Mary C

try RISA Section 27-20.4-1

I think you also need to provide more information in your post, too. For example, you say you weren't informed of any changes. What changes were made? Also, you don't mention if you were at the end of your approved leave time. You may get more information from your human resource department (that's what they are there for) than your boss.

QMCSO's are not applicable to spouse coverage - only dependent children. Massachusetts and Rhode Island do have laws that if its ordered in a divorce decree that the employee continue to cover the ex-spouse on the employer's plan, the employer must allow it. Coverage continues until the earlier of age 65, other coverage, the employee is no longer eligible or either party remarries.

Our plan coverage to age 19, 23 if full time student and proof of student status is required.

The regulations say if an employee terminates and then rehires within a "reasonable" amount of time, then all elections must be reinstated as if they had never left. They do not define "reasonable". We use 60 days.

Kirk - in 1997-1998 California passed a law that said employers were to provide extended COBRA coverage to retirees and their spouses who met certain age & service requirements for five years or until the retirees qualified for Medicare. This was immediately challengened in court and preempted by ERISA. California then went back and revoked that law and rewrote it to require any insurer who wrote a group contract covering employees in California to offer this coverage (identical to the group contract they were coming off of). This was not able to be preempted because it regulates insurance, not an ERISA plan or Federal COBRA. The extended coverage for all events was tacked on to the existing regulations for retirees in the state's insurance code and, according to experts/news releases I've read, is also not subject to preemption. I am not a lawyer and can't comment on whether the requirement to provide notice of extended coverage can be preempted or not, but California has for years required that employers send a copy of their HIPP (Health Insurance Premium Payment) program to employees who have had a COBRA qualifying event when the COBRA notice is sent and this requirement has survived challenges.

Managed to get my hands on a copy of the regulations - the employer only needs to notify the COBRA participant to contact the carrier to possibly continue the coverage longer and the carrier collects the premium for the additional coverage. This only applies to insured plans and is written into the California Insurance Code so it is not subject to ERISA preemption.

I asked a question about this law a few threads down and have since found the text of the regulations. While the Federal regs do not require a notification that the COBRA period is expiring, we do notify COBRA participants within 3-6 months before the end of their COBRA period and tell them to contact the carrier for possible conversion - a lot of states require this. To this letter we added the notification language for participants in the state of California who were over age 60 and had worked for the employer for 5 years to contact the carrier for possible eligiblity to continue COBRA longer. (This regulation was passed a few years back). We plan to amend this language to become more broader and direct any California participant to the carrier for possibility of continuing coverage longer.

Has anyone had a chance to review AB 1401 which took effect for events after 1/1/03? As I understand it, anyone who experiences a COBRA event after 1/1/03 in the state of California who was covered by an insured group plan is eligible for 36 months of COBRA. A few years back, California tried to extend COBRA for indidivuals over age 60 until they became eligible for Medicare. This was quickly challenged in court and ERISA preempted it. The law was rewritten as part of the Insurance Code and the insurance companies, not the employers or COBRA administrators, became liable for carrying these folks for the extra period of time. The only obligation the employer or COBRA administrator has is to notify these individuals of their right to elect continued coverage by contacting the carrier after COBRA expires. What I'm trying to determine is if the new AB1401 works the same way? i.e., the employer or COBRA administrator carries the COBRA participant for their normal 18 or 29 month period (if disabled) and then the insurance carrier is responsible for billing and administration of the remaining 36 months. Any thoughts?

the key here is the timing of elections. If he elects the retiree plan and enrolls BEFORE he elects COBRA, then under COBRA regs he can have both. Any coverage in place PRIOR to the COBRA election does not disqualify a person from being eligible for COBRA. Its only when you become covered by another plan after your COBRA election that would make you ineligible for COBRA. Also, check the plan document. The eligiblity provisions in our retiree health care plan explicitly state that you can only have our retiree health care plan or our COBRA , not both.

If COBRA is not available, don't rely on the company to come through and give her benefits back right away. In order to avoid becoming uninsured, start shopping for personal policies immediately - start with whatever carrier she had group coverage with. The state in which she resides may also have a policy for uninsured or uninsurable individuals. Also ask the plan she belonged to for a HIPAA certificate. Any time spent covered by any insurance will go toward fulfilling the pre-existing exclusion limitation under a new plan as long as she has not been uninsured for more than 63 days since her loss of coverage. In addition, HIPAA has provisions that affect the personal marketing side that supposedly make it easier to buy a personal policy (I don't work with personal policies so I'm not real sure about these provisions.) Good luck

zernik - try posting this on the cafeteria board here - i've seen similar questions there, but don't remember the answers.

