Mary C

What about protecting the plan? Fiduciary duty? As a benefit professionals we are required to administer the plan according to its provisions. Unfortunately that means if someone didn't elect coverage when eligible then gets ill and wants coverage, we can't do that. Is it morally or ethically right? Depends on your point of view, but I feel its part of my job to protect the plan and its provisions. That may mean being harsh or cruel to one person in order to preserve government qualification of the plan for everyone else. By the way, our "big wigs" have the same plan options and contributions towards coverage as the rank and file.

If she elects COBRA, not only are the unreimbursed funds in her account available to her, but the entire year's election (less reimbursed amount) is available. She will need to keep contributing (paying) to the plan her normal monthly contribution amount plus the 2% admin fee (if you charge it) in order to keep FSA COBRA in force.

OOPs - just went back and read the original post. Since the plan is self-insured, it wouldn't be subject to state law.

Massachusetts and Rhode Island law both provide that ex-spouses (and legally separated spouses, too, I assume) are to remain on the plan if ordered by the court or divorce decree at the same cost as prior to the divorce until either spouse remarries, the employee is no longer employed, the ex-spouse turns 65 or becomes covered by another group plan. For the attorneys out there - we challenged this law and lost.

I am the employee and also the benefit manager and this is how we and all our HMO's are handling this. Again, as you said, it could be open to interpretation.

Under HIPAA you are not supposed to be able to access an adult spouse claim information without an authorization. I can access mine and my minor child's, but cannot access my husband's. And with our HMO, I am not able to access my 19 yr old student's information either since he is an adult.

The COBRA provision that requires 150% of the cost for disabled individuals is only if the disabled individual is on COBRA and meets the requirements to extend the coverage from the normal 18 month COBRA period to 29 months. The disabled then pays 150% of the cost or premium for months 19 to 29. This shouldn't have any bearning or consideration on a healthcare plan or medical reimbursement plan for ACTIVE employees.

We are a large (100,000 employee) multi-state company and extend COBRA time period only upon receipt of the SSA award as long as it is presented to us within the initial 18 month COBRA period. We were asked once allow the extension based on a doctor's note and the fact the participant was receiving California state disability payments, but denied the request.

I received an email asking for the cite that would allow employers to cancel medical coverage while an employee is on an unpaid FMLA leave. To do so, the coverage must be contributory for active employees. The guidance can be found in the final rule implementing the Family and Medical Leave Act of 1993 published in the Federal Register in 1995. "Q&A section 825.212 What are the consequences of an employee's failure to make timely health plan premium payments? (a)(1) In the absence of an employer policy providing a longer grace period, an employer's obligations to maintain health insurance coverage cease under FMLA if an employee's premium payment is more than 30 days late. In order to drop the coverage for an employee whose premium payment is late, the employer must provide written notice to the employee that the payment has not been received. Such notice must be mailed to the employee at least 15 days before coverage is to cease, advising that coverage will be dropped on a specific date at least 15 days after the date of the letter unless the payment has been received by that date. If the employer has established policies regarding other forms of unpaid leave that provide for the employer to cease coverage retractively to the date the unpaid premium payment was due, the employer may drop the employee from coverage retroactively in accordance with that policy, provided the 15-day notice was given. . . . . . . . hope this is what you're looking for

FMLA does permit the employer to cancel the employee's coverage if there is an employee cost and the premiums are 30 days behind. The coverage can be canceled back to the date the last payment purchased coverage provided the employer gives the employee a 15 day notice.

This topic was discussed a while back on the boards. I believe there was an IRS revenue ruling or opinion that if the cord blood would be used to help correct a birth defect or disease, it was allowed. However, if it was collected only as a precaution for "possible" future use, it was not allowed. Try a search of these boards or the Q&A's.

Our health care plan has an inpatient hospitalizaiton copay of $500. The inpatient hospitalization began in November 2003. Patient was released in January 2004. Employee was not enrolled in flex spending account for 2003, and signed up for $650 for 2004. He has sent in a claim for reimbursement of the copay from the flex spending account for 2004. Is this expense eligible for 2004 reimbursement and can you provide why?

Not without running a foul of the Medicare Secondary Payer regulations.

G burns - Why couldn't a company have both a consumer driven plan and an FSA? after the first $1,500 in health care expenses, which are paid directly from the plan's reimbursement account, the participant would be 100% responsible for the next $1,500 in expenses. Even after surgery if there were $250 left in the FSA account, it could easily be claimed for any expenses the participant is 100% responsible for the rest of the year. And don't forget any OTC expese that the plan would not cover anyhow, if permitted by the FSA plan. Our FSA plan document simply states that any unreimbursed expense, other than cosmetic, is eligible. That could encompass the entire $1,500 the participant would be 100% responsible for under the consumer driven plan. Also, I am working on the assumption he's talking about 2004 expenses in which case there are 10 more months before the money is "thrown away". Its too late to plan for 2003 expenses.

