Sandra Pearce

While allowable to have a qualified 401k Plan as a benefit in a Section 125 Cafeteria Plan it is not required. We have our 125 plan and our 401k plans separate; i.e., separate plan documents, separate tax filings, etc. It would seem having the 401k as a benefit under your 125 plan is limiting.

In the state of Louisiana the calculation is based on gross wages. In the determination of "wages" and the average weekly wage at the time of the accident, no amount shall be included for any benefit or form of compensation which is not taxable to an employee for federal income tax purposes; however, any amount withheld by the employer to fund any nontaxable or tax-deferred benefit provided by the employer and which was elected by the employee in lieu of taxable earnings shall be included in the calculation of the employee's wage and average weekly wage including but not limited to any amount withheld by the employer to fund any health insurance benefit provided by the employer and which was elected by the employee in lieu of taxable earnings shall be included in the calculation of the employee's wage and average weekly wage. Using your example in Louisiana the wage definition would include pre-tax benefits. Your state WC statute defines the calculation.

Our company has had dependent life insurance available for employees for the past 25 years with many different carriers over those years. All of our contracts were written with the employee as the beneficiary for all dependent life insurance, spouse and/or child(ren), It is possible the form filled out was actually a combination form for Voluntary Employee Life Insurance - requiring a beneficiary - and Dependent life insurance. Meaning the employee, when filling out the form, believed the beneficiary was applicable to both the employee and dependent life elections. Like one of the other posters I have never seen a dependent life insurance election form with a beneficiary named.

Our company offers benefits that are not subsidized/contributed to by the employer and we do not put up-charges on those benefits. If the vision plan for employee only costs $95 per year, the employee pays $3.65 per pay period (26). We offer the benefit under our Section 125 Plan so it is pre-tax to the employee and it removes some tax burden from the employer as well. Not sure why an employer would want to inflate the cost.

Healthcare.gov has a step by step process for Special Enrollment periods outside of Open Enrollment. Regarding the specific circumstance the wording on the site is: You DON’T qualify for a Special Enrollment Period if: You decide to end COBRA early (and are paying the full cost yourself). You lose your COBRA coverage because you didn’t pay your premiums.

A self insured plan, by it's nature, puts the employer fully at risk for the cost of all administrative expenses and claims whether or not those expenses and claims exceed the cost paid by the employees. When an employee reduces income to pay for a pre-tax benefit offered doesn't that benefit becomes equal to employer paid? I would expect the refund to be retained by the employer. No legal expert here but an HR practitioner with many years of experience in the area of benefits, including self-insured medical plans. This is simply my opinion.

I am curious what change in status prompted the employee to stop participating in the spending account. A reduction in work hours would have been a COBRA event. A medical leave of absence may have been covered under FMLA and allowed the person to continue in the plan, making normal contributions or catch-up contributions upon return.

There is a wealth of information regarding Qualified Medical Child Support Orders on the DOL web site at www.dol.gov/ebsa/publications/qmcso.html If the order is qualified then one of the responsibilities of the health plan is to allow the custodial parent to file claims on behalf of the child and to have benefit payments made to the custodial parent or health care provider. This means you have to provide the custodial parent with the information necessary to file a claim and seek reimbursement for a claim. An ID card is only part of what you need to provide. Add to that a Summary Plan Description, any claim forms or claim filing information, etc.

Our Plan Document and SPD have the following wording regarding pre-tax contributions to health and dental insurance: If you do not file a new Salary Reduction Authorization Agreement form with the Plan Administrator before the start of the new Plan Year, your previous election for Health and/or Dental Insurance Premiums will continue the same as in the previous Plan Year. The Employer will reduce your compensation accordingly. We do provide a notice to make the change from pre-tax to after-tax and vice versa.

We open our enrollment for the plan year 60 days before the beginning of the plan year because we have many employees that travel for 30 days or more out of the country on company business. This is our, albeit imperfect, fix.

The 125 regulations regarding significant cost or coverage changes apply when the person is a particpant in the 125 Plan. Termination of employment would end participation in the 125 Plan. COBRA continuation is offered for the option the QB is enrolled as a participant in on the day prior to the Qualifying Event.

There is no law that requires a health plan to have an annual open enrollment period. HIPAA requires that the plan adhere to HIPAA's Special Enrollment rules.

