GBurns

Trixie The biggest downside in this whole issue is not whether to Roth or not Roth, but whether to save or not to save. Any savings is better than none. Any investment is better than none. Even a Roth sitting in a savings account would be better than no Roth. So the best thing is get prepared to start saving and start early.

A fully insured plan with retroactive experience rating causing retroactive premiums? I doubt that such an animal exists.

John G What is the outcome if you had continued until the end of 2004 essentially 31 Years?

tradbourne There are medical claims review services that will look after your interests but they usually only handle large claims. That is because the take a % of the savings and there has to be enough $$$ to cover even basic clerical time. It is a possibility that your insurance company might be willing to process your claims even though not paying them until the deductible is met, but this might be resisted by their provider network since it will reduce the provider revenue. However, as llerner points out your claims might have to be run through your insurance company anyhow so that they can keep track of your meeting your deductible. It might be good to find out how these HDHP providers will know when you have met your deductible. If they will be running the claims through their system, you should ask whether they will be repricing to their provider contract payment schedule or using the "retail price" that you paid. This might give you the ability to get the providers to give you the insurance company's discount rate instead. If the insurance company is going to process claims before you meet the deductible, then you will be by default getting some level of bill auditing. It might be also be possible to use a PPO repricing service. These services are usually available to group plans for use with out-of-network useage. It might be possible to find 1 that will do small individual claims. Regarding "requesting and consuming only medical services that are necessary". Even Drs and insurers cannot agree on what is necessary and proper. Without knowledge of treatment protocols, DRGs and the relationship between Procedures and Diagnoses, it would not be possible to know what to request or what is necessary. Last year USA Today and other newspapers ran articles that showed that American are not getting optimal care and the AMA agreed. In the 7 selected major diseases around 50% of treating physicians did not know the basic treatment protocols, plus also around 50% of diagnoses were wrong. If Drs cannot get it right, What chance does a layman stand?

The danger in your scenario is that you will be paying much more than necessary because not only because you would have no idea what are normal or reasonable charges but mainly because you have no idea what the appropriate services are. You say that "the bills are audited to make sure that only appropriate charges are paid by me", How do you know what should or should not be on the bill? Doesw the bill that you look at have the ICD and CPT Codes? Do you know what these mean and what should or should not be there? While it is simple when there is only a small co-pay at stake, it is a different animal when you are dealing with a lerge deductible. In billing an insurance company or even Medicare a specific form (HCFA 1500) has to be used and specific codes entered. Medical bill coding is complex. It consists of diagnostic codes and procedure codes. The procedures much match the diagnosis. But the system is so complicated that it needs scrutiny. The standardization of Forms and Codes is an attempt to help reduce the fraud and errors, but that has not been very successful. Overpayment, mispayment, unnecessary payment, fraudulent claims are probably the major cause of rising healthcare costs. Here is a simplistic explanation of the billing problem: http://www.hssweb.com/pdfs/NewPDFs/Collate...care_crisis.pdf If the insurance companies and Medicare with all the resources at their disposal cannot control this aspect, Do you think that you can? Do you have any idea what should be done and charged regarding any particular visit to a Drs office? Since you have no idea, How will you know whether or not you have been charged properly? Currently and in the foreseeable future the consumer using an HSA/HDHP will be at the mercy of the Dr's billing system. Do yourself a favor and do a Google search on "HSA provider balance billing" and read some of the warnings about what might happen if the provider is not bound by contract to not balance bill you etc. Also ask some of the possible Drs, hospitals and service providers that you might possibly use, what their current practices are regarding HSAs, Cards, up front payments etc are before you get an HSA/HDHP from any company especially those 2 that you have chosen.

Please let us see this case that shows that the key is self insured rather than ERISA. It would turn quite a few issues regarding non-ERISA plans such as Church plans and governmental entity plans. Who would then have regulatory powers and which laws would be applied since it would not be DoL, ERISA and now according to you not the State.

Why do you think that an insurance company auditing your bill has any benefit to you? In all these years that you ,and others that you know, have had health insurance, When has any insurance company bill audit ever given you back money or reduced your copay or deductible? With an HSA as with a regular plan you pay your portion and the Dr bills the insurance company for the rest. Why would an audit do anything for you?

