GBurns

I am not suggesting that you ignore what is published in the Federal Register. Not everything, nor every part/line that is published in the Federal Register is part of the law or Regulations, some items are comments etc. This is the IRS view, in the simplest form that I know, See page 6 item (d): www.irs.gov/pub/irs-utl/ intro_to_cafeteria_plans_doc.pdf As it says, you can revoke (drop) a dependent from a Cafeteria Plan upon their Medicaid entitlement. It also quotes 1.125-4(e) which I have been trying to get across. This is consistent with the Consistency rules among other things. Medicaid in most states includes SCHIP.

A 1040 includes amounts shown on other documents such as W2, 1099, K1. None of these have any provision for "amounts of income and deductions allocated up to the date of his death ". Also I do not see where exemptions etc on a 1040 are prorated either. Whatever is for the year is used. A "final" 1040 is filed for a deceased person not a 1041. A 1041 is filed after on behalf of the estate of the deceased person after the 1040. So logically, whatever he is due is due, such as having earned the right to an allocation. This is no different than if he was a monthly paid salaried exempt employee who died late in the month, he is still due his month's salary, dead or not.

I don't know how you read but I just read the link that you gave to http://www.floridakidcare.com/partners/facts.html and it clearly tells me that in 1998 KidCare brought together a number of programs including Medicaid. As stated in the CMS link explaining Title XXI, this is 1 of 3 options that the state has, 2 includes combining with Medicaid and 1 as a separate program. Florida has a combined program So says the link that you gave. Both of the Florida KidCare programs, MediKids and Florida KidCare, clearly state their relationship to Medicaid: http://www.fdhc.state.fl.us/Medicaid/MediKids/index.shtml http://www.floridakidcare.org/ Re the 125 Regs, This is what the regs that you quoted from actually says: (5) Loss of coverage under other group health coverage. A cafeteria plan may permit an employee to make an election on a prospective basis to add coverage under a cafeteria plan for the employee, spouse, or dependent if the employee, spouse, or dependent loses coverage under any group health coverage sponsored by a governmental or educational institution, including the following-- (i) A State's children's health insurance program (SCHIP) under Title XXI of the Social Security Act; (ii) A medical care program of an Indian Tribal government (as defined in section 7701(a)(40)), the Indian Health Service, or a tribal organization (iii) A State health benefits risk pool; or (iv) A Foreign government group health plan. I suugest that you read the entire document. http://www.changeofstatus.com/resources/2001final.asp

Since sue1jeff so desperately feels the need to sue, that the obvious recourse to their insurance carrier did not arise, I suggested the other just as obvious thing, Sue Yourself!! It is amusing that an employer does not understand that they have the responsibility to supervise the work of all their employees. Why do they think that they get to be the Boss, make the rules and keep any profit? It is also amusing that people buy insurance coverage and do not know what the purpose was. Unless, they had no insurance. A TPA with no E&O or Fiduciary Liability coverage? A business with employees and no General Liability?

The relevant Treas Regs 1.125-4(e) very clearly explains the change allowed for Medicare and Medicaid entilement or enrollment: (e) Entitlement to Medicare or Medicaid. If an employee, spouse, or dependent who is enrolled in an accident or health plan of the employer becomes entitled to coverage (i.e., becomes enrolled) under Part A or Part B of Title XVIII of the Social Security Act (Medicare) (Public Law 89-97 (79 Stat. 291)) or Title XIX of the Social Security Act (Medicaid) (Public Law 89-97 (79 Stat. 343)), other than coverage consisting solely of benefits under section 1928 of the Social Security Act (the program for distribution of pediatric vaccines), a cafeteria plan may permit the employee to make a prospective election change to cancel or reduce coverage of that employee, spouse, or dependent under the accident or health plan. In addition, if an employee, spouse, or dependent who has been entitled to such coverage under Medicare or Medicaid loses eligibility for such coverage, the cafeteria plan may permit the employee to make a prospective election to commence or increase coverage of that employee, spouse, or dependent under the accident or health plan Which Treas Regs do you see as prohibiting the change? Which Social Security Regs? RE;"State Healthy Kids program (SCHIP) is NOT part of Medicare or Medicaid." Most, if not all, SCHIP programs ARE Medicaid related although funded by Title XXI. The states have only 3 options to use the SCHIP money from CMS, 2 of the options involve making it part of Medicaid and 1 allows a seperate plan. Very few states use a seperate plan. You can start your research here : http://www.cms.hhs.gov/schip/

