Sandra Pearce

Employees retiring age 55 and up may continue health coverage at a rate that is considerably less that our COBRA rate but approximately two times our active employee rate. Stock-held companies considering adding retiree benefits need to be aware of the FAS 106 liabilities.

I did this several years ago. As I recall different states have different rules about what a hospital may charge or not charge the entity (audit firm) doing each audit. The bottom line for us was that because of PPO discounts, often per diem discounts, there was rarely enough savings to offset the cost to the plan for the audit. Didn't find this to be a benefit, but thought it was worth a try.

The Newborns' and Mothers' Health Protection Act protects mothers and their newborn children regarding the length of hospital stay following childbirth. I am not aware of anything in the act which relates to enrollments. HIPAA does have special enrollment rules which allow adding a newborn when requested within 30 days of the birth. This does not mean that the newborn is automatically covered during that 30 day period if the request to add the newborn is not made.

To snapper - Qualified Beneficiaries elect COBRA during the twelve-month period of established rates. Therefore a rate established on 5/1/2000 may be changed on 5/1/2001. A Qualified beneficiary who began COBRA coverage on 2/1/2001 would be subject to the same adjustment in rates as all other qualified beneficiaries on 5/1/2001.

Jeanine, thanks for your reply. The first case would not break out the counseling charges which, of course, would have allowed us to pay that portion. We haven't actually received the claim on the second one. We are self funded.

Our health plan has recently had two cases where adolescents were placed, by their parents, in Wilderness Camp programs as an attempt at intervention related to emotional and/or drug abuse problems. These programs are in some cases licensed by the state but most are not JCAHO accredited. The two cases we had required the parent to pay in full for the “admission” to the camp – usually a stay of from 21-30 days. Both camps stated that they would assist the employee in filing a medical claim for the “admission.” In one case that assistance was a statement on letterhead with the total charge stated to be tuition. Because the facility does not meet the standard required in our Plan we have denied coverage. I’m interested in any information others may have regarding these camps and whether or not the plans you administer provide coverage for this type of “admission.”