KIP KRAUS

I’ve never been involved in underwriting auto insurance but it would seem to me that even if a firm is offering group auto they would have to comply with laws of each state in which they are offering coverage. Therefore, it seems to me that if auto insurance in the east is more expensive then it will be more expensive in a group plan. I know that under an employer's fleet auto insurance the underwriting takes into consideration the laws of each statee where they have autos or trucks.

I’d like to know how you have maternity related carpel tunnel? Is she trying to have her previous leave count toward her LTD waiting period? Sounds like someone is trying to scam the LTD carrier to me, but if the carrier is smart they will question the claim.

The rational behind requiring an original bill is that originals can be doctored up to put by putting higher expenses on the bill and then photo copying it. Keep a photocopy for your records and send in the original.

I’ve never filed the reports but it is my understanding that employers file quarterly reports on FICA withholdings. They can make appropriate adjustments each quarter. They should be able to refund the FICA by the next quarter.

My experience has been that while these types of plans are a convenient way for employees to pay for such coverages with minimal individual underwriting they are not necessarily the most cost effect for employees. In addition, when employees discover that they could have gotten less expensive coverage from an independent agent or another insurer they tend to blame the employer for letting the selected insurer sell them a bill-of-goods. These plans are a convenient way for an insurance agent to generate great commissions, but not necessarily a windfall for employees.

If the retiree moves out of the HMO service area it is a qualifying event for changing plans. I would allow the change.

If you don't allow your employes to continue regular medical coverage during a WC case you should offer COBRA to him/her and eligible dependents.

Your employer’s plan document should define participation service and vested service. This will give you the answer. Ask for a copy of the plan document.

If you are merely taking over the administration of an existing 125 plan I don’t see how an open enrollment would be proper. A change in administration doesn’t change the status of the plan or the participants.

I disagree somewhat with JersyGirl. If the new vision plan is merely replacing the old plan it is not necessarily an improved plan. If, on the other hand the new plan is really an improved plan over the previous plan then I agree with her. My opinion also assumes that there was no laps in vision coverage, but Kimb’s post doesn’t make this clear.

I’m not sure what the problem is. If your group medical plan has premium rates based on single coverage two person coverage and family coverage providing this information to budgeting managers is a reasonable expectation. It doesn’t give them PHI because all employees similarly situated have the same premium cost regardless of individual health. It has nothing to do with HIPAA as far as I’m concerned.

You say that under the terms of the LTD plan an employee remains an employee of the company for two years. Is this the LTD insurer’s standard contract language so that they can continue to receive premium payments for these employees for two years or is it something that your employer decided to do? In any event, I don’t believe that the definition of an employee for purposes of the medical plan needs to be determined on the definitions in a separate LTD contract. The employer should be the one who determines when an employee on LTD should be terminated from employment as to benefits under a medical plan. You of course have to make coverage available during the FMLA period and offer COBRA continuation coverage after FMLA coverage ends assuming you are subject to these provisions. As to actually terminating their employment, I have in the past been cautioned by labor attorneys that setting a specific time limit for considering a person terminated from employment because of a long-term disability could cause ADA problems. Obviously at some point it could reasonably be determined that a person may never return to employment based on their medical prognosis for recovery.

I agree with oriecat. We need to know exactly what the problem is. Is the union plan the same plan design as the non-union plan? Are both plans insured through the same insurer under one contract? Does the management of Company B have a non-union medical plan?

If the equivalent fully-insured rates of Plan B and C have been calculated accurately based on claims, admin. and stop loss expenses they should have been adjusted up or down at each plan renewal. At what point during the plan year was it discovered that they were rated incorrectly? How did you determine that they were rated incorrectly? What changed the underwriting projections that indicates they need adjustments? If the original renewals were based on acceptable underwriting standards at the beginning of the year and actual experience currently differs from the original assumptions it doesn’t necessarily mean they are incorrectly rated. If, for instance you are only into the first 5 months of the plan year, you really don’t have enough information to determine that the rates could be off. We really need to know on what basis you have determined that the rates are incorrect.

There is no requirement to file a plan document. You shoud, however provide everyone with an SPD of the 125 plan.

If these are self-insured plans with or without stop loss insurance each plan should be rated on claims experience, and expenses. Arbitrarily deciding to increase the equivalent fully-insured premium rates by an across the board percentage increase to me is unreasonable. This method to me has nothing to do with the actual separate cost of each plan On the other hand, if the employer wishes to apply an across the board increase in the amount that employees contribute to each plan that would make sense. Your recent underwriting analysis may be correct and an adjustment to each plans equivalent full-insured rate may be prudent. I, like GBurns am curious as to how the relative value of these plans was determined. This is a new one on me.

Christine Not sure exactly what you are saying. Is the C-Corp the parent company of the wholly owned subsidiary? If so, why can’t they sponsor the plans and have the subsidiary adopt them by corporate resolution? Maybe I just don't understand the tax reasons for what they are doing.

I’m not sure what you mean when you say, ”Neither of these ideas sounds right to me”. Regardless of what the renewal rates for the individual plans are the employer surely has the right to increase the plan cost to employees across the board. An employee cost increase does not necessarily have to be related to the renewal increase.

What kind of premiums are you talking about?

How does one disclose personal medical information during enrollment? Was it verbal, and to whom? There shouldn't be any reason to put such information on an enrollment form.

I’m not sure what individual health plan selection and cost data you are talking about. Why would it be necessary to let managers know an individual’s health plan selection? It would seem to me that a summary of the selections by plan without identifying individuals would suffice, i.e., 2 employees in with single HMO coverage; 5 employees with family Comprehensive coverage, and the costs associated with each. This type of information would not be considered PHI.

blackacre I agree with alawyerinblack LTD plans that are EDEA qualified will pay LTD benefits for a person disabled prior to age 65 for a minimum of 5 years. Typically the LTD payment language reads something to the effect of; if disabled prior to age 65 benefits will be paid to age 65, but not less than 5 years. From your post it appears that you may have an ADEA qualified payment schedule. Some LTD plans also allow active employees to be covered until age 70. Of course at age 70 the typical benefit would last for only 1 year. As to your retiree issue, I agree with mroberts. LTD is intended to replace lost income from the employer. In addition, by definition ADEA covers employment discrimination. This of course doesn’t mean that a retiree couldn’t have an ADEA issue related to previous employment.

Typically when an employer wishes to allow an employee to receive WC weekly benefits and STD benefits the WC benefits are primary with the STD payments supplementing the WC payments. WC benefits are a legal entitlement and must be paid in accordance with your state’s WC laws; therefore they must be primary in my opinion. I assume that your STD benefits are self-insured if paid via payroll? If so, you can set your STD plan up to do exactly what you are intending to do. I also am assuming that your WC is provided via an insurer. If so, WC payments are paid by a third party and they will handle the non-taxability of those payments. Any STD payments to off set the WC payments as paid via the payroll system would be subject to W-2 earnings at year-end. One word of caution, paying additional benefits to a WC claimant can be a disincentive for that person to return to work in a timely manner especially of the combination of WC and STD payments would give the claimant 100% of pre-disability pay.

I’ll take a stab at this from what I understand. If you, as the employer are processing the FSA claims then you may be receiving PHI and I would say you might be a covered entity under the HIPAA privacy rules. If, on the other hand, you have a TPA processing claims then you need to make sure that you have an agreement with them that covers their use of PHI under HIPAA.

What triggering event?