Although I am not a lawyer, I would doubt very much that you could sue an ex-employee for work done while they were an employee. However, you might very well be able sue the employer of that employee. After all, isn't the principal responsible for the action of its agents? It might not be a practical solution but at least you get to sue. If you could sue the ex-employee, What would you hope to recover anyway? The most that you might recover would be your costs and losses associated with the client lawsuit, but that is covered by the insurance that you carry anyhow. Since you most likely cannot collect from both, there seems to be very little that could be recovered from the ex-employee, if you could sue. How about suing the General Liability and E&O (or Fiduciary Liability) carrier instead?

Would a Rabbi Trust be set up if there was no plan?

I think (hope) that this is just a matter of writing style. What are the limits on the death benefit? Is it the "core" amount that is limited or is it the "buy up"? Are these employees separated as a class? If so is length of service the only criteria?

It might be helpful to know the corporate entity structure of these businesses/companies.

I cannot see the relevance of the consistency rules to this situation. I suggest that you go to the Treas Regs themselves and see what they say so that you can understand and counter whatever is being told to you. http://www.changeofstatus.com/resources/regs.asp Pay particular attention to 1.125-4© 2)(iv) Dependent satisfies or ceases to satisfy eligibility requirements. Then check your Plan Document and SPD to see what the actual eligibility requirements are. There are many plans that state that if you are eligible for Medicare, Medicaid or any other coverage etc, you are no longer eligible for this plan. Also note 1.125-4(e) Entitlement to Medicare or Medicaid. Then ckeck the state plan for which this dependent has now become eligible. Many state programs are subs of Medicaid. While you are at the Treas Regs read the Consistency rules at 3) yourself and decide if they are applicable any at all.

The Union Agreement provisions if they were communicated to the members most likely would be regarded as supplemental to the SPD. If the UA and the SPD agree, I would say that the case law would lean towards the UA/SPD interpretation and override a conflicting Plan Document. The best course seems to be, as pax suggested, that the sponsor and union get together ASAP and come up with a compromise to resolve the differences.

RE: "If medicaid is being suggested for my cosmetic problems, I'm pretty sure they wouldn't cover something like that". "pretty sure" ? Why? Do you have some special expertise in processing Medicaid etc applicants? Why not let an expert who handles applications of this nature decide? RE: "cosmetic procedures" Your conditions are not necessarily cosmetic. Varicose veins are covered in many cases by many insurance plans, depending on the facts and circumstances of the particular case including scratching, burning, bleeding etc etc. Breast reduction of Big breasts which cause back pain etc would not be cosmetic. The determination should be made by someone expert in making such decisions. RE: "a school for electolysis". There are cosmetology schools who teach some minor aspects of electrolysis and there are medical schools who teach electrolysis for medical treatment purposes. There is a very big difference. What sort of school did you go to? RE:"I wasn't "standard" enough to make a good teaching subject. " I wasn't standard enough for baskeball so I played soccer. Not being standard for 1 thing has nothing to do with being standard for some other thing. Why not let them decide? I have come to the conclusion that you really do not want anything to be changed in your life. You will always have an excuse why something will not work. You need your problems so that you can use them to justify whatever you do.

That is why I posted: "It might be good to clarify your post: What is a "pretax means of reimbursing managers"? This suggests giving them back what they paid. A "pretax means for managers to pay the premiums themselves" is done through a section 125 Cafeteria Plan. Section 125 Cafeteria Plans have been around since before 1980 so I wonder if you mean something else? "

I do not think that this is the best Forum at which to seek advice, so maybe you should try additional sources. Try www.ahipubs.com I know that it is possible in some cases for her to prevail if it can be shown that the termination was related to an attempt to deny her benefits. I suggest that you search these Forums for prior discussions. What has her Bargaining Unit said? While she might not be a Unionmember she most likely belongs to a BU affiliated to a union and there should be a Collective Bargaining Agreement that should be applicable to her as a unit member. There also should be no problem if there is a CBU because usually the Union has to sign a Memorandum of Understanding as part of agreeing to this "outsourcing" and terminations involving BU members, both Union and non-Union. So, I suggest that you find out about the BU, any CBA and MoU, asap.

