jsb

If the employee's cost is significant or they have other coverage, I can see why they might want to discontinue. If the employee must pay, I don't believe that you can force them to continue. The employer is required to continue its contribution, but if the employee fails to make payment (or make arrangements to make the payments), you can drop them.

As usual, I think the answer depends on the employer's military leave policies and health plan rules as expressed in the plan documents. We would allow the employee to enroll in our plan upon return to active employment status (enroll within 30 days, coverage starts first of following month). If employee fails to enroll within first 30 days back to work, loss of the governmental coverage available while on active military service would trigger a qualifying event to allow the member to re-enroll in our plan. I think military coverage ends 60 days after active service ends. Have to watch the timing of the loss of military coverage or could experience a break in coverage.

And then there is HIPAA. Recommend your client find a good TPA.

Reposting. Really could use some insight from the experienced administrators in this group. Thanks.

EGTRRA permits in-service distributions (eg. current, active employee who is a plan participant) from a governmental 457 plan to purchase governmental DB service credit. As a trustee-to-trustee transfer, this is not a taxable event. Question: Can a post-service distribution (eg. former employee who still has money in your plan) to purchase governmental DB service credit be handled in the same way, without tax consequences, as a trustee-to-trustee transfer? For the discussion, let's assume that the 457 plan has fully adopted EGTRRA flexibility and the separate DB plan will accept the distribution. We can't find where this is prohibited, but neither can we find where it is permitted. Any cites greatly appreciated! Thanks in advance to all.

Many plans have a "living benefit", but you must be diagnosed as terminally ill to access it. Our plan will pay up to 50%. Check with your broker. But unless the employee's disability is also terminal in the short run, this will not help her. Hopefully she has designated her favorite church or charity as her beneficiary.

Should not be difficult for the person to get a doctor's or therapist's note "documenting" the successful treatment of the anxiety condition through hypnosis. I'd be inclined to find a way to pay the claim. Subluxation of the mind....

Wouldn't hypnosis in this case be treatment for anxiety? Is there any difference if a hypnotherapist does the treatment, or if it is done by a psychiatrist? At lease it is not self-administered, as would be GB's tee martoonies.

GB - Fortunately, I am past most daycare expense. But I had a provider who was a flat monthly charge, regardless of # of days my son attended in any given week. The daycare agreement called for 2 weeks worth of paid vacation and up to 2 weeks of paid sick leave for the provider. You got no break when your child was not in attendence due to the child's illness, your family vacation, or the provider's vacation. Flat rate, monthly in advance, 12 months a year, 2-week termination notice, period. Pay late or try to pay partial...find a new provider. It was not negotiable, it was the provider's business terms. In this situation, I was actually buying a whole year's worth of day care services to allow me to work, albeit paying for it a month at a time. Why would anyone accept this arrangement...quality care at an overall reasonable value compared to the market I was in. Lisa - Which part of this shouldn't be reimbursed: the provider's vacations, my planned vacation week, the week my son had the flu or the week the provider had the flu? Way too many variables for what was an annual daycare arrangement. I still would contend that a one or two week school break (why is this any different than a planned vacation?) should not pose any problem at all. This is not an attempt to circumvent taxation on a couple of hundred bucks, but a legitimate expense to allow the employee to have quality daycare throughout the year so that they can come to work for you. Will theplan allow the employee to change their election to $0 for the affected week(s) based on the qualifying event (reduction in work hours)? If not, perhaps the plan should be amended to permit this change frequency in order to accomodate the reality of the school's work schedules and plan administration needs. But what difference does it really make if the employee has $10,000 (say, 45 weeks x $225) of "legitimate" expense during the year?

Assuming a $5,000 annual election, at $225 per week your employee would only need to actually utilize 23 weeks of paid care during the entire year in order to qualify to receive their entire election. You shouldn't worry about the few weeks that your employee doesn't "technically" need care as long as there are more than enough care-weeks utilized to warrant full reimbursement.

Does the "Scope of Services" section of your contract spell out who is responsible? Because this is apparently an issue, it needs to be spelled out. We (employee benefits office in HR department) control eligibility for changes. Our TPA implements what we send. We have agreements with our carriers (fully insured plans) which also allow us to control changes and certify the the changes to the carrier. They accept that our process will be at least as stringent as anything they might come up with.

I think both MaryC and PhilB have hit it on the head...collection agencies will give you no quarter but the CMS may be able to help you out. Since it would have been CMS sending you to collection, only they can stop it. Can the client get off the hook? No, probably not. If client should have paid primary, it should have paid primary. But I'd sure be looking to the TPA for indemnification for charges, penalties or other costs, especially since the TPA has already admitted some culpability for not forwarding notices. And if the TPA's inaction caused client to lose its ability to contest the charges to CMS, then the TPA should pay that too. If the TPA won't step up to the plate for their error, you need a new TPA.

Under this logic, when the parent has to pay for care, but stay home with the child because of the child's illness, that day would not be reimbursed. ?? Same for provider's paid sick day?? It cost the parent $225 for day care for the 3 days worked. Reimburse it. ($5000 divided by 12 is $417 per month, which is way less than the $900 per month your employee is paying for care. Unless you are reimbursing before money is withheld from pay, I'm not sure why this is even an issue.)

