Mary C

Was it a true medical expense or braces under dental? Old government guidance stated that expenses for braces should be reimbursed periodically as the visits are incurred, not in one lump sum that may have been paid up front.

The provisions of the plan are in the Plan summary plan description - the plan provisions do not change from active employee coverage to COBRA coverage - and since COBRA coverage must be identical to that you had while your spouse was employed, it has probably been in place since you signed up for coverage. Your COBRA administration may not have the information you are looking for, but your husband's former employer would. And no, COBRA administrators are NOT required and do not have a fiduciary duty to inform you of the plan provisions - that's the previous employer's job. I do question how the coordination of coverage provisions under an active plan can state they presume you are enrolled in Part B if eligible. I would assume that goes against the Medicare Secondary Payer regulations for active employee coverage. Once the coverage provided is under COBRA though, MSP provisions state Medicare is primary.

Actually, that is a good question. A lot of legislation that applies to health care plans does not apply to stand alone dental or vision plans.

MaryMM - there wasn't a link included with your reply. QDROPhile, Section 132(f)(4) excepts bicycle commuting reimbursement "No amount shall be included in the gross income of an employee solely because the employee may choose between any qualified transportation fringe (other than a qualified bicycle commuting reimbursement) . . . . . . " What I'm trying to get at, is if the benefit is tax free, but we can't withhold it from the employee pre-tax to reimburse him or her, where does the money come from? If its withheld after tax to be reimbursed after tax, what is the point? Or is the benefit entirely employer funded?

We currently have a Flex Transportion program offering pre-tax contributions toward the cost of transit passes and parking as defined in section 132(f). We were recently approached by a few individuals regarding qualfied bicycle commuting as added by President Bush in last 2008. At about the same time, we were also approached by a national flex transportation administrator who claims the qualified bicycle commuting benefits is entirely employer paid and cannot be deducted from employees salary on a pre-tax basis. I have read the regulations which aren't helpful and the guidance which doesn't mention bicycle benefits. Has anyone had any experience with this or can shed some light on this?

Michelle's Law extending coverage for 12 months for students who cannot attend school due to illness or injury will be effective for plan years beginning on and after 10/1/09. Part of the law requires employers to provide in "language that is understandable to the typical plan participant" the provisions of the continuation whenever we request certification of full-time student status. Does anyone know if the federal government plans to issue any model "language that is understandable to the typical plan participant" that can be used for this purpose? or are we on our own for drafting up a notice?

We are a large employer with self-insured medical plans and ASO agremeents with 2 nationwide carriers. We are redoing all our Business Associate agreements and revamping and expanding our training in house. We will rely on our business associates certification that they have conducted the proper training on their end.

Never mind . . . . Will be in 8/24's Federal Register.

It was my understanding that Health & Human Services had until mid-August to issue guidance on individual notices of protected health information breach and other aspects of the new HITECH requirements included in ARRA. Has anyone seen anything on this guidance yet? (Other than what came out in April)

If this has been discussed in the past, and a conclusion reached, please give me a link to that discussion. In the past, we have utilized the same criteria to determine HCE as we used for the 401-K plan, therefore only pulling information once and using it for both tests. Since our plan year runs on a 7/1 to the following 6/30, we are preparing to do the year end testing. However, in the cafeteria plan regs effective 1/1/09, it defines HCE as : "Any individual or participant who for the preceding plan year (or the current plan year in the case of the first year of employment) had compensation from the employer in excess of the compensation amount specified in section 414(q)(1)(B), and, if elected by the employer, was also in the top-paid group of employees (determined by reference to section 414(q)(3)) for such preceding plan year or for the current plan year in the case of first year of employment)." Current plan year if the first year of employment is ignored for testing our 401K and pension plan. Is this a change in how the testing for flex spending plans is done?

If she is wanting to pre-fund in order to use daycare while on leave, be careful. Under the regs, reimbursements can only be made to enable the employee and/or spouse to work or attend school. Expenses incurred while she is out on a medical leave are not covered by the plan.

We regard it as voluntary and have stated such on appeals that have come from the DOL without a challenge.

Try this site http://www.changeofstatus.com/

I believe HIPAA set the 30 day rule in their special enrollment rights for addition of a new child. Most if not all the employers, and insurers, use that as the rule rather than allow more time.

We have had some success with just bringing together our two largest self insured medical carriers, pharmacy manager, EAP, and disability. The medical and pharmacy manager have integrated their systems together so that when a doc's office calls the medical carrier to get a script approved, it's automatically transferred to the pharmacy manager. If the medical case managerment is involved in a chronic or very serious illness, they may help get drugs that need prior approval through the pharmacy manager's system without inconveniencing the patient. The EAP's case managers now works with nurse managers at the carriers to provide additional services not offered or covered by medical but available in the communities. Individuals on disability are getting case management from the medical plan and rehabilitation services from the disability plan and help from the EAP. We plan to add workers comp into the summit at some point in the future.

