jsb

Oh Jimminy Crickets!! None of this affects reimbursing the spouse. If this ex is like mine, you reimburse first and figure out the details later. The issue is reimbursement of the employee with pre-tax dollars. If you deny, then the employee must use post-tax money to pay the spouse. But don't most of us already do this at the doctor's office, pay with post tax money? It's only later that we request reimbursement from the pre-tax account. But if you have to deny, at least give the employee some suggestions (like, that they pay all of the next bill) so that if the expense would otherwise qualify for reimbursement they will have proper documentation next time. With the collective experience of the posters who live this stuff every day, we can't seem to get on the same page as to how this might work. How does some poor employee who requests reimbursement a couple of times a year stand any chance of figuring out how to properly use their benefits if we don't help them through it?

We handle this by imputing income for DP dependents UNLESS there is a recognized, direct LEGAL relationship between the employee and the DP's dependents, such as adoption. I do not want to become the "IRS QUALIFIED DEPENDENT" police and set up a process where an employee is trying to prove the IRS dependency status. I suppose you could use an affidavit or certification of some kind where the employee attests that the dependent is their legitimate IRS dependent, but I don't recall seeing any kind of ruling or advisory that specifically addresses DP dependency issues in cafeteria plans. I do not want to invite the controversy. When we get to the point of an employee insisting on the tax preferred benefit, I'll let my counsel determine if I am required to do so under applicable state and/or federal law, and move on accordingly. Perhaps not very proactive, but at the moment I've only got about 40 DPs with coverage (not all with dependents), versus about 2800 retirees with rather pressing Medicare Part D concerns to deal with. The feds will eventually resolve all DP questions.

Then request a new bill from the doctor, pay your half, and ask the doctor to refund the money to the ex. (or for GB, get a bill from the office supply house, pay it - and deduct it - and have them credit Jim's account for his "extra" payment.) Or pay all of the next medical bill. Or the next medical bill ... or the next one ... the HSA money will remain available to be spent in the future, if necessary.

What "authority" are you looking for? Give the person reasonable written notice that an error was made and what you are going to do to correct the error.

Does the HSA require that the expense be PAID for or INCURRED before reimbursement can take place? If PAID, I'll agree that there may be a documentation problem, but would still argue that the pass-through-the-spouse arrangement should be acceptable. If the standard is INCURRED, I don't see that there is any problem; I've been doing this for years in FSA world with my ex. Granted we've had to go back to medical providers a couple of times for clean copies of bills, but that's just to make sure that I can provide "clean" documentation to the TPA. I see no difference (though can't provide a cite) between my standing with the ex in the doctor's office and each handing over a hundred bucks, or having either one of us pay the full $200 and collect the hundred from the other party ... as long as there is reasonable documentation of the expense. (Ever been with a group to a restaurant where you threw your $10 in the pot and someone else put the whole thing on their credit card? Did you pay for your lunch? Of course you did. What if you gave your friend the $10 when you got back to the office. Did you pay for lunch? Yes, you incurred an expense for lunch and then paid for it.)

Because the employee will reimburse the ex-spouse, the expense becomes that of the employee. How far must the employer go to verify the 213 deductibility? Is the account really an HSA (with a companion, qualified HDHP attached) or is it an HRA or FSA?

Submit a receipt from the medical provider showing a covered service for an eligible dependent. Reimbursement should not be a problem.

I would be very nervous about never making a COBRA offer to somebody who lost benefits due to a reduction in hours or termination of employment. Even if someone failed to pay FMLA premiums (though under our plan, employer paid ee coverage is always provided) I would still turn around and offer them COBRA, just so there will never be any question as to whether you did or you didn't. Your case sound potentially hazardous - denied WC claim, non-response to FMLA info requests, termination of employment based on a deemed resignation. Go with your TPA and send COBRA. Odds are you won't hear from her and you're all done. And if she does try to come back on you in the future, your offer is documented and your defense in place.