Recommend that he give his parents a vacation at the end of the year and utilize the paid care. Then he can make an appropriate election during your Annual Enrollment. Arguably, he does have a status change because he no longer has need for the Sept - Dec care. But whether that change is occurring now, or actually occur until September, is the operative point. I would try to justify making the change now (effective 4/1/03?) as long as he is within 30 days of something. (eg. the parents' retirement, the decision to put the kids with the parents in Sept - Dec?). I think worst case he no longer needs Sept care, which would be a status change. Good luck.

It would depend on why the catastrophic coverage is lost. As long as there is a status change event permitted by your plan, and the change request is timely, it could be allowed. If he simply dropped the other coverage and now wants onto your plan, I think not.

b2kates - Yes, we received subsequent notice from court releasing the original order. But it is a "...no longer required to provide coverage" notice, rather than a "...remove from coverage" type order. You are suggesting that this would be a COBRA qualifying event? Can you provide a cite? QDROphile - coverage was added involuntarily. Plan does not specifically address this issue, but we seek to be as permissive as the law allows, unless we specifically exclude something. As a change event, this would not be excluded by our document, though we need to establish justificaiton that the change would be permitted under 125, hence the instant question.

Employee's dependent was added to plan (against ee's will) because of court order. Plan is a 125 POP. Court order is rescinded after several years. Can employee (or employer?) make election change to drop dependent from coverage as a mid-year change? Let's assume that the dependet is otherwise still eligible for coverage and that dropping dependent changes premium from "ee+1" to individual coverage level. Any cites appreciated. Thanks in advance.

Employer provides paid military leave, including benefits. Employee wants to drop spouse and daughter from health insurance plan because they now have TriCare. (This will result in more supplemental pay for employee.) Would you permit this under your cafeteria plan or do you consider TriCare "governmental coverage" which would preclude this change? While we would like to accommodate, we're having a hard time with the consistency of this request as the military leave has had no effect on benefits cost or eligibility. If TriCare is just any other "group coverage" (the military being an "employer"), the consistency conundrum is resolved. Any thoughts (and cites!) appreciated.

Let's assume that the children are eligible dependents of your employee (they would be under my plan without regard to residence). Let's also assume that there is something that will constitute a "support order" (could be a formal medical supponr order, could be a statement from from the divorce decree, etc.). Make sure that the health carrier that will be adding the kids agrees with these determinations! The issue then turns on 1) whether or not your plan would permit a mid-year election change under these or similar circumstances, and 2) whether they have had a "qualifying loss of coverage" under another group health plan that would permit you to make a change under your plan. If the children are losing coverage due to an annual enrollment change by the ex, this should be a valid reason to allow the change, IF your plan permits this type of change. On the other hand, if the ex is simply dropping the kids mid-year for no reason other than it is too expensive (which is not a 125 reason), this might not be a valid reason if your plan is a 125 plan. By your facts it doesn't seem that there would be a change in premium, which may permit you to allow the add without an election change. Sometimes the easy route is to have your employee encourage the ex to get the court order. Then help out by making sure that your employee can supply the ex with suggested wording for the court order that you will need as plan administrator to permit the change! However it turns out, you have landed sqarely in your employee's corner regarding resolution of this problem. Good luck!

Hopefully your payroll system allows you to set "priority" levels regarding payroll deductions. Set 457 priority to last, which allows all other deductions to run and the 457 deduction to take whatever is left over. Whether or not you permit "100%" as a deduction amount, a fixed $100 deduction will not be taken if the employee has no money after other deductions are taken.

For the governmental types out there - does anyone have a form they would be willing to share for in-service distribution from a 457 to purchase service credit under a governmental DB plan? Thanks.

Is her mother her IRS dependent?

Appreciate the response. I guess the problem is definition of "governmental" plan. Federal, state, county, city,...? . The examples cited in IRS text lean toward indigent, grant-type, or mandatory medical programs. I suppose that medical coverage for activated military could loosely fall into this category. Similar guidelines apply to medical plans of educational institutions. But the example cited is mandatory coverage for a student, where losing coverage is a status change, but acquiring the student coverage is not. Would this same situation exist relative to medical coverage acquired through civilian employment with the government, which is arguably more similar to employer-sponsored group coverage? The feds exempt themselves from a lot of things, but how different really is the fed plan for its employees than my county-sponsored plan?

Is acquiring health insurance through the military (a governmental plan?) a life status change that would allow revocation of a health plan election? In this case, the affected employee receives supplemental military pay, including full health benefits. Reducing coverage would increase the supplemental pay. Could also apply to the spouse of an activated military member who is covered as a dependent under the military health insurance plan. Your insights appreciated.

Within reasonable boundaries, medical treatment is medical treatment. Probably need to reimburse the procedure. Travel is another thing. Is the same procedure available locally? Would the IRS allow a deduction for travel to Paris for a routine procedure available in the US? Would it make a difference if the person trying to deduct travel from California to, say, the Mayo Clinic for treatment of tendonitis? (I think I'll load up my FSA next year and go to Hawaii for some tennis elbow treatments.)