GBurns

Since you do not know what the determination letter covers, How can you say " Plan has been in compliance. So all that has been in good shape." ? Again, exit (termination) options and startegies should be addressed in the Documents.

The K-1 from Bay Partnership should be in the name of the partner which you said is Mr John LLC and would use the Mr John LLC FEIN and not the SS# of Mr John. Why would you so easily be comfortable with the ASG issue? It might not be prudent to gloss over it too easily.

Whether legally required or not it would be the prudent thing to do. If you look back even as far back as Rev Ruling 61-146 you will see that the IRS usually would require verification of such coverage whether you are seeking a tax benefit for the amount or whether the process is related to a cafeteria plan choice between cash and a qualified benefit.

Good point. I stand corrected/amended.

The SPD cannot change a statutory requirement regarding the need for a qualifying event. So as MaryC points out, this employee needs an acceptable reason.

The deferrals should not "lose their status" but that is not what Blinky said. Why was a retest needed anyhow?

Is the determination letter for/to the MET or is for/to the Plan?

b2kates Would a determination letter have addressed the funding?

Isn't all of this covered in the PD and Trust documents? Exit and funding strategies should have been among the prime considerations when participation in the scheme was initially contemplated. What directions/opinions have the plan promoters presented? Does this help?: http://benefitslink.com/IRS/revproc2005-25.pdf

Isn't all of this covered in the PD and Trust documents? Exit and funding strategies should have been among the prime considerations when participation in the scheme was initially contemplated. What directions/opinions have the plan promoters presented? Does this help?: http://benefitslink.com/IRS/revproc2005-25.pdf

Permission or authorization would only be applicable to the "Privacy Notice" section and any personal information. Although you could get employee permission regarding the "Privacy" portion, electronic delivery would still have to meet the "Safeguard" requirements which as per the article, include making the disclosure at a location (computer terminal) where the employee is reasonably expected to perform his/her duties and where access to the electronic IS is an integral part of those duties. IMHO the actual Regs are more restrictive than the article. The OP stated that not all hourly even have a computer terminal, and it is questionable as to how many (or how few) would meet the "Safeguard" requirements even with a computer terminal. If you do a subset of the hourly and the only qualifier is acceptable access to a computer terminal, I would think that that could raise discrimination/class issues based on disparate/preferential treatment. It also creates another avenue for error.

As noted in the link given and in the Regs. since it is known that the hourly employees do not have access to a computer terminal etc, electronic delivery would not be an acceptable method since, for one thing, you cannot ensure receipt.

Maja. Where did you get the idea that NJ PERS has a 10 year requirement for vesting?

So that still leaves unanswered, the question of what can/should this alternate payee now do as recourse? I would think that the only recourse is to have an attorney pursue this as possibly a fraudulent transfer by the participant. The participant must have know of the QDRO. Is a writ of replevin to the participant, by the Court, a posibility in this case?

Government employers cannot establish a NEW 401(k) plan. There are many that were establsihed durimg the "window" back in the late 1980's.

The prosecution of HIPAA violations is done by the Federal goverment. In any case there would probably only be prosecution if there was some quantifiable harm. In this case, I have to ask, What harm was done to you? It seems there was no harm because you did not say that you were either denied the appointment or prevented from doing what you went there to do. If there was prosecution, I would think that your sisiter would also have to be prosecuted, but then that raises the question of how did she know of the methadone. If you told her and she made no agreement regarding confidentiality, then she would be free to tell your uncle, which would mean that you were the one at fault for making the information public, in the first place. Should you then seek to have yourself sued for defamation or prosecuted for a HIPAA privacy violation?

Why would the employees and the plans be transferred to the purchaser if this is an asset only sale rather than a stock sale?

The Thread seems to have gone off on a tangent. The original questions were: 1. "If carriers wanted to use 5 digit ZIP code ids for evaluating claims experience for marketing (getting bids from other carriers at renewal time) is that information subject to Privacy and Security?" 2. "If yes, I assume the Privacy/Security rules will apply to the health plan and also filter down to a broker. if involved." Re 1. Carriers do not get bids from other carriers at renewal time, in the first place. What can be used for marketing purposes by the possessor of claims information is set out in HIPAA. Re 2. The rules that apply to the health plan are not the same as those that apply to the insurance carrier. What filters down to a broker depends on which entity the broker represents under a Business Associate Agreement and the scope of the brokers involvement.

The zip code information is on the enrollment form, a copy of which is already held by most employers. The individual claims experience information is not held by the employer. The SHI used for developing quotations has no zip codes and does not need to be de-identified since zip codes would not have been used in producing the SHI report. Zip code information is not required for developing the quotation and is not in the summary health info that would be provided by the insurance company. Zip code information used to decide on provider placement is not in the summary health info, not part of the premium quote and carries no names addresses or individually identifiable information. It isually answers or is geared towards questions such as How many Cardiologists are in zip code 12345 and /or within 5 miles?

Not what I was looking for. The summary information that that cite refers to is not the same as the summary information that an insurer would provide for use by another insurer to use in developing a quotation as per the OP.

Steve72 How can summary info be individually identifiable? Summary info used for bidding and quoting consists of info such as Number of Claims over $X and Shock Claims. There is absolutely no individual information in summary health information used foor this purpose. Where is it said that summary health info is PHI? Where is is said that it is a sub set of PHI?

The insurance company would not be providing the information for use by the employer. The information would be provided so that the employer can provide (pass) it to the prospective bidders. The claims information needed for bidding and quoting is summary information and would have no PHI. The employer is not allowed to actually view or use the information if it is in an individually identifiable form or contains PHI as a result most if not all insurers and claims adminstrators would refuse to give any employer individually identifiable information.

Including the company's portion in the employee's paycheck then having the employee deduct the entire medical premium through a cafeteria plan would make no sense and possibly could actually cost both parties more. Almost anything included in the paycheck is deductible as a business expense by the company. This would not be a double deduction scheme.

I do not understand your issues or what it is you are questioning. ALL information is subject to "Privacy and Security". But that has nothing to do with anything in your post. The restrictions on a group health plan are different from those imposed on an insurance carrier or service provider. The insurance carrier is eligible to receive any and all information. The insurance carrier is free to use any and all applicable info allowed by state law (if applicable) to develop a quotation. However, carriers would not be "getting bids from other carriers at renewal time". Claims information is not evaluated for marketing nor does marketing by an insurance carrier involve getting bids from anyone.

You posted that "The only certificate the employee gets is a statement of benefits under the 403(b) plan." The employee must have signed an insurance application and must have been issued a Cerificate of Coverage or Certificate of Insurance (I doubt that any other names are allowed). It does not matter that it was an employer sponsored Group Annuity. Because there seems to be some discrepancy as to what the employees received there should also be a discrepancy as to what really exists, I again suggest that you look at the actual contracts to ensure that the restrictions are really there in that manner.