Mary C

125 does recognize changes made during a spouse or dependent's annual enrollment period as events to allow a corresponding change to your coverage. If the husband elected single only coverage during his annual enrollment in September, the wife should be allowed to drop him from her coverage.

We allow new hires to add disabled dependents over the age of 19 to the plan if the disability was present before age 19. We have all applications to cover disabled dependents over the age of 19, whether they are new to our plan or just turning age 19, reviewed by an outside third party to determine disability before enrollment.

If they voluntarily choose to opt out of the employer's health care plan, nothing happens. The employer, however, cannot offer any incentives for a Medicare eligible employee to opt out of the group health care plan. Medicare will become primary coverage. If the employee is not already enrolled in Part B, they have a special eleciton period in which they can enroll and avoid the late enrollment penalty.

Employers are not covered by Cal-COBRA and they do not extend the coverage. The law applies to insurance companies offering the plans. The participant contracts directly with the insurance company and pays the premium directly to the insurance company. The former employer is not involved unless the contract to provide group benefits from that carrier is canceled. Then the company has to provide the participant with information on any other insured plan they sponsor in the state and the participant can then contract with that carrier. Self-insured medical plans and stand alone dental plans are not subject to Cal-COBRA either.

We regard failure to pay while on leave a voluntary cancellation that is not subject to COBRA. Regs concerning FMLA leave state that if coverage is canceled for lack of payment while on leave, it is not an event to offer COBRA at the time coverage is canceled. The event to offer COBRA is when they do not return from FMLA leave. In your situation, I would say she is out of the protected FMLA period and COBRA does not have to be offered.

I believe the guidance connected with mistake of fact elections cited someone enrolling in dependent care who did not have eligible dependents. That's the scenario we have allowed cancellations for and although the regs don't give guidance on any refunds, we have refunded all mistaken contributions.

We did the reverse in 2006. We announced in December 2005 before the sign up for 2006 that it would be for a short year from January 1 to June 30. We also lowered the maximum allowed to be contributed by half for the short year. Communication is key in changing the plan year because the participants who are used to the old way may not read closely or notice that the new year is for a shortened time period.

Our retiree plan does not allow addition of spouses to coverage unless they lose other employer coverage, or the retiree is newly married. If retiree and/or spouse do not elect retiree coverage at the date of retirement, they cannot enroll later. What does the SPD and plan document say?

Thank you Oriecat for coming to my defense. All the years I have been on this board you have proven to be a very knowledgeable gentlemen. As for me - I'm not at all bitter or unhappy at all in my private life and his comments, though rude and immature, don't bother me. In my 20+ years in human resources and benefits, I've had to counsel many, many associates such as thorfabio who are in his situation and don't think they're hurting anyone by enrolling non-eligibles. They seem to think they can have their cake and eat it too without any reprecussions. Sometimes you just have to lay it on the line like I tried to do and they don't like it either. Their only defense is to strike out. I wish both him and his female domestic partner luck, I think they may need it.

Have you ever heard of insurance fraud? Representing your girlfriend as your spouse to be covered by insurance is considered insurance fraud. Also, most companies, such as the one I work for, only cover opposite gender domestic partners if they have been "hooked up" for over a year, jointly own property, have a joint checking account, etc. and sign an affadavit to this effect. Gay couples in most states DO NOT have a choice to marry - you do and after 20 years, you should. Also, your attitude that if it ain't broke, don't fix it is foolish and immature. If something would happen to either one of you, neither one is considered next of kin to make decisions regarding medical treatment, burial, etc. unless there are legal documents in place. And should one of you die, you do not have the right of inheritance unless there is a will. My sister "co-habitated" and even took the name of a gentleman, but never legally married him. When he died in an auto accident in his early 30's, his family got their house, half her bank account, and even his IRA and 401-K account. If I were your girlfriend, I'd run away from this relationship as fast as I could just to protect myself and what I've worked for.

Louisiana does not recognize common law marriages, unless the "marriage" was entered into in a state that does recognize them and the participants later moved to Louisiana. So although it is a community property state, because they do not recognize you as legal husband and wife, community property laws do not apply in your situation and accumulated property.

Our insurance carrier (MetLife) requires a spouse signature to change the beneficiary in community property states if the beneficiary is anyone other than the spouse. While we do accept electronic beneficiary designations, we have not figured out how to do the spouse signoff electronically and require a paper form with signatures in these cases.

