lrc14

An employer has been approached by an employee who has asked for a pay reduction, which will allow the employee to qualify for Medicaid. Can/should the employer agree to this? I'm aware of prohibitions on incentivizing medicare-eligible employees from dropping their employer plans, and believe insurers cannot incentivize employees to participate in the Exchange rather than employer-sponsored coverage, but not aware of any similar prohibitions for Medicaid. The idea of it makes me uncomfortable, though.

A self-insured health plan covers routine physical exams, including the cost of the office visit, and any associated labs, x-rays, immunizations, etc..., but subject to an annual dollar limit of $500. Anyone have any thoughts on whether the annual limit absolutely must be removed under PPACA? This type of service could obviously qualify as a preventive/wellness type service, which is one category of Essential Health Benefits, but I'm curious whether others know of any reasonable argument that the limit would not apply to this type of benefit. (I understand there are no regs yet, and that all of this is subject to reasonable, good faith, consistent interpretation until then).

The administrator of a DB plan recently learned that an individual it was making survivor payments to died more than 15 years ago. The plan had been making survivor annuity payments by direct deposit into a bank account belonging to the now-deceased survivor and her son. The son is believed to be the subject of a pending Social Security fraud investigation. Obviously, the plan will be pursuing recovery against the son of amounts distributed since the individual's death; however, does the plan have any recourse against the IRS to recover the amounts withheld from the distributions and sent to the IRS? Assume for purposes of this question that neither the son nor anyone else filed any (fraudulent) returns on behalf of the deceased individual - in other words, the IRS never paid that money back as a tax refund. We do not believe filing corrected 1099s is appropriate, since distributions were actually made.

Thanks Linda. I figured out that part of my problem is that I've been using Cornell Institute's version of PHSA, which does not include GINA and maybe some other amendments. I haven't found a fully updated PHSA - do you have any suggestions as to where to get a copy of that, or the PHSA as amended by PPACA and the Reconcilation Act?

There are a couple of sections in the Patient Protection and Affordable Care Act that reference provisions that I think either don't exist or are not applicable - has anyone else found this or am I missing something? 1. In PPACA Section 1001(1), which amends PHSA to create a new Section 2712 re: prohibition on rescissions, the last sentence states that plans or coverage can only be cancelled in accordance with sections 2702© or 2742(b). 2702© does not exist in the pre-PPACA PHSA or in post-PPACA PHSA. If you assume it is a misprint and should read 2712©, and assume that pre-PPACA PHSA applies (since there is also no © in Section 2702 post-PPACA), you are referred to requirements for uniform termination of coverage in the group health insurance market. This makes sense. However, if you then look at 2742(b), you are referred to a section that deals with termination in the individual market which, instead of addressing uniform termination of coverage (that is found in 2742©), addresses the reasons an insurer can rescind or nonrenew coverage. 2712 and 2742 are substantially similar - I may be missing something, but it seems to me that these references are inconsistent - why not refer to both (b) and © of both sections, or (b) of both sections, or © of both sections, rather than this mix? 2. In PPACA Section 1201, amendment to PHSA creating new Section 2705, the text goes from subsection (a) (re: discrimination based on health status) to (j) (re: wellness programs). (j)(1)(A) refers to "subsection (b)(2)(B)," which doesn't exist. Even if you assume that (j) should have been (b), the cross-reference really doesn't make sense ((j)(2)(B) gives one example of the types of wellness programs that don't have to meet certain requirements, whereas (j)(1)(A) is providing an apparently general definition). Has anyone else noticed this? Are we all missing subsections (b)-(i), or were these just numbered incorrectly? Finally, is anyone else having trouble making sense of (b)(1)© of new PHSA Section 2719A (which deals with coverage of emergency services) - especially from (ii) on?

401(k) plan Yes, the vested benefit is greater than $5,000 The attorneys' fees will eat up almost all of the benefits; any left over amounts are to go to the AP State Family Court Distribution not required now, but the participant is eligible to receive one because he terminated employment (will be in jail for 20+ years) The Family Court appointed an attorney in fact for the participant against his will (or at least without his consent), and the attorney in fact has requested distribution. Thanks for any input you may have!

I am dealing with a similar situation except that the Court ordered the plan to distribute the participant's interest to the participant to pay various attorneys' fees and the participant is in jail and refused to do so, so the court then appointed someone attorney-in-fact for the participant and is now ordering the plan to distribute to this attorney-in-fact. Thoughts on this? No, but the definition of a domestic relaitons order is one which "relates to the provision of child support, alimony payments,or marital property rights to a spouse, former spouse, child or other dependent of a participant," Code Section 414(p)(1)(B)(i). A QDRO can only order a payment from the plan to a party designated as an alternate payee under 414(p). Lawyers are not designated as APs who can receive payment from the plan. There was recent federal court case which rejected payment to an attorney for the AP under a DRO. What is usually done is that the QDRO provides for payment to the AP who then endorses the check over to counsel.