KIP KRAUS

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What is your question?????????????

Never been in that cituation, but keep in mind that each plan participant can ask for an recieve a copy of the the complete 5500-C filing and still get the same information.

I agree with Cathie for most part. It sounds like you work for a small employer. If so, they probably have a fully insured medical plan and such plan has an eligibility provision set up by the employer and insurer. If you meet that eligibility provision you are entitled to enroll. Contact the insurer and ask them what the eligibility is. If they won’t cooperate contact the state insurance commission. You still may not be able to get into the plan until open enrollment, as Cathie says.

I agree with G, but 15% certaintly is not unreasonable.

Let me ask you a question about your question. In most cases the objective of the employer is to save money by offering an opt-out program. Why would the employer only want to offer it to salaried employees if they are in the same plan as hourly employees?

Your impression is correct. Employers nor insurance companies generally allow parents to be in their group plans. Why would they want the liability?

Christine: If a significant increase in the cost of medical coverage is a Qualifying Event wouldn’t it apply to the employer plan that is adding the dependent spouse? In other words changing your coverage do to this type of QE would necessitate a change in contribution, wouldn’t it? Just my way of interpreting the regs.

Christine: I don’t know why there would be an issue with Medicare Secondary Payer Act. Does the Act say that an employee who is offered employer sponsored medical coverage must take it in order to have Medicare coverage, I wouldn’t think so. If the employee opts out and has Medicare coverage Medicare would be primary. In any event, I believe an employee can opt to have Medicare be primary over an employer’s plan. As to the employer having the employee attest to having coverage elsewhere, I would say it depends on the employer’s philosophy of wanting employees to have medical coverage. If he doesn’t care, then don’t worry about it. Our company will not allow an opt out payment unless the employee can prove coverage elsewhere with another employer plan.

Have you asked them to put you in contact with at least 3 of their cliants so that you can find out what their experience was? I'd start there. If employees have been overpaid because their health care provider overbilled, or billed in error the employee should repay the plan and then get reimbursed from the health care provider. Nothing wrong with that.

We currently allow employees who retire early (by age 53 or higher) to continue coverage until age 65 at whatever the active employee’s pay for coverage. I have worked other places where we did the same thing.

It would normally be a QE, but timeliness is a key issue. Over 30 days is shakey. I wouldn't allow it after 30 days. I don't think it should take long to figure out that one plan's benefits are better than the other and that the cost is higer.

I would say that if independent contractors are covered under your group plan then they should be eligible for COBRA. I don’t recall the regs. making any distinctions between employees and independent contractors.

Let us not forget that the HMO Act of 1973 was the brainchild of our federal government and the answer to the high cost of medical care. Let us also not forget that the Act required employers to offer an HMO if “Activated” by a “Federally Qualified” HMO. As someone who has seen this process go full circle I believe that HMOs are the ruination of the health care system and the perpetuator of health care inflation. After all, when mommy’s or daddy’s little baby has a sniffle why not take him to see a doctor, it only cost $5 or $10. What is the real cost? Does anyone know or care? Doctors and hospitals are seeing more patients than bargained for and now want more money, and they’ll get. Get rid of the $5 and $10 copayments and get back to the person having some responsibility for a portion of his/her health care expenses, and competition will return. I realize it’s not as simple as that, but HMOs have not demonstrated that they are the answer. On the other hand, as you may or may not know, premiums are a function of how high claims costs are, be it a fully-insured premium, self-insured premium or community/pooled premium. Keep in mind that as Jeanine says an employer is not obligated to provide group medical coverage for employees, but then subsequently to that statement she says she and her husband deserve the medical plan they are in. No one deserves any particular type of medical plan. It is a fringe benefit and that’s all, take it or leave it, which a lot of people in this country choose to do. Jeanine and her husband are just fortunate that they have a choice. I hear what you are saying Jeanine, but most people don’t shop employers by the health care plan they provide unless they have special medical needs for themselves or dependents. As to your comments Larry, I agree that eventually all of the federal and state legislation will force the cost of health care so high that employers will stop offering it, because even if they do it will be so expensive that employees will not want to pay for it. Could this be the subtle agenda of congress to force use into socialized medicine? It certainly has been the agenda of Ted Kennedy’s for years, and more recently Hillary’s. Yes, eventually Uncle Sugar Daddy will take care of your health care needs and maybe as good as they have through Medicare and Medicare, but keep one thing in mind it won’t be free, you will be taxed for it. I thought I might as well get on the soap box.