I think that the first thing that you have to do is to understand that which you now have. Then, decide what it is that you want and whether the changes, if any, are viable. For example, you stated "We are currently in the process of transitioning our 401k, Pension, and H&W benefits to new vendors " To me that means a change of service providers not a change in plan. Then, you later stated "I have limited experience with starting new plans from scratch". Which you explain will be modeled after "the parents companies existing plan ". What plan will you have the day after the spin off? If you are transitioning to new vendors, under which plan will they be providing services? The old parent company or the new company? If the new company, Shouldn't you already have a plan? If you transition the vendors, With whom will they have a contractual arrangement and for whom will they be providing services? If benefits are provided to the employees, How will the benefits be delivered on a non taxable basis without a Plan, PD, SPD Adoption Agreement etc etc that are effective before the incurring of expenses, liabilities or contributions etc? Your phrasing makes me think that it is your opinion that changing service providers is the same as starting a new plan. You also stated "my experience in the past has been with 3rd party vendors.." This makes me wonder what you regard as "3rd party vendors"? Aren't these service providers, that you are changing, 3rd party vendors? To me the whole scenario is a mess, but then again I might just be misreading or maybe you did not explain sufficiently. In any case what you posted needs review.

I think that the first thing that you have to do is to understand that which you now have. Then, decide what it is that you want and whether the changes, if any, are viable. For example, you stated "We are currently in the process of transitioning our 401k, Pension, and H&W benefits to new vendors " To me that means a change of service providers not a change in plan. Then, you later stated "I have limited experience with starting new plans from scratch". Which you explain will be modeled after "the parents companies existing plan ". What plan will you have the day after the spin off? If you are transitioning to new vendors, under which plan will they be providing services? The old parent company or the new company? If the new company, Shouldn't you already have a plan? If you transition the vendors, With whom will they have a contractual arrangement and for whom will they be providing services? If benefits are provided to the employees, How will the benefits be delivered on a non taxable basis without a Plan, PD, SPD Adoption Agreement etc etc that are effective before the incurring of expenses? Your phrasing makes me think that it is your opinion that changing service providers is the same as starting a new plan. You also stated "my experience in the past has been with 3rd party vendors.." This makes me wonder what you regard as "3rd party vendors"? Aren't these service providers, that you are changing, not 3rd party vendors? To me the whole scenario is a mess, but then again I might just be misreading or maybe you did not explain sufficiently. In any case what you posted needs review.

You forgot to give a link and an acronym. Who is "we"?

Aren't long term unemployed people eligible for medicaid etc? What programs do the potential providers have for unemployed people? Is there a teaching hospital in the area? Many have programs for just this type of situation. If you let them try so that they can teach, they do it free. What is available from the local public hospital district?

vebaguru, "Of course the employer will invoice the employee for 102% of the $2,000." Invoice the employee for the employer's HRA contribution?

I suggest that you read the EBIA manual again. I wonder where you could have found anything that would suggest such a thing? The issue of reimbursing premiums that were paid pre-tax has been the subject of numerous articles since August 1999 ECFC Annual Conference. Do a Google search on ""Double Dipping" health plan" and "Double dipping IRS" then do a search on whatever names you then get. The IRS also addressed this issue in Revenue Ruling 2002-3 and 2002-80. Also do a Google search. It might be good to clarify your post: What is a "pretax means of reimbursing managers"? This suggests giving them back what they paid. A "pretax means for managers to pay the premiums themselves" is done through a section 125 Cafeteria Plan. Section 125 Cafeteria Plans have been around since before 1980 so I wonder if you mean something else?

The only certification that I have ever heard of a being given out is for MEWAs. which really is the acceptance of the filing of the M-1 form. I have never heard of the DoL certifying anything else. I suggest that you ask him what he means and in what form he has ever seen this "approval" etc. Maybe all he needs is something showing that F 5500s have been filed. I do not know of any receipt of filing or acceptance of filing that might be available from the DoL.

Who me? Lash? Never!! Lashings should be reserved for those who repeatedly and knowingly give bad advice, incorrect or irrelevant cites and misquotes. Differences in interpretation, opinion and reference sources, make for good discussion. Writing style is not an issue, it is just something to live with. AndyH, I found nothing harsh in any of your comments.

DBtech, Would you also clarify whether this was a Quarterly required installment or it was funding for the plan year under a filing extension.

My calculations show that the date will be

I visited the website, but found nothing other than 2 listings of the word "ISOP". Maybe it was too late at night etc, but I found No info, no description, nada, zip. Did anyone find out anything?