Mary C

Corrections to past elections can be made in extreme instances, but the regs require that once an election is made, it must remain in effect for the entire plan year unless certain events have occurred. AND AROSE SIGNED AN ELECTION FOR PRE-TAX CONTRIBUTIONS! The regs do consider a mistake of fact a reason to change the election, but the example given to satisfy the consistency requirement is someone enrolling in dependent care account who does not have any eligible dependents as a mistake of fact. I don't see how a mistake of fact can occur in electing pre-tax contributions vs. after-tax contribuitons. And I don't understand how this majorly reduced retirement benefits since most plans base their calculations on gross income, not income after pre-tax contributions, and income earned over a number of years, not just one or two.

Yes. Its still a valid expense whether the lenses are bought for future use or current use.

This may be off the subject, but few years ago I took my 10-month old to the ER when he fell out of a grocery cart and hit his head, they gave him less than a tablespoon of children's tylenol. Since we were certifying all claims in HR before submitting them to the insurance company at the time, I saw my bill and that they were charging $54 for the tylenol. The insurance company paid the whole thing. A week later, I got a survey from the hospital. I replied that it was criminal to charge $54 for 1 tablespoon of tylenol. A week after that I got a call from the patient representative to explain what had happened (they did not have a billing charge for an individual dose of children's tylenol and I was charged for the whole bottle) and later a check for $54. So yes, hospitals do itemize drugs and yes, insurance companies do pay for OTC drugs.

Try California AB Bill 1401 I think it amends the following sections: California Health & Safety Code 1373.621 California Insurance Code 10116.5 California Labor Code 2807.5

We don't "require" our retirees under 65 who qualify for Medicare as disabled to enroll in Medicare BUT our plan pays secondary and will pay as if they were enrolled. That means if the retiree does not have Medicare, they will have a huge gap in coverage. For example, for an average hospitalization, Medicare will pay the entire amount less the deductible. Since out plan pays secondary as if the retiree had Medicare, our plan would only consider the deductible amount and pay accordingly.

How about using the event of the children gaining ther coverage provided by the employer of their father as the reason for the mother to drop coverage?

We are a large (100,000+ employees), fortune 500 company. We allow the employee to continue coverage at the active employee cost for the length of the original leave (usually 1 year). Then COBRA is offered.

The new law has not been challenged as of today. California has based this new law on their older law, Senate Bill 761, which only mandated insurance companies to continue coverage for COBRA participants age 60 and over at the time of the qualifying event. Senate Bill 761 placed the same notification burden on employers that the Cal Cobra extension does and to the best of my knowledge it has not been challenged since it was passed in 1997.

COBRA law changed in 1998 to allow anyone who had other existing coverage, including Medicare, at the time of the qualifying event, to be eligible for COBRA. Its only after the employee has elected COBRA continuation coverage that enrolling in (not just being eligible for) other coverage, including Medicare, makes them ineligible for COBRA.

Does anyone have or know of guidelines on how long an employer and plan sponsor needs to keep paperwork regrading medical support orders that were never qualified or no longer in effect? Particularly in the following examples: 1. Newly received medical support orders that are not qualified because the parent no longer works for us, or is in a position that is not eligible for benefits 2. Qualified medical support orders that have been rescinded by the court or the child is overage or the parent has left the company

Another aspect to consider is whether the overage dependent became disabled prior to or after the limiting age of the contact. For example, our plan will coverage a disabled overage dependent of a newly hired employee if that dependent became disabled prior to his or her 19th birthday. If the dependent became disabled after their 19th birthday, our plan will not cover them.

HIPAA regulations give a plan participant a special enrollment period of 30 days after a birth in which to add the child. We use this as a guideline for our actives AND cobra participants. Premiums for the newborn must be paid from the date of the child's birth and we give the participant 30 days from the date the enrollment form is received in which to pay all back premium for the child. Thereafter the child's premiums are due the same time as the parents. You're right COBRA doesn't have guidelines to handle this sort of thing so we have tried to give the COBRA participant the same rules as we use for our active employees since COBRA does say the participant needs to be treated as similarly situated active employee.

According to FMLA regualtions, if employees on other types of leave who do not maintain payments have their coverage canceled retroactively to the day the last payment purchased coverage, you may also cancel coverage retroactively for those employees on FMLA leave who do not maintain payments provided you provide the 15 day notice that you are going to do so.

If he has health care benefits on his last day worked (the qualifying event date), yes he is eligible for COBRA continuation.