Your plan is one of the new "consumer driven" plans. They are typically set up with 3 tiers - 1. The first tier, the pca account in your case, pays 100% of the procedure up to the PCA balance. If you have a healthy year and don't use the entire balance, it "carries over" to the next year. Sort of a "Benefit Bank" to offset any expenses that would normally apply to the second tier in succeeding years. 2. The second tier is employee or participant pay all. Our plan is set up where this tier is the same amount as the first tier. In other words, if your PCA is $1,500, and you use the entire account, then you are responsible for the next $1,500 in expenses you incur. 3. Third tier is similar to traditional insurance with co-pays, etc. If you son is having cleft palate surgery, then total expenses incurred including doctor and hospital will probably exceed your $1,500 PCA. In that event, there should be no problem submitting them to your FSA. HSA stands for Health Spending Account where you can set aside tax free dollars to help pay the deductible for a high deductible health care plan.

If coverage was previously waived due to having COBRA coverage, our company requires that COBRA be exhausted in accordance with HIPAA. We do not consider voluntarily dropping or losing coverage because they didn't pay the premium as a family status change event under 125 to allow enrollment.

I may be reading between the lines, but I'm assuming that the WC leave is an unpaid leave. Going on or coming off an unpaid leave is considered an event to allow a corresponding change. If that won't work, consider that manual payment of premium while on leave, i.e., it is not being deducted from his pay on a pre-tax basis is after tax method of funding. I don't know what your plan descriptions say, but ours allow dropping coverage paid for on an after tax basis at any time since the premiums are not going through the 125 plan. just a couple thoughts.

What does the underlying SPD say? COBRA is a continuation of the group plan. The full time student may stay on the parent's COBRA coverage until the limiting age for full time students under the group plan or until whatever age full time students may stay on an actively employed parent's plan. The same is true for non-full time students - they may stay on the parent's COBRA coverage only as long as they would have been allowed to stay on an actively employed parent's coverage. If the reach the limiting age while on the parents COBRA coverage or drop out of school, and therfore lose eligiblity to stay on the parent's COBRA coverage, it is considered a second qualifying event that may allow them to have a total of 36 months coverage from the original qualifying event.

You will need to read the contract. We have a self-insured waiver of premium, whereby the company continues to pay the premium due as long as the participant meets the carrier's definition of disabled. All insurance forms, approval letters, etc. refer to it as "waiver of premium." To the employee the continuation is identical to a fully insured waiver of premium, but it really isn't. The advantage to us is that by self-insuring the disability continuation, we have lowered our premium overall. The advantage to the carrier is that if we should switch carriers, our disableds go with us to the new carrier.

As a certified benefit specialist and a mother with two children in braces, I vote to pay. Our orthodontist charged one fee for braces, no matter what the color - one child has clear and the other has his school colors.

As recently pointed out to me by a representative of the Department of Labor, the COBRA regs are only a "floor" and only describe the very minimum required. If the employer, plan administrator or COBRA administrator wants to make a loss of coverage due to cessation of contributions by the employer an event to allow COBRA, it can be done as long as that employer, etc., does it consistently. In terms of employee relations, ceasing to cover dependents on short notice will not be favorably received and perhaps offering the option of COBRA coverage will help to mitigate any adverse reactions.

What about the medical savings accounts in the new Medicare Act? They accept employee or employer money and can be rolled over each year.

Another thing to consider is the entitlement to A or B or both. While entitlement (eligible for and enrolled in) in Part A is sometimes automatic, the beneficiary must actually elect and pay for B. However, COBRA can still be terminated if they are only entitled to Part A and choose not to enroll in Part B.

No, you are not required to allow a participant to switch plan options at termination. In fact, COBRA only requires the opportunity to continue the SAME coverage they were enrolled in when actively employed. While you can do it voluntarily, what you do for one person must be consistently offered to all future terminations. As far as problems, there could verly likely be problems with your carrier allowing them to change and possibly refusing to accept them mid-year which could open a whole lot of other issues. It might also cause some pressure from your active employees to allow them to change options with a mid year event, too.

Be careful on what the child is actually enrolled in. Final regulation guidance does allow for canceling coverage if the plan the child is enrolled in is Medicaid, but the regulations also say "The regulations do not allow a cafeteria plan participant tio cease participation in a cafeteria plan if he or she becomes eligible for SCHIP coverge during the year because of a concern that such a rule would violate a fundamental principal of Title XXI of the Social Security Act that SCHIP coverage not supplant existing public or private coverage." SCHIP stants for State Children Health Insuran Program and typically use "Healthy Kids" or "Healthy Start" or something similar in their name and are admistered by Medicaid.