Mary C

According to the regs, the employer has to be "at risk" for the full amount from the first day of the plan year and cannot recoup any amounts they may have reimbursed the employee over the amount the employee contributed if the employee should terminate employment.

Frank - the only "loophole" where your former employer does not have to offer you COBRA was if you were discharged for gross misconduct (which is not defined in the COBRA regs) but can include non-compliance with company code of conduct, flagrant disregard for personnel policies (especially safety policies). But I don't think leaving without notice would stand up as gross misconduct.

If the decree or order qualifies as a Qualified Medical Child Support Order, the child may be added at any time, regardless of seasonal enrollment rules, Section 125 rules, etc. However, I don't know of any regulations that would mandate he coverage an ex-spouse (except in Rhode Island and Massachusetts) under the active employee plan.

The newest regs say you can rely on the certification of the employee that the event actually happened. We have language written into the signature section of our form which states that and that if incorrect information is given, it could be considered fraud and grounds for discipline. It also states we reserve the right to request documentation, which we do in suspicious cases.

The Georgia law is "Consumer Choice Option". Basically its a form of any willing provider regulation. The participant submits his provider's name to the HMO, POS or PPO and the HMO then contacts the doc. If the doc is willing to accept the contractual rate from the HMO, POS or PPO and their utilization management, then the participant receives "in network" benefits (usually only has to pay the co-pay) from a doc that isn't "in network". The insurance companies may charge an additional 10-17% premium for individuals electing this option.

Debr - whether or not you allow dependents to be covered without also covering the employee is a plan decision - should be in the spd. I'd be surprised if it were allowed since most all plans require the employee to be enrolled in order to get any dependent coverage.

HIPAA guidelines state that there is a special 30 day enrollment opportunity upon the birth of a baby. The section 125 regs only say "reasonable" time. As for the DCAP plan - the spd should spell out how long after a status change event the employee has to change their election.

Thanks, Jeannine. I knew we could enroll the parent against their wishes, but what I have a problem with is that we require the employee to pay 50% of the premium for coverage. If the parent is enrolled in a New York HMO and the child lives in Florida, I don't think we should need to enroll the parent in the Florida HMO too just to get the child enrolled. In addition, I think this would violate the plan since it states you can only be covered by it once. I guess I was hoping that the government would require the HMO's to enroll the child even without the parent enrolled.

Our plan states that children can only be enrolled in same HMO option as parent. However, very often the custodial parent and children live in a different state/HMO service area than the parent-employee. In these cases, some of our HMO's will enroll the children without covering the employee-parent, and some won't. Does anyone know if the parent lives in a different service area whether an HMO in the child's area MUST enroll the child or not? What experiences have you had regarding this?

Debra - go to www.dol.gov and search for excepted benefits. The HIPAA clarification of group marketing regulations defines FSA plans as "excepted benefits under section 9831 and 9832" (and also say that no certificate needs to be issued for FSA plans and that coverage solely under an FSA is not considered creditible coverage) which is one of the criteria of the COBRA regs for plans that do not need to be offered continuation coverage. mary

Final COBRA regs - 54.4980B-2, q&a 8 state that if the FSA is exempt from HIPAA requiresments, then the COBRA regulations provide 2 exceptions - 1. COBRA does not have to be available after the plan year in which the qualifying event occurs; and 2. COBRA does NOT need to be offered at all if the the maximum FSA benefit available as of the date of the event is less than the the maximum amount of premium that would be collected. We just put in an FSA and just went through determining if it was exempt from HIPAA (it is) and what obligation regarding it under we had under COBRA.

Although the situation does feel like a scam, remember the 125 regs allow an employee to cancel pre-tax coverage when going on an unpaid leave. AND FMLA regs allow the employee to cancel or not pay for any or all benefits while on an FMLA leave. So I feel that the cancellation is certainly permissable in this event. Whether or not he has an opportunity to change his election again when he comes back should be handled the same way you handle other benefits canceled while on FMLA. If you customarily reinstate automatically, he should be made to resume the same level of contributions as before the leave. By the way, FMLA regs also allow the employer to recoup any usually employee paid premiums the employer may have paid for the employee while he was on leave upon his return. Q&A #155 under Section 125 Q&A on this site - How can a participant remain in a Medical Reimbursement Account while on a leave of absence? - talks about how to handle contributions to the FSA while on leave.

