and he has already shown he is cheap. Let's assume that your employer is fed up and is only willing to spend the current premium amounts. My suggestion would be to find a high deductible plan and ask the employer to apply the money to that plan. At least you will have catestrophic coverage. In addition, I would bring in voluntary plans, such as Aflac or Colonial, to help employees. And lastly, and I hate to sound harsh, if my assumption above is correct, you may want to go find another job or get coverage from a spouse if you can. Good luck.

JDuns...you are correct. There are no accurate descriptions/explanations of preventitve prescription drugs as of yet. Don't know when a clarification will occur. I am guessing that groups/adminstrators/enrollees, etc will walk softly on this issue, but this is my own opinion. Some will use HSA funds for drugs correctly and others will not. As to the second part, about IRS finding plans in violation. I don't know. But I would tend to believe that if the participants were acting in good faith, the most they would get is a over-turn of their expenses. Again, just my opinion.

jmor99. Thanks for the reply, I was focusing on the administrator, not the card. The use of the limited debit card is ok, and does not interfer with the employee. Who knows, someone may challenge this legally in the future, but for now it is ok. Just because someone has a limited debit card, does not preclude them from spending those dollars illegally. There are situations where the card is not used (did not bring it with them, vendor may not have card processing capabilities, etc.) and the employee uses cash and submits a claim.

You are correct, but perhaps there may be some confusion about the wording being used in the marketplace. Yes, the HSA account holder is responsible for the funds and how they are distrbuted. Where I believe there may be some confusion is what services the adminstrators are using. The administrators that I have seen who offer "adjudication of claims" is not actually denying the claim, rather, they are just providing an opinion about the claim. Could this be what you are running into?

Could you please verify something for me? You said that the new rates will be composite, so will the family rate (employee+spouse+child or children) be one rate or mulitple rates depending on if the employee has more than one child. Hope this makes sense.

Since the request came from the 3rd party and not the employee, how would you know that the employee will receive it? Seems like you are risking something here. If they employee provided you with written direction to go ahead and send it to the 3rd party, that would be better.

I do not disagree with you b2kates, I was not even thinking about the request coming from the employee. The post said that the request came from a third party, without any indication that the ee ok'd it.

I would not do that under any circumstances. To begin with, how would you know that the intended receipient of the packet would actually receive it, or receive it in time? Stick with what the law wants you to do, which is to make every reasonable effort to provide the receipient with the actual packet. By the way, what was the reason that the 3rd party gave to you?

Don, you are certainly right on your observation. The govt, especially the fed, is pushing HSA's, but this is no different than when the pushed managed care model in '72 or so with the HMO act and in the late 40's when they helped benefits in general. Without the tax breaks, most benefits would have been much more difficult to implement. As for HSA's and HRA's, they represent a significant departure from the current plans available. And to a large extent, they mirror G. Bush's conservative view of accountability and responsibility. About the only thing a state could do to stop such a movement is to withhold tax deductability of the side funds. They could try to legislate that carriers could not offer larger deductible plans, but it is too late, most states, if not all, already have such plans. And beside, it would be almost impossible to stop a carrier from developing one.

Sounds like you might be a little confused. There is no law requiring HSA's. And you are correct, the states do regulate insurance. My guess is that you are confusing the offering of insurance products with the ability to take a tax deduction. States are left to their own as to how to tax HSA contributions for STATE INCOME. Some states allow for deductions, some don't. Is this what you are asking?

I agree wholeheartedly with Taylojeff, and what a great explanation. I do have 2 cautions for Benefitsguru67. The first is that there are many different ways to structure the plan, and many nuances that need to be understood and addressed. After agreeing to the basics, I jokingly refer to the next step as the "1 million question step", because of all the different issues that you need to understand. The second is the capability of the broker. I DO NOT MEAN TO DENEGRATE OR QUESTION YOUR BROKERS ABILITIES. Rather, you need to understand what you are getting into, and make sure the broker has a good understanding also. Min Prem plans became popular in the late 70's, but somewhat faded as Managed Care took hold. As I got into the business in the early 80's, we had to learn these type of plans (Alternative Funding) because of their popularity. Now that Alternative Funding is making some gains again, brokers are again selling them. I have seen many instances where the broker was unaware of the details and sold a plan incorrectly, leaving the client and employees upset. Good luck. Lee

My first reaction would be to ask if regular paper/us mail is still available. If not, I would be stunned. I have most of my bills (utility, phone, cable, etc.) sent to me via email alert. However, I have opted for that, it was not forced on me. I agree with your statement that not all employees have access to computers. Plus, think of all the other issues that surface, such as distrust of the internet, use of someone elses computer for confidential information, the frequency of which someone changes their email address, and more. If this TPA only offers web-based, I would leave them in a NY minute.

