Mary C

In my post DP = domestic partner Sorry if it confused anyone

We cover DP's where state laws and carriers permit us to. Participants are allowed to enroll DP's only when the participant is initially eligible to enroll or during annual enrollment. We do not all enrollment of a DP due to a family status change. Because a DP is not considered a legal dependent (in most cases) under Federal law, we require that the coverage be paid for on an after-tax basis. Since the coverage is after-tax, it is not under the 125 plan and the DP may be dropped at any time.

FMLA is not applicable. In order to qualify for FMLA, you have to be with your current employer for 12 months and have worked at least 1,250 hours in the past 12 months. Since blb will not be with her employer 1 year until July 2005, she is not covered for or eligible for FMLA protection.

The 18 months of COBRA still runs from the event date. There is no coverage from the event date to the date the election is post marked. The participant begins paying from the effective date of coverage (post mark date). All other COBRA rules (45-day initial grace period, etc.) remain in place.

I agree with Kirk. We've had this happen a few times and the regs specifically do allow for a break in continuous coverage if the prospective participant waives coverage then later elects during the 60 day election period. Coverage (and premiums) then begins when the election form is provided not at the end of active coverage. We contract with over 80 HMO's and have never had a problem with this once the Q&A Kirk cites is reviewed.

What does the SPD say? Are changes/cancellations allowed mid-year? Unless there is more information behind his request, the regs do not allow a partiticpant to cease contributions in mid-year without an event.

Oriecat -We, too, have over 45,000 employees covered through about 80 different HMO's. The carriers ask for and monitor student status, we do not. The carrier have and do cancel overage dependents when they do not get satisfactory student status. Although they are supposed to notify us monthly, this does not always happen. Since we self bill, we do not reconcile who we think is covered to who the carrier thinks is covered (the carriers are supposed to do this) and have run into situations where the employee doesn't notify us until a year or more after the child loses eligiblity. In these cases, no COBRA is offered. We don't like that this happens, but it can and does despite everyone's best efforts to avoid it.

To the best of my knowlege, nothing requires a group health care plan to disclose any Medicare regulations.

Thanks Pax and JReddi! http://www.buddybuddy.com/d-p-reg.html has especially been helpful with domestic partner registration requirements.

The Medicare penalty is applicable to the Part B premium only. However, the regs do specify that an individual does not need to enroll in Part B if they are covered by an active group health care plan after they turn 65 and gives the individual a grace period of 7 months after they lose the active employer group health care coverage in which they can enroll in Part B without incurring the penalty.

Does anyone know of any web site or publication that may list all locales that have registration for domestic partners other than California, Massachusetts or the Vermont civil union act?

Yes but the regs do state that eligible expenses are those incurred to allow you and your spouse (if applicable) to work or attend school. How do you verify that the ex-employee has another job for the remainder of the year and is not just taking some time off?

This is similar to reimbursment of ortho expenses where one fee is charged event though services are spread out over a period of time. We've dealt with this situation with an employee enrolled in a PPO plan with a $500 deductible and 70%/30% copay when the OB was out of network. We asked the doc to provide a breakdown for the cost of a pre-natal visit, the sonogram, the blood tests, delivery, etc. then calculated the reimbursement based on that less what the plan would reimburse. And yes, prenatal visits should be considered services eligible for reimbursement when incurred if you have a breakout of the cost.

I have to agree with Sarah and Lori. The comparison to paying a hospital bill by line item is not really valid. We're not looking at line items here but if any services were received and what the dates were. Fed regs do not allow a reimbursement if there are no services and state you can only reimburse based on date of service - not when paid, but when services were received. If I go to the emergency room on 12/28/04 but don't pay for it till billed in January '05, it's still an expense eligible for reimbursement during the '04 year, not '05, and then only those expenses related to medical care (i.e., no TV, phone or personal care item expenses if an inpatient stay). As Sarah Pearce pointed out, if no services are received - i.e., such as the internist's monthly "retainer" fee, but the participant does not actually see that doc in the month - no reimbursment is allowed. The Chief Counsel Information Letter regarding ortho services warns against reimbursing for everything when initially paid or as paid, and instructs how to spread reimbursement out over the course of treatment as services are received or deemed to be received.