We are a large employer (100,000 + employees nationwide) and have had many viatical assignments on our group life coverage. The viatical settlement companies typically request we complete a questionnaire which contains questions regarding continuation of coverage due to disability, waiver of premium, conversion, amounts, suicide clauses, beneficiaries, etc. If there is a true waiver of premium in place on the policy or if the waiver is self insured where the company continues the premium once the employee qualifies as disabled, buying the policy becomes very attractive - no premiums for the viatical company to pay and an almost guarantee of coverage continuing. Also, the payout to the insured has generally been in the 30-60% of face value range. Typically ownership is transferred by executing an absolute assignment, not a bene designation. We also have a living benefit provision in our plans, but it requires the expected lifespan be under 12 months. It appears that the viatical settlement companies aren't so picky.

Yes you can elect to continue the FSA without the health care plan. The government considers the FSA to be a separate, stand alone medical plan subject to a separate COBRA election. In addition, active employees are usually not required to enroll in a group health care plan to enroll in the FSA plan at the same employer.

GBurns - we put in an HRA last year utilizing Lumenos. It has the medical reimbursement amount, and when that's used up a 100% out of pocket amount, then insurance protection. We (the employer) fund the medical reimbursement portion of the account with an annual amount that partially rolls over into the next year if not used, and yes, we DO charge the employee a premium which can be attributed to the insurance coverage that pays expenses over and above the medical reimbursement and deductible amount. mary c

If the SPD is the plan document or incorporated into the plan document, wouldn't it have to be amended to comply with the requirement to amend all plan documents? Thompson's HIPAA Manual recommends using a short (4 paragraph) summary in the SPD since the regulations don't specifically address what language to use in the documents.

What plan? What does the SPD say? For the most part, HIPAA did away with actively at work provisions for health care plans, but you can still require the employee to be actively at work to enroll in life or disability plans.

If the reimbursement request was generated prior to 1997, there was no legislated statute of limitations. You can dispute the debt by providing proof of the plan's timely filing limit, but that is not always accepted as a defense. Generally, proof of a timely filing limit is the plans' SPD and plan document, HMO certificate of coverage or any other "official" documents that states the time limit.

The three year limit is only on brand new, first time sent reimbursement requests. If the request had been sent to someone before, whether its a TPA, Union, plant location, home office, insurer or whoever, the three year limit does not apply. Its now considered a past due debt and the collection agencies involved are NOT accommodating or considerate.

Yes if its defined that way in the plan document.

DevoFan: Severance is considered an up-front, lump-sum payment in lieu of earned salary to ease in transition of employment, not a bonus or windfall. If you reemploy at the same company before the end of your severance, you are collecting earned pay. You are, therefore, being paid twice for the same week. If the company erroneously issued you two paychecks for the same week, would you would feel you were entitled to keep both? You've been paid since January 1 without having to work so in fact, you've really not out any money at this point. Is double dipping so important you risk losing any seniority/vacation/ continued pension accrual/medical benefits you built up over 15 years? Think of it, 3 weeks vs. 15 years? Could you walk into a new position at a new company with the same seniority, pay and benefits as a 15 year employee? I don't mean for this to sound so harsh, and I'm sorry if it does. I've been caught in workforce reductions and have received severance, too, and believe me, in some instances the company were to extend an offer for reemployment based on repayment of a small portion of severance, I would have jumped on it.

From the employer's point of view - At the request of our carriers, we pay and report COBRA premiums paid only once a month to the carriers. (They do not want to be contacted and have payments sent in every day and prefer the once a month reporting). Our report goes out mid-month and includes all premiums paid through the report date. If you haven't paid by the 10th of the current month for coverage, there's a good chance you will show canceled. For example - our carriers cancel coverage at the end of each month until the next COBRA premium report is received. So all COBRA participants (unless they have paid more than 1 month is advance) are canceled February 28. The COBRA report for March will show all payments received after February 15 and what month they apply to. If your last payment was postmarked February 20 and was for February, we would report your paid through date of February 28 and the HMO would update their records to show coverage during February 28, but none for March. If you called to verify coverage for a procedure in March, you would be told you were canceled. It is our experience the carriers will NOT update to show coverage until payment is received. So depending on when your boss paid for coverage in the month, he may still show as canceled.

DevoFan - we are a large (120,000 employee) nationwide company and yes, if we rehire within the severance period (i.e., in your case within 15 weeks after your termination), then we do require a repayment of the remaining severance.