I don't see any problem with it as was described. Why don't you go one step further and have a place for members to share/advertise? Don't know exactly how, but it seems it might be of help. I have noticed that there are all types of members (attorney's, CPA, TPA's, producers, etc.) who might be interested.

I'd like to make a clarifying statement about Mary C's comment. The law does allow for fsa and hsa to be offered together, but only in 2 scenarios. The first is when you have a limited purpose fsa (dental, vision, and preventive services) and the second being a post deductible. Since you are just now offering an hsa, I would assume that your fsa is not a limited or post, so Mary C's comments are correct. As you go forward, you may want to consider revising your plan.

Hey Pax...don't you think were a little rough on Learning? Sounds like this person is relatively new, or less knowledgable about benefits and saw "SSI" in the title and thought it was Social Security.

While I agree with the comments from Papogi, I would like to caution you about this. To begin with, dropping group coverage will require your employees to purchase individual coverage plans, which more than likely will be more costly than the proposed $500 and may very well be underwritten, which could leave some without coverage. Is this really what you want to do? My guess is that the decision is being driven by cost considerations of the employer. I would hope that you have exhausted all of the group avenues available to you. It may take a little work on your/your broker's behalf, but there are all kinds of new products/strategies available that can decrease the employers cost, and maybe to a level that they are willing to keep the group plan. Good luck.

You are correct, it is not an eligible expense. If you need support documentation, provide them with a copy of your plan documents.

djodavis...I am not un-sympathetic to your cause. However, as I and the others have posted, it is very difficult to determine when the "end" of treatment has occured. Any kind of an open-ended or similar level of benefits would cause health insurance premiums to rise rather significantly. Being in the employee benefit field for 25 years, I can assure you that while the jmor examples may sound extreme, they are not unusual. As for an employer or carrier taking on a voluntary approach, it would cause adverse selection in the market, causing costs to increase. My suggestion would be to work through the state agency that is responsible for benefit levels. You may not get much headway, but that is the route you should take. Individual carriers or employers will not work for you.

I have another thought on this. Could there be a selfish reason why he/she would want to do this? Aside from all of the prior discussion about the true costs of doing this, why would he/she offer to cover the costs? Does he/she gain in any way from structuring the plan in this manner? I don't mean to offend this person, but it does sound a little strange. As a client, I would immediatly think that something is not right.

HI. Larry and Don. Thanks, we have thought of this also. The payout seems to be a little low, but we are not that concerned about it yet. It's just that I am suprised that a carrier would be allowed to do this. thanks.

Don't know if it is listed in the contract...thanks for the lead, I'll follow-up. No we have not contacted dept of insurance yet. Still trying to get a better perspective on this issue by asking for feedback. Thanks. Lee Vena

Hi. I did not want to name the carrier, it is a limited pay plan and most people will recognize the name. They are not withdrawing from the market. Rather, they believe that the insured will incur significant amount of claims over his life. They offered him $ to walk away now. If he does not receive it, the policy remains. My guess is that they will continue to drag their feet when it comes to claim payment time. He is uninsurable.

A friend of mine has a limited pay hospital plan (pays a $ benefit for each day as an inpatient). Long story short, he was offered a lump sum of $35,000 to turn in the contract. I have limited experiences with these types of plans, but was quite suprised. Does anyone have any comments about this? I find it unusual to say the least. Is it legal? Is it common? Thanks for any feedback.

Could you describe why the subsidy is being offered? For example, was the money made available to employees because of an income threshold? This may help us better understand the implications. There are health plans available in California that have money available for lower income employees. The question of discrimination is different under this type of situation.