Mary C

Currently Puerto Rico does not recognize Section 125.

Be careful! The regulations do not recognize all the same family status changes for FSA as they do for health and other welfare plans. I believe that a spouse become eligible for benefits does not allow for a change in the FSA election.

We are a very large nationwide company and regard the date of service as the date incurred. We ignor when it is paid. GBurns - what is the difference between incurred and date of service? How do you define incur an injury? Isn't it the date you're injured?

It does not matter when the expenses were paid, the reimbursement is based on when services are received. Our company asks for a breakdown of the fees - placement fee and monthly maintenance fee. We then reimburse on a pro-rated basis. For example, if the total fee is $3,600, and $1,000 was the placement fee, then we allocate the remainder, $2,600, over the course of treatment. If the treatment is expected to last 24 months, then $108.33 is reimbursable each month. We would only reimburse the months after the participant enrolled in FSA and under your example, no reimbursement would be made for the placement, or for the months of 11/05 or 12/05. I believe this method is in line with the letter guidance issued by the IRS.

As I see it, the benefit to electing COBRA is to give her time to incur services and claim what she already contributed - in other words, avoiding forfeiture of what she's put in. If she elects and makes a large claim (more than what is in her account), that's just part of the risk shifting inherent in the plan.

You can have a HDHP but if you are also covered by an FSA, you may not contribute anything to an HSA.

Unfortunately, this is not only corret, but legal and in government regulations as part of the Medicare Secondary Payer (MSP) requirements. The regs have been around since the 90's and apply to all employers of 20 or more if the sponsor or contribute to the cost of a health care plan, whether fully insured or not. The regulations override any contractual or plan timely filing limits for claims incurred within the three years immediately prior to the date of the original collection notice. Regulations can be found at Section 1862(b) of the Social Security Act (42 U.S.C. Section 1395y(b)) and also at 42 C.F.R. Part 411. If the claims are not repaid within 60 days (and if a collection agency is involved, its over 60 days), then CMS can charge interst at an enornmous rate until payment is made. Many insurers have separate departments just to deal with these claims and typically called "Coordination of Benefits." I know Blue Shield CA does because I've sent dozens to them. As stated above, they reimbursement demands typically come in waves a couple times a year.

djodavis - I, too, have seen the abuses cited by jmor99. For example, mom and stepdad want an extended vacation so put teen age daughter in a residential mental health facility for 6 weeks due to "incorribility" while they are out sailing the Mediterranean. Never mind that daughter is an honor student and active in her church youth group. Daughter, is mysteriously cured and released when they return from their trip. And to top it off, she bragged about it to co-workers and even suggested someone else try it! or my own sister, who was traumatically widowed at an early age, sought counseling to help at that time. Its almost 10 years later, she's remarried and she still goes at least once a week for her "bereavement" counseling. Sometimes more often. She's admitted if her plan didn't pay, she'd quit going, but as long as it continues to pay, she continues to go. These situations are not as extreme or uncommon as you may think. Because its a gray area as to what is acutely needed, what's custodial, and what's just to unload, its not as easy to design guidelines to control abuse as it is for physical health treatments. That's why there is and will probably continue to be limits for mental health treatment. Just my humble opinion.

High Deductible Health Plan

Yes, each covered participant can elect or decline COBRA coverage on their own.

An employee can elect a high deductible health care plan (one that is eligible for an HSA) regardless of whether they participate in an FSA or not. If they do participate in an FSA, they may not be able to open or contribute to an HSA depending on the type of FSA and what they use it for. If it is a limited purpose FSA, i.e., only reimburses OTC medication and supplies, and unreimbursed dental and vision expenses, then they can open or contribute to the HSA. They may not use an FSA to reimburse for medical expenses unless they have already met the deductible under the HDHP. Hope this helps.

In order to qualify to have an HSA, any FSA the participant is in must be limited in purpose to reimburse only for dental and vision expenses. Speech therapy is considered a medical expense and would not be reimbursable under a limited purpose FSA. Accupuncture could be for many ailments and although I've never heard of it used for vision purposed, it could be. You would need to know the underlying diagnosis or condition to determine if its reimbursable.

I doubt anyone can top QMCSO but here's one that's in the new issue of Employee Benefit News - HIPAA - Hiding Involving Privacy as Alibi

We view our enrollment form as a company document and record. If an employee knowingly enrolls an ineligible person or knowingly mistates a relationship to make someone eligible, we view that as falsification of company records subject to displinary action up and including termination of employment. Yes, the employing company absolutely needs to know, particularly if they are taking deductions for the coverage and will need to adjust the amount taken due to the deletion of the ineligible person.

As a member of our city's large employer health coalition, I can attest to the fact that very few employers carry coverage through the end of the month any more. The majority in our state stop coverage either on the last day worked (date of termination) or the end of the week that the termination occurs in. This is especially true if the employer is large enough to self bill for coverage. Also, our carriers end coverage at midnight on the day of termination. So if he went to the doctor on January 31 and his last worked was also January 31, his coverage under our plans would end midnight January 31.

from the acronym you used, I am assuming you are talking about neither an Healthcare Savings Account, or a Flexible Spending Account arrangement but a Health Care Reimbursement Account. We currently have one that is directly linked to one of our health care options. Becuase it is connected with the health care plan, coverage under it and eligiblity for reimbursement of expenses stops when participation in the health care plan stops. So if you were covered on January 31, those expenses are eligible for reimbursement. But if your participation in the health care plan stopped on that day becuase of your termination, then the expenses from 2/8 are not eligible for reimbursement. the place to look for answers would be in the summary plan description for both the HRA and health plan under a topic such as "When Coverage Ceases."