You get the information from your State regulator of insurance companies, which in MI can be a challenge. Within the Dept of Labor & Economic Growth there is an Office of Financial and Insurance Services which is divided into (1) the Office of Financial Evaluation which has an Enterprise and Insurance Examination Division, (2) the Office of Policy, Conduct and Consumer Assistance which has both a Health Plans Division and a Market Conduct Division. Between them they would have the information that I referred to in my post. There is an OFIS number that might help to locate the people with the information. Do not take your answers from any telephone Customer Service Rep, get to someone in a higher position who actually works in the relevant section and actually handles such issues 1-877-999-6442. Community Med HSA is NOT an HSA. As per their own website "The Community Med HSA is a qualified high deductible health insurance plan that can be combined with a health savings account". So combining it with an HSA would be up to you to find a Trustee.

I was not aware that American Community offered an HSA. I thought that they were HDHP only. However, I would be more concerned with the reputation of the provider of the HDHP regarding payment of claims. Certain insurers do not have a very good reputation and I suggest that you do some research and also find out from your Dept of Insurance how many complaints have been filed, and what investigations and actions have involved these companies. Especially look at what the Schedule S (or F) that they have on file. This is the required Schedule on which they have to report Resisted and disputed claims. It is usually not filed timely and usually has a substantial number missing. Apparently some insurers are willing to pay the fine rather than give full disclosure. I would also be concerned as to how service providers will be accepting HSA/HDHP in your area especially involving these companies. In some areas the service providers are demanding full payment up front or a large deposit. One reason is that for most Drs visits the full price cannnot be readily determined until the billing is done and coded and even then the amount that will be paid by the insurance company is not known. With standard insurance whether PPO or HMO the co-pay etc is smaller and so the service provider is willing to extend credit and collect later. However, with HDHPs many of the insurers have no established relationship with the Drs etc, the insurance company payment schedule is not known and the deductible is too large for credit to be extended.

Note that even if you can "Have someone else unrelated to the FSOs own the entity" you will still have the "leased employee" problem and as vebaguru points out "if the employee is deemed to be an employee of an affiliated service group member, the employee is entitled to be covered under a plan which is comparable to the best plan adopted by any of the other entities forming an affiliated service group with the service org.".

dh003i I did not understand "If they just squeeze by by one cent, or a small percentage factor, or whatever, then it's completely legit. " Squeeze by with what? : Ownership of the IRA Ownership of the business Family relationship Business purpose Tax avoidance as sole purpose Step transaction analysis

Jet352 What puzzles me in this issue is your concern that "We will soon be out of time to retoractively cancel the policy back to the last payment." It seems that you are seeking a way to cancel the coverage, Why? Your OP quoted from the DoL that "Premiums for successive periods of coverage are due on the date stated in the plan " and that your TPA had calculated a particular date based on their interpretation of your PD. You, on the other hand have made no reference to whatever it is that your PD actually states on this issue. If your selected TPA has read and interpreted your PD as allowing a certain date, What is the reason for questioning the decision of your TPA? Do you as a matter of standard operating practice question the claims adjudication and other decisions of this TPA? If not, it makes me wonder why you are singling out this particular employee and searching for a stricter interpretation of whatever rules apply even beyond your own PD. Have claims been submitted that you do not want to pay? By the way, the DoL rules are the minimum required. Any insurance policy or health plan can have a longer grace period, can waive premiums and can allow whatever reinstatement priviliges if allowed by the policy or PD. No one has to stick to the COBRA minimums.

WC that covers an IC or sub contractor is covering an IC or subcontractor and not an employee. Even for WC an employee is an employee and an IC is an IC. WC covers either but the classification needs to be correct and consistent. If the counting of days for vacation excludes July 4 or any public holiday, then it is not counted and the employee gets another day. This occurs very often in plans that count vacation by the days. Yes, they would enter the Plan on January 1, but in practice would not be able to do so for a number of reasons or if they did would not accrue any benefits. Not actively at work, no forms, no earnings for deferral, not enough hours etc etc.

They might not be applying it for retirement plan purposes but they had better have consistency across the Board in the event of litigation regarding the retirement plan or otherwise. And they better have legality in all issues. In any case isn't there a difference between "term date" "last date of service" "last date of employment" and "last date actively employed" which could all be different dates?