Some medical FSA accounts DO fall under COBRA and from what I've read, they may also be prepaid on a voluntary basis. However, the COBRA period for medical FSA is only to the end of the plan year in which the termination occurred.

Cheryl COBRA is mandated by the Federal government and the Department of Labor enforces its compliance, not a state agency. The regulations do not require any COBRA coverage be offered if the employer drops ALL group health care coverage. That is, he doesn't offer health care coverage to any active employee any more. As a general rule of thumb, a COBRA participant needs only be treated as any similarly situated active employee. So if the employees aren't offered health care coverage, neither are the COBRA participants.

Regulations do not require a notice be given when COBRA runs out or is terminated early for any reason. Although you state 30 days is not enough notice to get a personal policy, by your 2 posts it looks like you've known that your COBRA should have expired and you should have been looking. In any event, under HIPAA if you can provide a certificate of prior group coverage (including COBRA)that can show you've been continuously covered for at least 18 months with no more than a 63 day lapse in coverage, you should find getting a personal policy easier.

Other than Publication 502, does anyone know of any other information regarding expenses that can be reimbursed under a medical FSA? Specifically, we are receiving questions regarding cosmetic dentistry - such as bleaching, caps, bonding, etc. Since cosmetic surgery isn't an allowable expense, is cosmetic dentistry? Any ideas on how we could determine if caps are cosmetic or not? Mary

COBRA can start at termination of employment or a reduction in hours. Being off work due to doctors orders or a disability leave can be considered a reduction in hours. The employer can choose to allow someone to continue to pay the active employee rate during part of their of the COBRA period or the full 102% allowed by the regulations, as long as the do so in a consistent manner. The medical summary plan description may give more insight into how they handle terminatnion of coverage while on disability, etc.

It depends what state you live in. What you describe sounds like a California state insurance law. However, after the initial 18 months of COBRA through the employer, your coverage continues with the carrier, not your employer's COBRA. The carrier can and usually does charge up to 213% of the group rate it charges your former employer for the coverage and it is identical to the benefits under the former employer's group contract. Coverage could end earlier than age 65 if you get other group coverage, do not pay a premium on time or the former employer cancels its contract with the carrier. Please keep in mind this is just a quick and dirty description of the California mandate. Other states may have different provisions. And if your former employer's plan is self-insured, it is not subject to these state laws. Check with your state insurance commissioner.

Check your summary plan description. We run ours till the end of the pay period.

I know of no regulations requiring a 30 day notice of a rate increase, only that 1 increase a year is allowed. I would be interested if anyone knows of anything different, too.

HIPAA requires insurers to offer personal policies if you can provide a "certificate of creditable coverage" from either your past insurance carrier or employer showing that you have been continuously covered for at least 18 months without a break in coverage. You may want to check with the carrier you had on your last job to see if providing proof of prior coverage will help in getting a personal policy. Good luck

Jenni - most participants on this board are more familiar with laws regarding welfare plans - i.e., employee benefits like life insurance, disability insurance, etc. - not public assistance welfare. I, for one, am not up on public assistance welfare law changes.

The HIPAA regulations say that for the birth of a baby, you can enroll yourself and add any eligible but not enrolled dependents at the same time.

Susan - this isn't as easy to answer as it was to ask. COBRA regs state that you have 45 days from the election date in which to pay the initial premium for coverage. The initial premium covers the period of time from the date you lost active group coverage until you elect coverage. So, the initial premium for coverage from January 1 (the day after you lost your group coverage) until January 29 is due 45 days from the election date or March 15. Also, the regs state that if a regular monthly premium (for example if we use the dates above - February's premium), falls within the initial premium grace period, payment for that month isn't due to the end of the grace period for the initial premium, or until March 15. Monthly premiums, beginning with March's, are due and payable on the 1st of each month for that month's coverage. You have 30 days after the firstof the month in which the payment may be postmarked and still be accepted. Good luck.

You and your friend should be aware that COBRA coverage is continous from date of termination. So if she elects now, she would be covered from the date of her layoff and her expenses would/should be covered. However, she only has 60 days from the date of layoff or date she received notice to in which to elect it. If its after 60 days, she's no longer eligible to sign up. The company's obligation is to send her a notice of her right to elect COBRA within 44 days of her date of termination. If they did that, they are not in violation of COBRA. They are not obligated to notify her that the coverage was termed or that her 60 day election period has expired. Like Kip says, if she signed something, it was all probably in writing.