We are planning for our annual enrollment. We will be unbundling dental from medical and offering full time employees three options - a DMO, a basic option POS and a high option POS. Since we are unbundling dental, we will also be offering dental only COBRA if someone is only enrolled in dental coverage when an event occurs. Also new this year, we will be offering the basic dental POS option to part time employees. Our question is this - when a full time employee who is enrolled in the DMO or the high option POS decreases hours to part time and loses eligiblity for the DMO or high option POS, does COBRA need to be offered due to the reduction in hours? They will still remain eligible for a dental option, just not the one they are enrolled in.

Nowhere. Was just using it as a nice round number for calculation purposes.

Actually I have found an answer in the IRS guidance. A deductible carryover is permitted if the plan's deductible is increased proportionately over the IRS minimum. For example, the IRS minimum single deductible is currently $1,500. If the deductible carry-over period is 3 months, then the plan's deductible for 2007 must be at least 1 &3/12 of $1,500 or $1,875. Since our plan deductible is more than that, we can use a 3 month expense carryover.

We are introducing our high deductible health plan and employer sponsored HSA effective 7/1/07 to a group of newly acquired companies. 7/1 is our usual annual enrollment date and we are bringing the new companies on board with our benefits on that date. Company A just went through annual enrollment 2/1/07 and Company B's annual enrollment is effective 3/1/07. My question is - for the employees in Company A and B who elect the HDHP as of 7/1, can we rollover any deductible they may have satisfied in the prior plan to the HDHP because of the short plan year on their prior plans?

Other than OTC drugs, we will only reimburse expenses if they can otherwise be deducted on your federal tax return. IRS Publication 502 - Medical and Dental Expenses has the following paragraph in the section "What Are Medical Expenses?" "Medical care expenses must be primarily to alleviate or prevent a physical or mental defect or illness. They do not include expenses that are merely beneficial to general health, such as vitamins or a vaction" Later in the same publication they list expenses which are not deductible and it includes health club dues or amounts paid to improve one's general health. Since gym memberships do not appear to be deductible we have in the past denied them. The only way we would consider reimbursement is if there is a doctor's letter of medical necessity that lists what condition is being treated and how the gym membership is treatment for that condition.

Under FMLA regulations, you can but need to provide a notice that you will be cancelling 15 days before the cancellation. And should the employee subsequently terminate employment, the COBRA event is the termination of employment or not returning from leave, not when they lost coverage while on FMLA. There may be additional state regs governing workers comp leaves and insurance that I am unaware of, but you didn't tell us which state you are in.

Sorry, only precedents I could think of support your company. Many employers who increase the employee cost share or are beginning employee cost sharing bump up the pay of those currently enrolled to cover the increased cost. Anyone enrolling or hired after that certain date does not get the increase. I've seen a lot of situations handled this way and don't believe its discriminatory.

Ira - I don't think the question was can someone have COBRA who has other coverage, such as Medicare, which is what the Geisel case refers to, but rather has he even had an event for COBRA. Yes, reducing hours to "0" can be considered a COBRA event, but then the questions arise such as - If you consider the event when he went on leave and reduced his hours to "0", what would you call his coverage from that date to the date he goes on LTD? Would you include this in his 18 months of COBRA? Also, however you treat this individual, you will need to do the same for any employee who goes on leave in the future.

Our plan specifically states that if both husband and wife work for us, each member of the family may only be covered once. We do allow husband to elect one plan option and wife to elect another plan option, but do not allow them to cover each other as dependents if they do this. Children may only be covered under once, also. Check the plan document or SPD. You should also make it clear to the employer that you are electing to cover each individual only once, but under different options.

I didn't think you could condition enrollment in a health care plan upon completion of EOI or health assessment under HIPAA.

The dependents may get reimbursed for expenses they incurred only while the deceased was a participant in the plan. However, if there is an account balance and the plan is subject to COBRA, they should be offered COBRA. If they elect COBRA, and pay the required "premiums", then expenses incurred after the employee's death upto the entire pledged amount may be reimbursed.

Employers may continue coverage for however long as they wish after a termination of employment, i.e., as part of severance, as this employer has done, or under state continuation laws. It is called under COBRA regulations "Alternative Coverage". COBRA regs set forth criteria that can be applied to alternative coverage to determine if it can be run concurrent with COBRA or consectutive to COBRA. In any event, I agree that giving them a COBRA notice now using the current date or the date of the sale as the date you cancel ACTIVE coverage and allowing them to elect 18 months of COBRA may be your best course of action.

The statement was made the company is going under. If the company neglected to pay the premium to the health insurer, all employees could be without coverage. I would be more concerned about this scenario. Unless he is an owner or keeper of the purse strings, I don't think he would be able to cancel your health care coverage without canceling anyone elses.