GBurns

Because the original post uses terms such as "starts up another business" and wants to make "the old business a participating employer", I read this to mean that the poster is not considering any sort of termination of the initial plan, but instead is contemplating what seems to be a plan with 2 participating employers that are under common ownership with 2 different sets of participating employees. Is this what you meant pjb?

Are you sure that "Our Health plan is governed by the 125 rules " ? I have never seen such a Plan. If you are fully insured this would conflict with state insurance laws. Whether fully insured or self-insured, there is compliance with HIPAA, COBRA ,USEERA etc etc etc.

So therefore the employee did not miss his chance and should be allowed to elect coverage under the employer's plan.

Shouldn't the answer be No, since the question was "Did the employee miss their chance ..."?

JerseyGirl, I suggest that you reread ALL the posts, neither q8r or I advocated anything that you have suggested that we did. And a Congressman would not be relevant to anything said in any of the posts. Further, no one said anything that should suggest that the administrator of a Section 125 plan " ‘pay the hospital’ for anything". The context of the statements made by q8r and me related to the payment of claims in general.

Your WC Notice that is posted at your worksite and the injury notice should have a claims denial process. There usually is a response time stated for any denials and appeals. You might want to call the State division that regulates WC issues and find out how long the law gives for the insurance company to not respond and who to report the matter to. I get the feeling that they are letting you run out your claims time. I would also ckeck to see if the OSHA report was made and also follow up there. The Labor Board should have given you a better response but since I do not know how you explained it to them, I cannot comment except to advise that you call again and speak to someone who specializes in WC and someone who specializes in OSHA. Do not speak to telephone CSR people, speak to a specialist or investigator, and get names. I also suggest that you get and immediately file the complaint forms.

I suggest that you put together a collection of the more in-depth articles, both pro and con the various decisions (such as Xerox etc), and then decide what side of the fence you are on regarding the chances of successful appeals by IBM etc and after that you could rationalize with the client how and when to proceed. I personally suggest a "wait and see how it turns out" position.

A Google and FindLaw search will bring up more cases than you have listed. Also if you look at the opinion or briefs for the recent cases there should be cites from other cases.

Please clear this up for me, iWhat is it that is required to get the benefit, is it..... 1. 500 hours AND last day? 2. 500 hours OR last day? 3. 500 hours IF you have terminated? 4. Last day if you are still employed? 5. 500 hours if you are still employed?

Re: "The ‘great scrutiny and fear of improper reimbursement’ arises from the obligation of a TPA to keep the plan (and everyone in it) in compliance, and not any desire to keep the participant and his hard-earned money separated." That is exactly the point that both q8r and I are making. It does not "keep the plan (and everyone in it) in compliance" or correct an "operational violation" if you pay the hospital but will not pay for the same thing if it is from the participant. By the way, *OTC* is not a method of purchasing, it is a classification.

If you are in one of the major cities (with public transportation) there is a lot of help available from the Transportation Authority. Look at the DOT, the SE Pennsylvania, NJ, NYC and DC areas websites for some guidance. You can find them by using a Google search.

q8r, I agree whole heartedly. It always amuses me to see that claims are readily paid for exorbitantly over-priced items such as Ibuprofen and Bandaids etc when the bill is from a Hospital, but when an item comes from an employee trying to use up their own FSA money, all of a sudden there is such great scrutiny and fear of improper reimbursement.

Blinky the 3-eyed Fish, What is the relevance of the credentials of blaum8 or any other poster?? Are you saying that credentials determine competence, knowledge of the subject or intelligence? Or, are you saying that only persons with certain credentials are allowed to have and freely express their opinions? What have been the IRS or other court positions? Are you also questioning the credentials of the various IRS and Treasury Dept persons who have expressed opinions?

Brenda N. What answers have the various card providers given to you on this issue? SLuskin, What are the 1099 issues? (This is not a dumb question, I have some follow-up to your/or other posters' response that should lead to a discusion)

I would expect that a non-contributory plan (by the employee) would have participation as a mandatory condition of employment for a number of reasons, ease of administration being one. However, if the employee is contributing there must be an opt-out provision, which even if there was not, and the employee elected $0 as contribution it would have the same effect.