The four weeks of pay for the female who gives birth is similar to pay for the disability. The bonding time for adoptions for a female employee and the bonding time for the father for birth or adoption could be equal periods with pay. I would check any state regulations that might apply and then consider separating the "disabililty" of the birth from the other leave provisions. Our company is large enough that we must apply FMLA provisions. Those provisions do not require pay. The female employee delivering the child can apply for our salary continuation program for the period in which she is considered medically disabled. Once her disability ends she may continue to use available FMLA leave but must take all available vacation pay before being on FMLA leave without pay. The male employee must use any available sick leave (to care for the medically disabled spouse) and then any available vacation before leave is allowed without pay.

Depending upon what your plan says about deadlines for filing claims, the ex-employee can timely file a claim for out-of-pocket medical expenses incurred during the period of participation in the Plan year (period employed) and be reimbursed the entire amount elected at the beginning of the Plan year.

I reviewed the two sides of our QSLOB each year and if the information provided previously had changed (companies added or deleted, plans added or deleted) then I filed a new form.

I did the QSLOB analysis and IRS forms for our Pension Plans several years ago. The plans have now merged into one. Annually I reviewed information to see if we still qualified. After the first filing I only completed a new filing when we added or dropped a pension plan on one side of the SLOB (acquisitions and sales).

Most employees do not even bother to send in a rejection. They simply ignore the COBRA election notice and if at a later date they accept (within the 60 day election period) the coverage must be retroactive to the date coverage was lost. The regulations simply allow you to not provide coverage for someone who has actually submitted a rejection of COBRA and then later (again within the 60 day period) changed their mind. Your election form must stipulate how you are going to handle this.

The regulations discuss what happens when a QB declines coverage and then later, before the end of the 60 day period, accepts coverage. This QB has notified the COBRA Plan that they have other coverage and if that was the case and the other coverage did not impose pre-existing exclusions then the COBRA Plan could deny or terminate the QB's continuation coverage. However, in the scenario as stated this is not the case and the QB does not have other coverage. Timely payment is sufficient to continue the coverage. I would suggest that the person send in at the same time as the payment the denial from the other company. If the payment is not made timely, within the 30-day grace period, then the COBRA Plan has no obligation to continue the QB's coverage.

If Jim asked to be dropped during his military service because he was enrolled in US military coverage, then his return and discharge from the service would terminate that coverage and that would be a loss of coverage; therefore, he would be eligible for special enrollment in the health plan. This would not change the amount of time that he or his family members are eligible for COBRA continuation.

The new regs require you to send a notice of early termination in a case such as termination for non-payment of premium. You would have the requirement of the HIPAA Certificate of Creditable coverage at the end of the 18th month period.

For medical spending account: If you are saying that they must make one payment for the remainder of the elected contributions for the year, then that would be more strict than the regulations and not allowable. If you are saying that you are allowing them to continue their contributions on an after tax basis then that would be alright although there are certain circumstances stated in the final regulations when you would not be required to offer COBRA for a medical spending account. For Dependent Care account: The regulations do not require you to offer COBRA. If your plan is written with a 90 from termination of employment/participation deadline for filing claims, then there is nothing wrong with reminding the COBRA qualified beneficiary of that. If you are saying that you are reimbursing claims for services rendered within a 90 day period after employment/participation ends, then that is not allowed.

If your document is using the term "Coverage Period," likely that period is defined. Usually the period of coverage would be the period of time that the person is an employee participating in the plan and would end upon termination of employment. The COBRA regulations include spending accounts for that reason. The period of time to file a claim after the end of the employment or the end of the Plan year should also be stated in your Plan Document.

I've had employees bring this type of arrangement to me for consideration as a medical expense in our health plan. Not with a Chiropractor but with the Internist. One was in Seattle, WA and the other in Houston, TX. The physician offers the patient a monthly fee arrangement which would allow the patient access to the physician's services any time during the period of the arrangement for no additional charge. The monthly fee cannot be associated with a specific treatment or service and therefore cannot be paid by either our health plan or our 125 plan.

I handle a self insured health plan and would have no problem retroactively reinstating the dependent.

As you know your employee is obligated to notify you when a dependent is no longer eligible. As you also know sometimes they do not do this. Since you have a routine audit procedure set up, perhaps when you do not receive the response and drop the coverage you could send a letter stating that no response was received to your previous inquiry, based on most recent available information provided the coverage for the dependent terminated XX/XX/XX. Presumably the dates involved would be so far back that the lack of timely notice to the Plan by the participant would eliminate any COBRA obligation. Just a thought from another HR person with similar problems and issues.