Perhaps I didn't word my response correctly or perhaps you didn't fully understand. 1. Yes, we know the number of community property states is limited and we list those states that require spousal consent on the application and change of beneficiary forms. And we only apply this requirement to people living in the community property state (we operate in 44 of the 50 states and in Puerto Rico and Guam) 2 Yes, our life insurance plan is an ERISA plan and we know ERISA plans are exempt from state laws, but the carriers are not. 3. Our life carrier is the one that requires the spousal consent and we administer the plan to comply with regulations the carrier may be subject to so they (and we) may offer fully insured coverage in states where we do business Hopes this clarifies

Our fully insured life insurance plan held by the Welfare Benefit Trust complys with state community property regulations by requiring the spousal consent to naming someone other than the spouse primary beneficiary.

Our plan currently states that coverage ends the end of the month in which a dependent child over the age of 19, but under the age of 23, ceases to be a full time student. We are thinking of amending the plan to provide coverage until the end of the year in which the child ceases to be a full time student and are wondering what other employers/plans do.

Better question - Will this thread turn into another very long, very rambling, off the subject thread that bashes not only benefit professionals and the decisions they need to make but human resource professionals like the last posting by Banality? No offense intended, just my humble opinion after following the last thread to the bitter end.

There has definitely been a violation of privacy and a lack of good sense here. But, I believe HIPAA rules only apply to health care information collected by or used by the health care plan. I don't believe the HIPAA regulations apply to information volunteered for disability or life insurance situations.

I have been called stubborn, but I prefer tenacious. Here's what the Social Security Admin law says regarding SCHIP coverage - see section (b)(3)© - that the SCHIP coverage not substitute for coverage provided by employer plans. SEC. 2102. [42 U.S.C. 1397bb] (a) GENERAL BACKGROUND AND DESCRIPTION.—A State child health plan shall include a description, consistent with the requirements of this title, of— (1) the extent to which, and manner in which, children in the State, including targeted low-income children and other classes of children classified by income and other relevant factors, currently have creditable health coverage (as defined in section 2110©(2)); (2) current State efforts to provide or obtain creditable health coverage for uncovered children, including the steps the State is taking to identify and enroll all uncovered children who are eligible to participate in public health insurance programs and health insurance programs that involve public-private partnerships; (3) how the plan is designed to be coordinated with such efforts to increase coverage of children under creditable health coverage; (4) the child health assistance provided under the plan for targeted low-income children, including the proposed methods of delivery, and utilization control systems; (5) eligibility standards consistent with subsection (b); (6) outreach activities consistent with subsection ©; and (7) methods (including monitoring) used— (A) to assure the quality and appropriateness of care, particularly with respect to well-baby care, well-child care, and immunizations provided under the plan, and (B) to assure access to covered services, including emergency services. (b) GENERAL DESCRIPTION OF ELIGIBILITY STANDARDS AND METHODOLOGY.— (1) ELIGIBILITY STANDARDS.— (A) IN GENERAL.—The plan shall include a description of the standards used to determine the eligibility of targeted low-income children for child health assistance under the plan. Such standards may include (to the extent consistent with this title) those relating to the geographic areas to be served by the plan, age, income and resources (including any standards relating to spenddowns and disposition of resources), residency, disability status (so long as any standard relating to such status does not restrict eligibility), access to or coverage under other health coverage, and duration of eligibility. Such standards may not discriminate on the basis of diagnosis. (B) LIMITATIONS ON ELIGIBILITY STANDARDS.—Such eligibility standards— (i) shall, within any defined group of covered targeted low-income children, not cover such children with higher family income without covering children with a lower family income, and (ii) may not deny eligibility based on a child having a preexisting medical condition. (2) METHODOLOGY.—The plan shall include a description of methods of establishing and continuing eligibility and enrollment. (3) ELIGIBILITY SCREENING; COORDINATION WITH OTHER HEALTH COVERAGE PROGRAMS.—The plan shall include a description of procedures to be used to ensure— (A) through both intake and followup screening, that only targeted low-income children are furnished child health assistance under the State child health plan; (B) that children found through the screening to be eligible for medical assistance under the State medicaid plan under title XIX are enrolled for such assistance under such plan; © that the insurance provided under the State child health plan does not substitute for coverage under group health plans; (D) the provision of child health assistance to targeted low-income children in the State who are Indians (as defined in section 4© of the Indian Health Care Improvement Act, 25 U.S.C. 1603©); and (E) coordination with other public and private programs providing creditable coverage for low-income children.