There's another regulation to consider here - HIPAA. HIPAA states that the birth or adoption of a child is an event to allow the enrollment of the child and any family member in health care within 31 days of the birth or adoption. This includes employees who had previously waived coverage may now elect it.

Personal experience with DOL backs up no COBRA for DP's. A former employee called the DOL because we did not offer DP COBRA. In our converstion with them, they concurred that the regulations only cover legal spouses and dependent children, not domestic partners. Similarly, if the plan allows you to enroll your dependent parents on the plan, they would not be eligible for COBRA either.

We're a nationwide company that has seasonal fluctuations in our workforce needs and have utilized a similar program that we call "Voluntary Time Off" or VTO instead of layoffs. May not be exactly like what you are doing, but our employees like it.

Kip - under what event? According to the COBRA regs, the only qualifying events to allow COBRA to be offered to depedent children is is the loss coverage due to an employee's termination, divorce, death or legal separation, entitlement to Medicare or the child reaches the maximum age allowed under the plan. There is NO qualifying event listed in the regs to allow COBRA to be offered due to a change of custody. If the regs have changed, I'd be interested to know when and how. However, if the employer wants to offer COBRA for an event (change of custody) that is NOT listed in the regs, they will have to continue to do so for any dependent child who loses eligiblity in similar circumstances. And they should check with the insurer and their COBRA TPA (if any) to see if they will go along. I speak from experience - we wanted to offer COBRA in a similar situation and were promptly refused by both our COBRA TPA and the insurer.

If the child is enrolled in your plan and the father regains custody, this is NOT an event listed in the COBRA regs to allow for continuation of coverage. While the child is no longer considered a dependent eligible for the plan and therefore has experience a loss of eligiblity, it is not an event for COBRA. However, since the regs are only the "minimum" you need to do, you will need to make a decision if you would allow this as an exception. If you do, you will also need to allow it for all employees whose covered dependents may move out of their household for any reason.

Papogi is right, but I think the "termination" date he is referring to is termination of participation in the FSA plan, not termination of employment since the employee is still with you, but only on a part time basis.

Federal regs prohibit you from collecting the amount reimbursed but not yet contributed. And you can't gross up the employees wages on the W-2. Part of qualifying as an FSA plan is that it would need to operate as insurance and that the plan is at risk for the full annual pledge contribution from the first day of the plan year. Just as the plan gets the forfeitures at the end of the year, the plan could also lose money when the employee gets all the reimbursement early in the year then leaves.

We allow our retirees to cover domestic partners. However, we only contribute toward the cost of the retiree's coverage - any dependent coverage is paid for entirely by the retiree whether its a spouse, dependent child or domestic partner. Because of this, there is no imputed income problem.

According to the Thompson COBRA guide, the Texas law states that coverage under it ceases if the individual is eligible for similar coverage under Federal law. So if the individual is eligible for COBRA under the Federal regs, they aren't eligible for Texas continuation which is only 6 months in the case of termination or 12 months in the case of divorce or death.

Since they were entered as "pre-tax" it was really to the employee's advantage since less taxes were withheld. I'd have a conversation with the employee, tell them what happened, and correct the election for the new plan year.

There are also COBRA obligations imposed on FSAs that differ depending on whether they are HIPAA excepted or not.

This is under the Medicare Secondary Payer act which has been around since the early 90's. Although most companies have fully insured plans, the Department of Health and Human Services and the Department of the Treasury (both of which are involved in sending out these Secondary Payer Medicare Reimbursement requests) ultimately hold the employer responsible for repayment. We've dealt with a number of these and even though the first notice for repayment went to the carrier, they are also sent to the employer, especially since the insurers did not respond when the requests first went out in the 90's. One agency actually told me I wasn't very good at my job because I did not keep on top of the insurer to get them to pay!

Someone in our office recently attented a benefits conference where they believe they heard that Massachusetts adopted a new law whereby employers are required to communicate to employees the total medical rate in addition to the employee contribution rate. I've searched the Massachusetts code on-line and can find no reference to this. Does anyone have any idea of any new requirements in Massachusetts? Can you provide me the cite? Thanks. Mary C