I think your state wage and hour laws will control whether or not you can take a mandatory payroll deduction for health insurance (or anything else, for that matter) without signed authorization from the employee. Shouldn't be a problem for NEW hires (from a purely legal, condition of employment perspective), but may be very problematic to impose such a scheme on existing employees. In CA, you could pick up existing unionized employees if it became part of the union contract, but I don't think there would be a way to legally deduct from unrepresented (current) employee payroll without a signed authorization. Pay $150 (or whatever) per month less salary and make the coverage 100% paid by the employer. Same result.

You might encourage the employee to elect COBRA, at least through the time period that would cover his claims. This gives you both an "out" to handle this properly. If 8/1 was term date, and COBRA offer timely made, the QB still has until at least until 9/30 (60 days) to make the COBRA election.

What is "DC FMLA", and why only 16 weeks of entitlement? It is not at all difficult to arrive at 24 weeks of federally protected FMLA in a 24 month period, so I am curious about this restriction.

We call this "controlled leave." It's usually step 2 or 3 in a progressive discipline process (following at least a first level verbal counselling, and maybe even a written warning). Requires that a doctor's note be provided for every unscheduled absence due to illness. Must state reason for absence, expected length of absence, any physical restrictions, and any accommodations that can be made to assist the employee's return to work. If the absence is due to a protected and documented FMLA leave, the doctor's note requirement is waived as it has already been covered by the FMLA leave application policy. Failure to provide proper documentation (doctor's note) is failure to comply with a reasonable employer requirement and results in absence being considered AWOL. Too many AWOLs, goodbye.... HIPAA is not an issue. Granted, it should be for the doctor if you are trying to deal directly with the MD, but your requirement is on your employee to provide the note, and once provided by the employee it is not HIPAA covered. HOWEVER, you are likely subject to other records confidentiality laws so the information should be carefully safeguarded. Good luck. Been there too....

If the father sets his deduction amount based on total expected annual child care expenses (with the summer break factored in) then there would be no need to change the election to allow for the mother's visitation time. I would agree, however, that an election change could probably be allowed on a prospective basis based on the change in care provider.

Could the QB want coverage only for the time period paid, and would you accept payment if that was the case? If you reject the initial payment as insufficient, wouldn't the QB still have the balance of the 45 days to pay in full? I think the safest bet is to provide the full 45 days for payment to bring the COBRA payments current, and even then "current" is really only to the end of last month because there is still a 30 day grace period for this month! Make sure that your Trust document doesn't inadvertently violate COBRA payment provisions as they have evolved through case law.

Under the law, the employer has the right to ask for verification of your illness and your need for leave. If there are questions about the written documentation provided, a phone call can help clear it up. As noted by Steve72, the doctor may or may not be able to respond depending on the level of authorization you have provided. I suppose the employer could have contacted you to advise that they needed more info, then you could have contacted the doctor, then the doctor could have provided additional written documentation back to you, and you could have provided it to the employer. But this could also be viewed as rather intrusive. If you need the protected leave, it is in your best intrests to have the information provided by your medical provider, whether directly or through you.

Mamaeck, sorry you perceived my post as a personal attack. It may have been direct and perhaps blunt, but it is the same advice I would give to my own family member in a similar situation. Based on your self-reported experience in HR and benefits, it is even more perplexing that the erroneously low COBRA rates caught you by surprise. You originally asked: "Is there anything I can do about this?" Yes there is. 1. Write an a letter to the employer explaining your situation and the error. Ask that they make good on the rates. Get a copy of any plan document governing this employer's plans. Read the documents to identify any other remedies you might have and to identify the appeals process. If your request for the lower rate is denied, carefully adhere to the appeal process and time deadlines and appeal the decision to the next level as determined by the plan. Continue to file every permitted appeal in a timely manner until there is nowhere else to go. 2. After all appeals are exhausted, take your case to an attorney with experience litigating this type of claim on behalf of claimants. Find out their success rate. If they tell you you don't have a case, check with another similarly qualified attorney. If they tell you that you don't have a case ... you might actually not have a case. If the attorney will take the case but wants payment up front, assess your situation and decide if it is worth the risk to pay the attorney and possibly lose the case. Also, determine what you might gain by pursuing the litigation and determine if it is worth the time and effort it will take. 3. If the above steps don't get you anywhere, move on. In the interim, you will probably want to make some arrangement for your health insurance, either by paying the higher COBRA rate, accessing your AICPA coverage option, or purchasing private coverage. You perhaps strengthen any position you might subsequently assert by seeking to mitigate your loss exposure. Also, making sure that your family has comprehensive, affordable coverage should be a high priority.