I got my pill box for free from the pharmacy.

Don - Yes, we are going to one plan, 3 options - high PPO benefit, low PPO benefit and an HDHP - nationwide on a self insured basis with stop loss coverage. Our reasoning is mainly economy of scale and control. We currently have 94 different HMO's providing coverages with 94 different sets of benefits and different administrative, reporting and payment requirements. And 46 state mandates, like NJ's, to be aware of. After the change, we will have two carriers, both nationwide and both self insured with one plan design per option, one set of administrative requirements, and one electronic format for reporting eligibliity. Which carrier is offered where depends on the qualify of the provider network in that area of the country. We were partially self-insured back in '91-'94 and jumped on the HMO bandwagon when that promised to curb cost of providing coverage. Now it seems we've come full circle seeing 20% + increases in rates.

Hope there are some NJ experts out there! In January, the acting governor signed into law a bill that would amend the insurance code requiring any group contract issued or delivered in NJ after May 12, 2006, to cover children until age 30 provided certain qualifications are met. As we read it, the law requires the the employee or "child" (if you can call a 25-30 year old a child) to apply for this coverage in writing to the insurance carrier and pay necessary premium to the insurance carrier. The benefit then provided are identical to the group plan and employers are not required to contribute to the cost of coverage for these overage children. Employers are, however, obligated to notify the employees of the law immediately before its effective date (May 12) and when any child would age out of the plan otherwise (we use age 19 and 23 for full time students). My question is this, we currently have several fully insured HMO's in the state of NJ that provide coverage. Our plan renewal date is 7/1, after the effective date of the law. However, as of 7/1 we will only be offering a self-insured national plan. Are we still obligated to send out a blanket notice of the law to all NJ employees even though it will never apply to our plan?

Are different types of weight loss programs covered under an FSA? For example, bariatric surgery, programs such as Jenny Craig or Weight Watchers, OTC pills, prescription pills? I feel that there is some merit to covering some of these, but balk at covering Jenny Craig meals or Weight Watcher's meeting fees.

I have to agree that these plan do not offer hope to the working poor. In the past few years, we have offered a lower priced consumer driven plan with an FSA to help defray the higher deductible and coinsurance. After the first year, we have had miserable participation from our lower paid employees. They can't afford the deductions for the insurance AND a deduction to fund an FSA. They live paycheck to paycheck and would rather go uninsured than pay for a plan where they do not reach the deductible in a normal year. They view it as a waste of money. We will be changing to a HDHP with HSA's along with two PPO options at annual enrollment. I don't forsee our lower paid population taking advantage of an HDHP for the simple reason they can't fund the account that is supposed to help out with meeting the deductible and co-insurance percentages. They live paycheck to paycheck as it is. They need help with getting their everyday office visits for flu or maintenance medications not having these expenses apply to a $5,000 deductible. These are also people who do not have the sophication or knowledge to "negotiate" to find a lower priced doctor or hospital, especially in an emergency which is predominantly the only time these people seek treatment. Who is going to shop around when your child is in an accident?

New HIPAA regs recognize moving out of a service area of a managed care organization as a special enrollment opportunity. If you have another plan that would cover him you will need to offer it.

I can't speak for all administrators, but we do not allow a retroactive change to FSA or DCA accounts. We increase the pledged amount on a prospective basis only - the first of the month following the election change and this is stated in our SPD. Check your SPD or plan document to see what your plan allows.

I posted this a little while ago on the HSA forum and thought someone here might be able to help, too. My company will be implementing a high deductible health plan at annual enrollment 7/1. We will have two carriers nationwide because of network access in various parts of the county. We will have a $1,500 single deductible/$3,000 2 party or family deductible. After the deductible is met, there is a 80%/20% coinsurance until the OOP maximum is met. Recently one of the carriers came to us and said because of regulations governing HDHP in order to allow an HSA with the plan, the deductible must work differently than what we thought. According to the carrier, if you have a family of 3 and one person has $1,600 in claims, benefit co-insurance will not begin for that individual because the family deductible of $3,000 has not been met. Can anyone confirm this or provide the legal site for this? thanks in advance for any help you can provide.

My company will be implementing a high deductible health plan at annual enrollment 7/1. We will have two carriers nationwide because of network access in various parts of the county. We will have a $1,500 single deductible/$3,000 2 party or family deductible. After the deductible is met, there is a 80%/20% coinsurance until the OOP maximum is met. Recently one of the carriers came to us and said because of regulations governing HDHP in order to allow an HSA with the plan, the deductible must work differently than what we thought. According to the carrier, if you have a family of 3 and one person has $1,600 in claims, benefit co-insurance will not begin for that individual because the family deductible of $3,000 has not been met. Can anyone confirm this or provide the legal site for this? thanks in advance for any help you can provide.