CaliBen

The DOL published FAQs last week. For self funded medical and pharmacy plans, how are you going about preparing the comparative analysis and ensuring compliance? I understand that (at least the PBMs) are not planning on providing this analysis to plan sponsors. Are you looking to law firms, your H&W consultant or elsewhere to make sure the analysis is complete? https://www.jdsupra.com/legalnews/show-your-work-faqs-on-non-quantitative-2551955/

Cannot take a loan from a non-qualified DCP. Possibly the plan document provides for early distribution in the event of an unforeseeable emergency. Other options - reduce or eliminate deferrals for the next plan year. Find another source of funds - bank loan, 401k loan, loan from employer etc.

For NJ statutory benefits, the benefit amount is based on the date of disability and is not adjusted as maximum benefits increase.

I've been told by a vendor that the address for an ERISA plan administrator must be in the same state as the plan situs. Is this accurate? Thanks in advance.

Thank you for the response. A follow up question. If imputing based on Table 2001 is the employer able to deduct the premium cost? There is no cash value and the employer will not receive any of the death benefit or any other type of recovery.

Not sure which message board to post this. Client is purchasing life insurance [contractual protection insurance?] from a Lloyds specialty broker to provide coverage to key executives above what is available in group plan. Client will be owner and pay premiums, but executive will be able to name beneficiary. Can the client impute income to executives based on Table I rates, and then the benefits paid would be received tax free? Or does the full premium amount need to be included as taxable income like a 162 bonus plan? Or will death proceeds be taxable to estate, or as income in respect of a decedent, or taxable to the beneficiary?

Not sure which message board to post this. Client is purchasing life insurance [contractual protection insurance?] from a Lloyds specialty broker to provide coverage to key executives above what is available in group plan. Client will be owner and pay premiums, but executive will be able to name beneficiary. Can the client impute income to executives based on Table I rates, and then the benefits paid would be received tax free? Or does the full premium amount need to be included as taxable income like a 162 bonus plan? Or will death proceeds be taxable to estate, or as income in respect of a decedent, or taxable to the beneficiary?

Any legal issues with an employer policy that pays employees full pay when they take intermittent FML, but no pay for employees taking continuous FML?

Can an employer offer longer COBRA duration, for example 30 months instead of 18 for a class of employees - executives, or salaried but not hourly? Assume that the employer does not subsidize the premium.

Correct. They are permitted to purchase these voluntary group benefits on the same terms as the organization offers to their w-2 employees. The insurance is provided by state-regulated insurance companies.

Does anyone know of a site similar to BenefitsLink that solely focuses on PBMs and Rx plans?

Not an insurance company. But the 1099ers happen to be independent insurance agents.

Yes. Sorry I had workers’ comp on my mind while typing reply.

Thank you. Yes, worker compensation is a separate issue that is being addressed.

Organization has no employees, only 1099 contractors. The contractors can purchase vision, dental and disability insurance through the organization. Is the organization required to file a 5500?

We have a client with a self-funded health plan. Ex-spouse of employee in Nebraska claims he should still be covered for 6 months (until divorce decree is final for purposes of health plan per Nebraska statute). Question: because the plan is self-funded would ERISA preemption apply? Would the answer be different if the plan was insured? Nebraska Statue Below: 42-372.01. Decree; when final. (1) Except for purposes of appeal as prescribed in section 42-372, for purposes of remarriage as prescribed in subsection (2) of this section, and for purposes of continuation of health insurance coverage as prescribed in subsection (3) of this section, a decree dissolving a marriage becomes final and operative thirty days after the decree is entered or on the date of death of one of the parties to the dissolution, whichever occurs first. If the decree becomes final and operative upon the date of death of one of the parties to the dissolution, the decree shall be treated as if it became final and operative the date it was entered. (2) For purposes of remarriage other than remarriage between the parties, a decree dissolving a marriage becomes final and operative six months after the decree is entered or on the date of death of one of the parties to the dissolution, whichever occurs first. If the decree becomes final and operative upon the date of death of one of the parties to the dissolution, the decree shall be treated as if it became final and operative the date it was entered. (3) For purposes of continuation of health insurance coverage, a decree dissolving a marriage becomes final and operative six months after the decree is entered. (4) A decree dissolving a marriage rendered prior to September 9, 1995, which is not final and operative becomes operative pursuant to the provisions of section 42-372 as such section existed immediately preceding September 9, 1995. Source:Laws 1995, LB 544, § 2; Laws 1997, LB 434, § 1; Laws 2000, LB 921, § 34.

We have a client with a self-funded health plan. Ex-spouse of employee in Nebraska claims he should still be covered for 6 months (until divorce decree is final for purposes of health plan per Nebraska statute). Question: because the plan is self-funded does ERISA preemption apply? Would the answer be different if the plan was insured?

An employee died, had six children on the plan. Employee was divorced. Four different moms. We are not aware of any court orders. We provide subsidized COBRA for 24 months. Questions: Who do we offer COBRA to and and at what rate - do we offer at the subsidized employee + child(ren) rate (and net out the employee only rate) to each mom?

What is the best source for state and local compliance calendar for health welfare plans? Has anyone seed a comprehensive calendar that includes multiple state/localities?

How difficult is it to add another benefit to an existing VEBA. We have an existing VEBA and management asked us to evaluate adding the existing retiree life plan. The company pays most of the retiree life premiums, but retirees contribute a portion. What are the key considerations? Upfront and ongoing legal and accounting costs? Our current annual retiree life premium is relatively small (about $600,000 per year including retiree contributions) so one of my concerns is that the initial cost to move the plan into the VEBA and the ongoing legal, accounting and investment expense could be significant in comparison.

Understood. I'm thinking for self-funded plans it make make financial sense for employer to cover cost of employee travelling outside country and to pay for meds outside plan.

Appreciate all insight on merits of in-sourcing claims administration v. using a TPA v. using medical vendor for larger (Fortune 500 size) corporations.

Any insight appreciated.

Looking for opinions on reasonable fee range for one of the big consulting houses to conduct an RFP to help us select a new PBM? We are a 40,000+ employee company operating in almost all states. Pharmacy is currently carved in with medical. Also need reasonable fee for implementation and ongoing oversight of PBM. Thank you.

What is the obligation of an employer to notify an employee who is collecting workers' compensation benefits that they may be eligible/should consider filing a claim under the employer sponsored/paid LTD plan?