Yes, coverage can be limited and items excluded if detailed in the PD and SPD etc, but it usually is instead done by categories such as medical, dental or vision. Notice that in the HSA Notices the IRS refers to limited scope FSAs.

The accountant thought and so told the attorney who also thought and so did it, then the employer signed without seeing the error, and the consultant and eveyone else through the 5 years never bothered to read and never noticed the error even while doing annual valuations and reports etc. Scrivenor's error might be a stretch but maybe another lawyer might see merit. It is worth a try. Anyhow correction now is better than a quash or disqualification later.

I am glad that you noticed this strange trend? Will you be next or will you continue being in denial? Didn't someone post the thought ,about 2 weeks ago, that we might be connected?

I do not think that either the Gen Liability or the WC carriers would accept that as term date and I have not seen UC accept it either.

The only thing that comes to mind is ... Get a loan asap. I did not even think that it would be worthwhile to go after the consultant's E&O. This seems clearly the employer's sole fault.

I did not respond because I thought that the answers were self evident. Minute details and odd ball situations cannot be addressed in a PD because not every situation can be predicted or even imagined. The same applies to the Administrative procedures. In Example 1 New Years day is the next PY. New Years Eve however is within the PY but is no diffferent from any other holiday or weekend. Examples 1 and 2 have the same situation. If the employees in these examples are not considered employed on New Years Eve and on weekends for purposes of the PYE then they would not be considered employed on weekends during the year and would therefore have a termination every Friday with a re-hire every Monday. That is not done because the employees are considered to be still employed just not at work. Just like they are not at work at lunch time but are still employees. An employee on paid vacation is still employed. That is why the employee is still covered under the health insurance, FMLA etc etc. "Actively at work" would be a different issue.

PP The proper course of action for any advisor to any client requires that ALL avenues be considered and ALL options explored and ALL consequences and benefits weighed. This therefore includes all sorts of advice and pros and cons. Regarding "How did the industry put the employer in this situation?" Simple. The industry consists of the concept designers, the document writers, the package providers, the enrollers, the investment plans, the Trustees, the record keepers, the actuaries, the TPAs, the legal advisors to any party and the sales reps who represent each of the forementioned parties, along with others who do not come to mind right now. Brokers are sales reps. Sales reps sell products and services for various providers of whatever is used that is related to Pension and Retirement Plans. The broker representing a provider sold this employer (PS) on using a package created by a "package" provider using that design and documents prepared by a document provider, and the money was put into an investment vehicle promoted by a "broker" (does not have to be the initial broker). During the years this PS invested hard earned money with this investment provider and misc fees including fees to record keepers and other service providers. ALL of these providers comprise the industry. ALL happily took his money. Brokers do not magically appear, the are sales reps representing various service providers. I do not know what you think the industry is but as far as the law and logic goes the broker IS part of the industry.

Agreed.

There is a big difference between doing things that are not deductible or which have penalties and things that are fraudulent. Since the issues do not involve attesting to things on a tax return etc, I do not see where "fraudulent practices" even deserves mention. Not operating a Plan accordance with its PD could cause disallowance and penalties, but even if tax returns are filed, there is usually no fraud. If corrections are done befors tax returns are filed, there definitely is no fraud. I think that there probably are more posters who are upset that the industry still puts employers in these positions and then do not have the ethics/conscience to solve the problems created and leave these clients (who paid good money) floundering. Why hide inappropriate service and sometimes even incompetence from public scrutiny? And, if we do not discuss these things in public forums, How will many people even find out about the pros and cons of these issues and the pros and cons of whatever might have been suggested in private probably even by a party with a particular bias?

Thank you. But the fact that someone had medical care from whatever source has nothing to do with a pre-existing condition, by and of itself. There are other factors to be considered. If I had Cancer, and went to Mexico for some experimental treatment, according to the cite that you gave, that treatment would not count. BUT, the fact that I had Cancer could depending on other facts. So the treatment by whatever source might be irrelevant in many cases.

I would think that it makes the industry look even worse by getting Plan Sponsors into this sort of situation in the first place. The rules are going to be broken anyhow, so the most pragmatic thing is to evaluate the paths that minimize the penalties the most. Playing audit roulette is something inherent in almost every tax return, anyhow.