It seems to me that there are an awful lot of theories about how or how not to invest, What bothers me is that none of these authors or "gurus" seem to have made any reasonable money whether from their own "advice" or from any other "technique". The money seems to be made from the book sales and speaking engagements instead. All I ask of all these people is "Show me the Money" that they or anyone else made following the advice. As for Dollar Cost averaging, I first asked in my Series 7 licensing course back in 1986 for actual factual examples that would show that it really would work, but after all these years I have never seen or heard of anyone who had real life examples. All I want is that they spend the money on an actual stock selection over the period. Like all the other theories there seem to be no real life examples.

Almost all non-federal governmental entities have such a structure with non-union employees still part of the collective bargaining process. For example, many school districts have clerks and administrators etc who are not union represented. The clerks are usually "lumped" with the instructional staff, paraprofessionals are put with the non-instructionals (usually AFSCME) and the proncipals and administrators have a non-union "Committee".

As JerseyGirl said .. "Absolutely not!"!! What has this FSA vendor given you as support for their interpretation? I just saw a prospective client who had been told the same thing down here in Florida, but it turns out that the vendor was not really selling FSA services but a scheme using medical expenses that looks like an FSA but really is the "famous" Double dipping arrangement that the IRS addressed in Rev Rul 2002-3 and 2002-80.

The disclosure should be as stated in the policy and as governed by State insurance law. I would leave it up to the insurance company to decide if they want to make any disclosure.

Can you give any cites for this opinion that ERISA preempts state payroll laws? Why would any state payroll law apply or relate to any benefit plan? State and federal payroll laws apply to payroll and what happens on the payroll. The deduction from an employee is a payroll issue not a benefits issue. Try making deductions that reduce the employee below minimum wage and see what applies. Try withholding without the employee's permisssion and see who takes the action against the employer.

Although I have not seen many freezes, I have never seen one that was noticed via a CBA. In fact I have never seen any plan of any sort that noticed anything via a CBA. The CBA usually has a time frame that would not work. A freeze or change quite often is accepted by the Union through a Memorandum of Understanding so as not to have to go back to the formal bargaining table etc. and then reprint the CBA In any case I cannot see the CBA as being the proper medium since it is not from the Plan or Plan Sponsor.

Karin, I think someone has this situation backwards. If any consultant or anyone looks at the plan or procedures etc that any client currently has in place, there are only two relevant conclusions that can or should be drawn, the client has a reason why the plan or procedure is in place or the client does not. If the consultant etc thinks that the plan or procedure that the client has in place is not proper, then the onus is on that consultant etc to point out why they think that the plan or procedure is not proper. If he/she thinks that there cannot be 2 OEs per year let them state why.

Yes, the validity of the Regs will and should be questioned, but then again there are claims, quotes and/or interpretations in the Koresko letter that I question for accuracy and or relevance. The writing of a letter claiming invalidity etc does not make it so. IMHO, the purpose of the IRS action is to stop the abusive schemes. What is abusive will be decided in Court not in Forums or by attorney's opinions. The fact is that there are abusive schemes, some have deduction questions some have questions regarding the "insurance" that is involved. Are all 419 Plans "good"? Are all 419 Plans "bad"? The answer to both is obviously no, which means that the questions should be resolved in Court. All the IRS is doing is setting the stage as best they can for the expected Court actions. The use of so called "propaganda" is no different from the use of sales material complete with allegedly "supporting" legal opinion letters. It just levels the playing field. To criticise the IRS actions as "propoganda" makes me wonder if "Methinks thou dost protest too much" is in order.

jstorch, I read your post to mean that there is no separate SPD just 1 document that serves both purposes. Is that correct?

I wonder if any of my Advanced Market friends and the advisors who facilitated these abusive plan designs think that their E&O will cover much other than Defense costs to a restricted extent?