leevena

I hear you, but would strongly suggest you get professional opinion from cpa/attorney. If I understand your post your ex is paying for these expenses thru a tax favorable account first. Your reimbursement of her expenses does appear to be double-dipping.

Terrasan, if she is paying the bills and using a tax favorable account for those payments, it does appear that you have a problem. You cannot double-dip. It appears someone else is paying the expenses first, through the FSA, and then you are reimbursing them. Still believe you have a problem.

I am not an attorney nor accountant/cpa. I doubt very much that you can use your health savings account in this manner. Your funds can be used to pay for eligible health care expenses. If I understand your post, you are sending money to your ex-wife after she has already used a tax favorable account to pay for the eligible health care expenses. Your funds are not being used to pay for eligible expenses, they are being used to reimburse her. Did I understand your situation correctly?

Luke you are correct. For health ERISA address communication and discrimination for the most part. At the state levels, I cannot think of any state that regulates this issue either.

Luke, I do not believe there is any legal law/reg to point at for this. I have been in the employee benefit industry since ‘82 and have seen it in both ways. Looking at it now I should have added more to the answer. I do not believe plan documents address this issue, at least not that I ever remember. My response earlier was to state it is can occur. As for this persons situation, I do not have sufficient information to comment. By use of example. Employee is hired 4/1, with a waiting period of 0 days, 26 pay periods, $50 per pay period employee contribution. The employer will not have a full employee contribution for the month of April, but makes it up in last month.

Yes

Sorry, but not my area of expertise.

Your reply is interesting. Can you help me understand how this issue relates to IRC 105? Thanks

Employees do not need to be seen by the rep, this is a tactic to increase their sales. The employers’ responsibility is to provide a yearly opportunity for eligible employees to make decisions about their coverages. This could be done with face-to-face meetings, group meetings, or by providing each eligible employee with the information. Whichever the employer chooses, I would suggest they have a method of documenting that the employee has received the information and has made a decision as to coverage.

I agree with Chaz. But on a separate note, have you fixed this issue to prevent it from occurring again? To some extent I understand the employee not catching this error, even though they should have received confirmation and materials. But who is tracking your enrollment and verifying the final enrollment? If she was not enrolled, what was the administrator doing with the extra money? Who is coordinating the monthly transactions for the employer and why did they not pick up on this? Not trying to be mean, but if this happens once, it could happen more. Good luck.

This is not the right venue for your issue, too many variables. If you have verified with provider that they were paid and that no other monies are due, count your blessings and move on until an issue arises. No need to worry yourself sick on a possibility.

Start with your Summary Plan Document (SPD), it will contain a significant amount of information. It is provided to you on a yearly basis.

When a company liquidates via bankruptcy there is no COBRA available.

I agree with most of what has been said by the other posts, but not the last sentence by Michelle. If the company is bankrupt, and if it did not segregate additional funds in a trust for the claims, it is more than likely that any employee who has claims unpaid will need to line-up in bankruptcy court with other creditors. Chance of receiving any funds could be very low and the amount due to the provider will still be owed.

I am sorry for your situation. Also, there a many variables in this scenario which are unknown and will not lead to an answer from me now. But it is possible that the provider was paid, so bear with me as I explain. An underwriter determines the amount of expected claims for the employer, let’s use $1,000,000 per year. Some employers may purchase Aggregate coverage ( a percentage of expected claims, 110%, 115% etc.) some may purchase Specific coverage ( a specific number, $25,000, $35,000, etc) to help lessen their risk. For this example, let’s assume the employer purchased an Aggregate of 110% and a Specific of $25,000. This means that the employer is responsible for $1,100,000 of claims ( expected claims $1,000,000 x 1.10). The $1,100,000 is the amount the employer needs to be ready to fund. The specific is $25,000, which means that the employer is financially responsible for only $25,000 of an individual claim. Since your husbands claim was incurred a few months ago, it is possible that the provider was paid, especially since the administrator paid it and the provider confirmed it. In this scenario it is possible for the employer claim account to have paid their share ($25,000) while the specific carrier paid the remaining. I AM NOT SAYING IT WAS PAID, JUST A GUESS ON HOW IT COULD HAVE. I would not put much credibility into HR response, many of these people mean well, but do not understand this issue. If this were me, I would verify with the provider what, if any balance is due to them.

HHS decided to not provide a definitive definition of essential health benefits. Therefore self funded plans can use a definition based off of the state they are in, or operate in. Since states have different benchmarks and definitions of what is essential it makes it possible for limits like this one.

Self funded plans are not subject to essential health benefits. Yes the plan sponsor can do this. Yes, emergency services are an essential health benefit.

I have done both, but do not know the answer to your question, sorry. But I do not know if I would agree with your statement that a level-Funded Plan is un-Funded. (Damn spell check). If anything, it is the opposite. Level funded requires the employer to fully fund the claim accounts, and at the end of the contract if any claim dollars remain, they are returned to employer. Did I misunderstand.

I disagree, sorry. If Mel B is sending out invoices to a number of employees and each of those employees can see the names of other participants, their coverages, costs, along with other information, I would be concerned. I agree with Chaz, they should seek guidance.

Assume you are asking me. I agree with your comments, but imagine a scenario where multiple employees/union members are starting to receive larger amounts of additional PTO, due to a medical reason. One could argue that it is a de facto short term disability plan. As I read this post I kept thinking about maternity coverage years ago, prior to 1978. Health insurance defined eligible expenses as something caused by an accident or illness. As a result, pregnancy was usually not covered because it was not an accident or illness. In 1978 the courts ruled maternity to be covered as any other illness. I bring this up as an example of another situation that most benefits people would have argued it would never happen.

Just when I thought I heard everything, lol. I am betting a large pepperoni pizza that it will be paid out to the estate.

Chaz brings up a very good point that made me think about it more. At first glance I would have said it is not an ERISA plan. Clearly PTO is not covered by ERISA, but disability plans are covered. For those who withdraw a minimal amount of hours, say 8-40 per year, I would not expect an issue. But what if someone withdraws a much larger number of hours, because a physician found the employee unable to perform their job? I can foresee someone interpreting it as a disability plan.

Loserson, are you in the benefits industry? Could you provide us with a quick overview of your experience?

Not an expert on PEO, I am a benefits person so bear with me. If the PEO has a single health plan than it is the plan sponsor and will file a single 5500 form. I have heard of, but have never seen, of a PEO that acts as a broker. In these situations each employer sponsored their own plan and would be responsible for their own separate 5500 form. A multiple employer plan is a situation where 2 or more employers maintain a plan. I doubt a PEO would offer this.

A PEO becomes the employer of record for tax purposes and would need to file the 5500 form.