I’m not so sure that emancipation in and of itself would result in loss of medical coverage. Some dependents become emancipated strictly to get more college grant money. If the medical plan covers students to age 23 how would it know that a dependent became emancipated? All most plans want to know is if the dependent is a full time student. I’ve never heard of emancipation being an issue. That’s not to say it isn’t.

In my opinion a self-insured LTD plan is an ERISA plan. It must be established by a written plan document and you should have an SPD that defines all of your benefit options. Unless the plan states that if you are fired LTD benefits cease I’d definitely have a problem with LTD benefits being canceled just because your employer fired you.

What is it? Something other than group medical insurance, or are you talking about executive medical reimbursement insurance?

Tracy: There are so many things to consider when establishing a dental plan where no prior dental plan exists. You could solicit quotes from insurers and let them determine what your claims are going to be or you can hire a consultant to design a self-insured plan. Depending on what size group you have going the insured route will typically be the most expensive route, they will be conservative in establishing initial expected claims, they will require a reserve, there will be premium taxes, risk charges, maybe commissions and a profit built into the rates. Personally, on a dental plan of 100 or more employees, I’d never purchase a fully insured plan. I would always self-insure. I know there are brokers and insurance reps out there that will try to tell you different, but my answer to them is that there is nothing magic about dental plans or there administration. If I was going to establish a new dental plan I’d design one that covered preventative services only @ 80% of R&C. Then in the second year I’d add minor restoration coverage @ 80% of R&C. It wouldn’t hurt to contact a few brokers and discuss it with them. They will either want to solicit insurance quotes for you or, if they know what they’re doing charge you to design a self-insured plan, and there charge to do so shouldn’t be more than the commission you’ll have to pay to a broker on a full insured plan.

I've never heard of a presonal care account. Why can't the vendor explain it to you?

Most employers who go from a fully insured medical plan to a self-insured or partially self-insured plan do so to save money. I find it hard to believe that their fully insured equivalent rate for COBRA would go from $548 to $1,000. If it did they’re getting shafted by someone. I can’t see how an actuarial calculation got increase that much. By the way, a fully insured rate of $548 for the Empire Blues plan is reasonable. In upstate NY our HMO COBRA rates with BCBS in Rochester are $573.

AFRICA6796: I’ve never heard of this type of situation before. My questions is this, if the loan has been defaulted and a 1099-R issued why would the loan still have to be paid off via payroll deduction? It seems to me that the outstanding balance would get gets deducted from the participant’s account balance as an uncorrectable receivable. If the participant pays the penalty and taxes on the defaulted loan, why make him pay it back any way?

An employer changing insurance companies in and of itself is not a QE, especially if the plan benefits do not change, and there is not a significant change in the employee's contributions. I wouldn't think this change in contributions would apply to a spouse's plan all of a suden being less expensive. Maybe I would want to know what the cost of the dependent wifes plan was before the employer changed insurers, and if it is significant I might let the employee make a change. Just my way of looking at it from the regs. I've seen.

The Plan Year is the determinant. Insurance contracts do not establish an ERISA Plan. An ERISA PLan document does.

Try this site http://www.gov/dol/pwba/public/pubs/forms

There is no obligation by the employer to extend FMLA leave. If the employer wants to allow a person to take a leave of absence beyond FMLA that's the employer's choice. However, no job protection need be guranteed during the subsequent leave of absence.