Yes. We received 150 new cases in one day - most for under $100. We have also experienced a very large number being turned over to collection agencies while MSPRC is still sending us correspondence. I would say out of 20 or so that have been turned over to collection agencies, only one had not had any payment or defense previously submitted to Medicare. In some instances, we get a closure letter on the same day as the notice from a colleciton agency. We are also experiencing a tightening of documentation required. MSPRC used to accept an insurer's "claims payment worksheet" showing how they adjudicated claims, but now they are insisting on EOB's. The entire plan document must be submitted to assert a timely filing defense when they used to take just the pertinent pages. No call backs from messages left, but the answering tape on the MSPRC line is priceless - "if you have received an intent to refer letter, please be assured we will not turn your account over to Treasury until all correspondence has been worked." Is that the same as we're from the government and we're here to help you?

If he were a divorced single parent with custody of the child, and found a free day care provider, would the issue of whether he was married to that provider or not be an issue? The regs recognize the change of day care providers as an event to change the election.

The secondary event makes the dependent ineligible to continue on the family's coverage and therefore must make a new election to continue coverage under his own single COBRA account.

We're treating it as a material modification and distributing the info during annual enrollment in June. We are only extending the 60 day notification period to the two specific events listed in the regs and keeping 31 days for all other status change events, both under HIPAA special enrollment and Section 125.

Under Title III of CHIPRA, it states - (g) Opt-Out permitted for any month - A state shall establish a process for permitting the parent of a targeted low-income child receiving a premium assistance subsidy to disenroll th child from the qualified employer-sponsored coverage and enroll the child in, and receive child health assistance under the State child health plan, effective on the first day of any month for which the child is eligible for such assistantance and in a manner that ensures continuity of coverage for the child. To me this sounds like the employee-parent may elect to cancel coverage for the child to enroll the child in a CHIP plan that was established under title xxi of social security. However, Section 125 does not allow coverage paid for on a pre-tax basis to be canceled to enroll a child in a CHIP plan established or funded by title xxi of social security. It only recognizes Medicaid coverage under title XIX to be coverage to allow cancellation of a dependent. Does anyone have any words of wisdom on this?

COBRA ends when the participants becomes covered by another group plan. ARRA subsidy ends when they become eligible.

Current regulations do not allow employees to cancel dependent coverage paid for on a pre-tax basis if the child becomes enrolled in a state sponsored SCHIP program. However, the new SCHIP Reauthorization Act of 2009 allows employees and dependents 60 days to request to enroll in an employer's group health care plan due to becoming eligible for premium assistance under a Medicaid or a SCHIP program. Does anyone know if the new regs also allow employees to drop pre-tax coverage to enroll dependents in a SCHIP program?

We are having a bit of a dilemna. Although the payroll system is supposed to limit dependent care deductions to $5,000, one participant inadvertently had $5,800 withheld and forwarded on to the TPA. We asked for the extra $800 to be recharacterized as taxable income. Payroll refunded $800 under the dependent care deduction account then withheld $800 as a general deduction to get the tax consequences in sync. They are also only reporting $5,000 in box 10 of the W-2. This creates a disconnect betweeen payroll records and what the TPA shows. What amount should be listed in Box 10 of the W-2, $5,000 or $5,800?

We have implemented a new enrollment process where the newly eligible enrollment notice and all applicable SPD's are on a CD that is sent to eligible employees after one month of service. This mailing includes the initial COBRA notice in the health care SPD. As we read the regs, they specify that the initial notice must be sent within 90 days after enrollment. Since the CD and notice are sent PRIOR to enrollment is there any problem here?

This is from the August 2008 Electronic Code of Federal Regulatios (on the internet): (4) Change in coverage under another employer plan. A cafeteria plan may permit an employee to make a prospective election change that is on account of and corresponds with a change made under another employer plan (including a plan of the same employer or of another employer) if -- (i) the other cafeteria plan or qualified benefits plan permits participants to make an election change that would be permitted under paragraphs (b) through (g) of theis section (disregarding this paragraph (f)(4)); (ii) the cafeteria plan permits participants to make an election for a period of coverage that is different from the period of coverage under the other cafeteria plan or qualified benefits plan. Since the plan of her spouse's employer permits the spouse to make an election for a period of coverage that is different from her period of coverage, her situation would fit this permitted change in coverage. Of course, the plan does not have to honor any of the changes listed in the regs, but if they do, this one is permitted.