Mary C

I believe under HIPAA you are not allowed to discriminate against someone due to health conditions in a group plan.

too little too late? the ayes have it? mid-term examination?

You are partially correct Appleby. A revenue ruling did come out that a medical FSA could be amended to include expenses incurred for 2-1/2 months after the end of the plan year (3/15 if the plan year is also a calendar year - ours isn't). But it was optional for the plan sponsor to adopt the amendment. From what I've observed, many companies, including ours, did not adopt an amendment to do so.

Is is permissable under HIPAA to condition coverage on the completion of a survey?

Many local churches & schools sells gift certificates from large national grocery/drug stores (for example Kroger's) as a fund raiser (they get to keep a percentage of all sold). If a participant buys the certificates and use them to for the copay for prescriptions why wouldn't the script be reimburseable from an FSA plan?

I took a lady police officer and a Scion trick or treating. My son was playing with a box a couple weeks ago and said "look, I'm a new Scion" so that stuck as his costume. You mean the candy collected by these two isn't mine?

Also, for all employers subject to Federal COBRA, if the terminating employee is determined to be disabled by Social Security beginning before termination or within 60 days of termination, the employee can continue COBRA coverage for an additional 11 months after the 18 months run out. The employee has to provide a copy of the SS disability award within 60 days of receiving it and before the original 18 months expires. Premiums for coverage after month 18 are 150% of the cost of coverage.

HIPAA only applies to the health care plan and its functions. HR functions such as absences, short term disability and proof you had an appointment are not covered by HIPAA.

Were some or all of the expenses related to nursing home care? Were they paid by Medicaid and its the state looking to recoup the payments? Is the house owned solely by your brother or in both names? There is still too little information to give you much help. I believe the deadline to file bankruptcy and have all debts forgiven is passed. He or she or they would need to file under the new Federal laws which may not forgive all past debts but set up a five year repayment plan.

While I agree with you Don, I am being told that the carrier needs to file the plan with the state insurance commission and it needs to meet all state criteria before they can be licensed to sell that product in the state. That's why I'm asking for cites - our contract lawyer wants to review before accepting the carrier's word for it.

I need some help before I go blind from trying to read state regs on line. We currently offer benefits to same gender domestic partners in the above states. One of our carriers has written our coverage to include coverage not only for same gender but also for opposite gender domestic partners in the states of Georgia, Maryland, New Jersey and Arizona. The carrier has stated that it is a state requirement that if we cover same gender domestic partners, we need to cover opposite gender domestic partners in those states, too. I am having trouble finding that requirement and wonder if anyone more familiar with regulations in those states can point me in the right direction.

Non-payment of premium is considered a voluntary cancellation of coverage. No COBRA event.

If she is on FMLA, coverage may be canceled when premiums are 30 or more days behind only after she is given a 15 day waring. Once the 15 day warning expires, coverage may be canceled retro to the last day a payment purchased coverage. However, neither the act of canceling or the date of cancellaiton is considered a COBRA event. The COBRA event is the expiration of the 12 week FMLA leave or if she states she will not return to work, if sooner. COBRA begins on the event date (expiration of the leave) and she pays from that date. You cannot go back and recover costs from 9/3-27 under COBRA.

Got "assigned" to benefits by my then boss when COBRA first came out and the company needed to have someone to administer it. Guess that makes more years than I care to remember. Have always worked for an employer who administers their own benefits, never a TPA, insurance or sales. Earned my CEBS designation early on and now work in benefit plan compliance area for a large corporation. Never had much home town sports teams to be proud of, but the Bengals seem off to a fairly good start so that may change.

One of our employees enrolled in our Health Care FSA has filed a claim for a home drug testing kit for marijuana. This is a first for us. Does anyone know if this is a reimbursable expense? Its not technically needed to treat an illness or injury unless your consider it for diagnosis similar to a pregnancy test kit.

Technically, you can't even take pre-tax contributions retro for the health care plan (unless the retro is due to a birth, adoption or placement for adoption.)

I agree with M Bozek - HIPAA does not apply to short-term disability plans including determining if the absence from work is valid or just playing hooky.

Aren't really sure how this topic fits under Health Care Plans? You should probably consult a local attorney who specializes in NY Workers Compensation. While there are attorneys on this board, there may not be one who is well versed in the rules of NY Workers Comp and Social Security law at the same time and I feel that is what you need. Good luck.

You don't really give much information, but the answer is yes, the employer can deduct required cost of employee pay all benefits on a pre-tax basis.

Unfortunately the question and answer is correct. Unless the ex-employee is covered by COBRA there can be no second COBRA event. We had the exact same situation a few months back - the employee did not elect COBRA at termination, but his spouse did. When they divorced and the ex-spouse wanted to extend COBRA to 36 months, both our TPA and the DOL said she was not entitled to it.

What does the plan SPD say? We specifically state that only expenses incurred while a plan participant are reimbursable. If cotnributions are stopped, they are no longer a plan participant and the expenses are not reimbursable.

I agree with Oriecat that you got a poor explanation, but no one on this board can explain it any better because we do not have the information your human resource department and benefit department is working with nor do we have knowledge of your company's policies and procedures. While you and your partner may work for the same company, company policy and government regulations may have changed since your partner began her leave and when you began your leave. Also, the worker's comp laws may mandate how your coverage is handled in Texas. All three sets of regs, COBRA, FMLA and Workers Comp, need to be taken into consideration. And the size of your company - the number of employees has an impact on whether we're talking Federal COBRA or state mandated continuation of coverage. But I can tell you, the Company can set policies on when to terminate active coverage (and a lot of companies do terminate active coverage at the end of an FMLA leave allotment) and for the company to decide whether to charge you the entire amount of premium or subsidize it.

According to the regulations, the most the COBRA participant can be charged is the entire premium plus a 2% administration fee. However, the company is free to charge a lower amount or no amount if they so wish as long as they charge this lower amount in a non-discriminatory manner. The Company is also free to set policy when active coverage ends and COBRA begins when the employee is on leave subject to other government regulations, such as FMLA. For example, when we layoff someone due to job elimination we offer 3-6 months company paid COBRA depending on their length of service. The COBRA participant does not pay for COBRA coverage until their 3-6 month period runs out. A call to you local human resource department or benefit department can clear things up, but from the dates in your post, it appears that your medical coverage remained active while you were on the 12 week FMLA period, but that at the end of that time in March, your coverage changed to COBRA, and the company is picking up a portion of your COBRA premium.

ARe you in your 10th or 15th month? Another post by you today indicates you're in your 10th month and this one indicates 15th month.

We only allow the pay as you go method and we do cancel coverage is payments are not made. However, you must follow the FMLA guidelines regarding the period of time the payments are behind and sending the proper notices. We also allow them to cancel any coverages they do not wish to retain during FMLA - i.e., drop dependents from coverage but retain their coverage, drop life insurance, etc. While an FMLA is not an event, beginning or returning from an unpaid leave is an event to allow changes to coverage. We require that the employee exhaust all paid time off before taking an FMLA making our FMLA leaves unpaid.