Different contributions for different groups of employees are not unusual. I have 18 unions representing 23 different bargaining units, plus we have management and other unrepresented employees. While we try to keep things fairly similar, I currently have 4 different contribution levels (have had as many as 8) and 2 separate and distinct offerings of health plan choices. If you change representation units, you potentially change health plan contribution level and maybe even health plans. (I am not an ERISA plan.)

So, if they would have given you the correct COBRA rates, your husband ABSOLUTELY WOULD NOT have taken the other job? If that particular health plan is so important, why is he changing jobs...or are there other reasons which you can continue to be greatful for? Or, maybe, would you have considered the AICPA plan sooner, in which case consider it now? If you are bent on retribution, see if you can get an attorney to take your case, but you may end up having to pay up front as this doesn't look like too strong a case (though I'm not an attorney). Administrative goofs happen. Even bad administrative practices happen. But unrealistic expectations happen, too, and you apparently had no real idea about the cost of health insurance. Make other arrangements for your health insurance and move on. Don't let this eat you up for the next couple of years.

I would agree with mbozek - AARP, EEOC and ADEA are not your problem. I think the real issue is whether or not your plan is vested, and whether or not someone sues you when you terminate it to try and prove vesting. You need benefits counsel opinion regarding your plan document language, vesting, and your past practices in order to properly evaluate your risk here.

Require that the signing of all forms, including those enabling the companion HSA, is a requirement for enrollment in the HDHP. No signatures, no enrollment. On the other hand HDHP is a requisite for an HSA, not the other way around. What if the employee has other coverage that makes him or her ineligible for the HSA? Conceivably they could still get some value from the HDHP.

If the plan permits options, how can you arbitrarily "require" one over the other? What if the guardian objects?

1. If an employee quits mid-year and does not elect COBRA, would he/she be entitled to the grace period? Could the plan be written in such a way that the grace period only applies to participants who are participating on the last day of the plan year? 2. If an employee quits mid-year and elects COBRA but ceases payments before the end of the calendar year, when would the grace period begin for the former employee? If not same as above, could your grace period be written to run 75 days beyond the date that the participant ceases participation? If so, how can this be considered an incidental or minimal extension of time if, say, the participant leaves your plan in the middle of the first month of your plan year? What is available during the extension period, the salary reductions that had been made as of the date of termination, or the whole plan year election amount? 3. If a former employee electing COBRA benefits from the grace period, should additional premium be charged? Would you charge extra "premium" for a continuously employed participant who doesn't make an election for the subsequent year? You must (generally) treat your COBRA participant the same as a similarly situated active employee.

I think the individual is mistaken. Cal COBRA requires coverage for smaller groups, and (generally) provides for an extension of benefits up to 36 months if the Fed COBRA period was shorter and has been exhausted.

As per GB, if the change has not yet gone into effect I believe it can be rescinded. But if it has gone into effect, I think you're stuck. It would get sticky if you were still within the original 30 days and the plan change was effective. You would still be within 30 days of a qualifying event, but part of the rule is that the change requested must be consistent with the event. Marriage might provide you with access to new coverage, so it would be consistent to allow a change based on acquisition of that new coverage (ie. drop your employee only coverage through your own employer). But if you didn't take the new coverage, dropping your employer's coverage would fail a consistency test. Similarly, dropping your coverage (which went into effect) under the new spouse's plan in order to pick up your individual coverage under your own employer's plan might also fail the consistency test.

It's no wonder the order of these rankings, what with the general gullibility of public. I wonder how different things might be if THE SONG was different, and chorused "Mamas, don't let your babies grow up to be actuaries..."