Needless to say, I agree with Papago. What you cite is the section allowing enrollments due to loss of other coverage. Please show me the section that allows cancellation that says enrollment in a SCHIP program, and it specifically states SCHIP, is an event to allow cancellation of coverage? Are you suggesting we ignore what's published in the Federal Register?

G Burns- While the regs do list losing eligibility under SCHIP as a reason to allow a change to add dependents, they do not specifically list enrollment in a SCHIP program as allowing a participant to drop dependents. However, when the relevant final Treasury regs were published in the Federal Register - online via GPO access (wais.access.gpo.gov) entltled - Deaprtment of the Treasury Internal Revenue Service 26 CFR Part 1 Federal Register January 10, 2001 "In response to comments, the rules udner the proposed regulations that allowed an employee to change his or her election in response to a change made udner a spouse's or dependent's plan has been clarified and broadened. Under the final regulations,t he rule applies to coverage available from any employer plan, including any plan of the same employer and any plan of a different employer. In addition, the regulations have been modified to allow an employee to elect to participant in a cafeteria plan if the employee (or the employee's spouse or dependent) loses coverage under a group health plan sponsored by a governnmental or educational institution, such as a state program under the State Children Health Insurance Program (SCHIP) (footnote 9) THE REGULATIONS DO NOT ALLOW A CAFETERIA PLAN PARTICIPANT TO CEASE PARTICIPATION IN A CAFETERIA PLAN IF HE OR SHE BECOMES ELIGIBLE FOR SCHIP COVERAGE DURING THE YEAR BECAUSE OF A CONCERN THAT SUCH A RULE WOULD VIOLATE A FUNDAMENTAL PRINCIPLE OF TITLE XXI OF THE SOCIAL SECURITY ACT THAT SCHIP COVERAGE NOT SUPPLANT EXISTING PUBLIC OR PRIVATE COVERAGE." Footnote 9 states - Added to the Social Secutirty Act by section 4901 of the Balanced Budget Act of 1997, Public Law 105-33. Also, as I said, we've reviewed a number of state eligibility guidelines for SCHIP plans and have found that while all are ADMINISTERED by Medicaid, they state they are NOT Medicaid. Florida Healty Kids, for example, consists of Medicaid, Florida Kid Care (their SCHIP program), Medikids and others- http://www.floridakidcare.com/partners/index.html. The eligiblity guidelines state that the SCHIP program is not Medicaid and that in certain circumstances if you have family coverage available from an employer, you CANNOT enroll in Kid Care. The program also charges a low monthly premium which Medicaid does not. Even if you make more than the income limits, Florida allows you to buy into their SCHIP program. Doesn't sound like Medicaid to me. just my humble opinion

The Social Security regs which set up the state healthy kids program prohibit dropping group coverage to put the kids on the plan. This is also in the Section 125 regs and most state healthy kids plans I've reviewed for our associates also state the kids are not eligible if enorlled in group coverage and some even is not enrolled but available. State Healthy Kids program (SCHIP) is NOT part of Medicare or Medicaid.

This was discussed in the past on this site and I think may have a "Q&A" entry. IRS rulings say if the blood is banked because of a visible illness or disease, then the expenses are reimbursable. If it is banked only as a "just in case" situation and there is no disease or illness present, then the expenses are not reimbursable.

Its my understanding that HIPAA does not apply to disability or life plans or health information collected by those plans. However, the information should still be considered confidential.