Chaz

The proposed regulations on the employer shared responsibility clarify that employers must cover the dependents (i.e., children to age 26 but not spouses) of FT employees. But the penalties under both 4980H(a) and (b) only apply to the extent that the employer receives a Section 1411 Certification that a FT employee obtains a subsidy/credit for obtaining coverage on the Exchange. Despite the coverage mandate, it is still not clear to me that there is any penalty if an employer provides affordable coverage to all its FT employees but not to their dependents because no FT is eligible for coverage on the Exchange. What am I missing?

The DOL is most certainly stepping up its audit activities of health and welfare plans. I am working on one for a client right now. The DOL seems to be mainly concerned with complying with PPACA, but also with MHPAEA, HIPAA, and COBRA. The document request is generally ambiguously broad (as is usual with the DOL) but the DOL generally is looking for documents from 2010 going forward. I can't provide the letter my client received but below is a link to one posted on Jackson Lewis's website. It is generally the same (but not exactly) as the one my client received. http://www.jacksonlewis.com/media/pnc/2/media.2172.pdf

To my knowledge there is no longer any concept of "household" in the DCAP rules. (I think there was until Congress overhauled the DCTC.) A married couple filing jointly or an unmarried single parent can be reimbursed up to $5,000 per year. I believe that two unmarried individuals who live together and who each have their own child can get reimbursed $5,000 each.

Is this a Nasdaq- or NYSE-listed company?

I think the issue is whether the parent/employee has the ability to drop the (adult) child from the plan or whether the child has the independent right to enroll apart from the wishes of the parent/employee. I have not seen subsequent guidance since I posted my original question.

Hypothetical (real fact pattern changed to protect the innocent): Employee is awarded restricted stock units that time vest in 2010. Upon vesting, out of negligence/ignorance/etc., the employer does not deliver the shares to the employee nor does it withhold and remit the applicable taxes or report the award at all on the employee's Form W-2 for 2010. To correct this, does the employer just need to issue an amended Form W-2 and the employee just need to file an amended return for 2010 or is does this situation impose 409A penalties on the employee as well? I think a strong argument can be made that this does not implicate 409A at all and it can be analyzed under the traditional concept of "constructive receipt" but I am interested in other thoughts.

Report the total cost to the employer. The COBRA cost is a good proxy.

Is the release from prison of an employee's child a change in status event permitting the employee to add the child to medical plan coverage mid-year? I believe it is since, upon release, the child is losing coverage sponsored by a governmental entity (i.e., the medical care was provided by the prison authorities and presumably, but not definitively, the prison was government-run) but I wanted to see if anyone has had experience with this situation. UPDATE: See this thread, which my memory failed to tell me that I participated in: http://benefitslink.com/boards/index.php?showtopic=14493

We've had clients look into these types of arrangements. One of many implications is that terminated employees must be offered the opportunity to continue "coverage" for the clinics through COBRA. If the clinic is actually physically onsite, this could raise awkward issues in the event of a contentious termination. Depending on what state you are in, there may be licensing issues for the provider(s). You will definitely need to speak to counsel before proceeding.

I'm not sure if this is the same or related issue as above but posts are no longer marked as read after I read them. Also, "Mark All Posts" as read does not work for me at the bottom of the forum index. I CAN mark posts as read within each forum.

In general, claims must be paid monthly.

I'm asking about MediCAID, not MediCARE. Do you think the rules are the same?

An employer offers an opt-out payment to employees who opt-out of medical coverage and provide evidence of other coverage. Can the employer make the opt-out payment to an employee who opts out of coverage because he or she is enrolled in Medicaid?

Employer has a educational assistance program that generally meets the requirements of Code Section 127. The only possible issue is that, although all employees are eligible to participate, full-timers are eligible for reimbursement for up to $5,000 in expenses, while part-timers are only eligible for half that amount. Will this program fail the nondiscrimination tests because of this discrepancy? Or does the reference in the regulations to the 410(b)i)(B) tests only require that all employees be eligible regardless of the maximum benefit? Thanks!

I'm not sure. There are a bunch of these types of posts in these message boards. I can't figure out what they are trying to do. I can confirm that there's nothing in ERISA or the Code that sheds any light on it.

Spammer

P.S. I use it on my desktop (a Mac) and my laptop (a PC) and it performs similarly well.

Our firm uses it. As a user, I think it is great; much better than Citrix. I can't comment on its security.

My experience is that actual enforcement is inconsistent. It depends on the particular Medicare Intermediary(ies) and the facts of the particular case. Sorry I can't be more specific.

This is a complicated issue. You need to speak with counsel on this. You can start with 42 CFR 411.25 and HHS Notice 94-1978.

I believe andrearlov is a spammer or something like that.

The arrangement can be structured along those lines to be okay but this is definitely something that you should speak to counsel about before implementing.

The dental and vision benefits would not be ERISA benefits and thus would be exempt from the Form 5500 requirement if (i) the benefits are completely voluntary, (ii) there are no employer contributions, and (iii) the employer does not "endorse" the benefits. It appears that the first two requirements are met. The third requirement is extremely fact-specific and there is not a lot of DOL guidance on the topic. Employers are permitted to collect and remit premiums without losing the exemption but if participants pay the premiums on a pre-tax basis through a cafeteria plan, the conservative approach is to consider the benefits as ERISA benefits.

I can definitively say that HIPAA does NOT apply to this situation. HIPAA only applies to protected health information used or disclosed by covered entities.

As I mentioned earlier, the regulation requires that the benefits be the same. They are not the same. Hence my question. (My example is a hypothetical that I made up on the spot. For sake of discussion, let's assume that the HCIs have one more option than non-HCIs. Still no problem?)