KIP KRAUS

God Bless Hillary. She did so much for this country, and is doing tons for New york. Being articulate gets a lot done. Didn't mean to upset any Hillary fans. After all she is compassionate, and represents us New Yorkers.

Mojo: I’m aware of all the glittering generalities of why employers offer medical care coverage to their employees. Didn’t I say they were the ones who designed employee health care benefits in the first place? Yes they did it to be compassionate and keep their workforce healthy for productive purposes. Just because people are used to this doesn’t make it an entitlement. I’ve also seen the studies on how expensive it is to replace dead employees, and how it is perceived that a healthy work force is more productive, common sense would tell you that, studies only give credence to the obvious. You may want to check out your statistics on the uninsured. The last I heard less than a third of the population was uninsured and that’s only based on whom you believe, and on what day of the week you hear it. In addition, about ½ of those are uninsured by choice because they refuse to pay premiums. There are people in this country that won’t even take their children to get free immunizations. That underinsured argument for a national health and welfare program is getting to be a tired issue. There are probably as many people in this country that are underfed and undernourished too. You don’t see Hillary Clinton trying to take over agriculture to make sure that the underfed and undernourished are taken care of do you? No, because there would be no perceived justification for it. We can’t continue to use the standard cliches used by politicians, such as it’s for the children, unemployed and uninsured to continue to collect and spend tax dollars on programs that don’t do a damn thing but hire people to administer them. I guess you must have missed the recent article concerning the 15 consumer groups who are suing 28 pharmaceutical companies for defrauding Medicare and Medicare patients by overcharging $800 million dollars for prescription drugs in 2000? I want the same people who administer Medicare to direct my health care.

I don’t see the relevancy of the company being in financial difficulty and them allowing former employees to get their vested account balance. They clearly cannot use 401(k) monies to get them out of financial trouble. Contact the Department of Labor.

In my opinion G what other employers are doing is irrelevant and immaterial. To expect an employer to do anything as magnanimous as what MM is doing is preposterous. No matter where the money is coming from to pay health care premiums for three years is magnanimous. Many people daily have the tragic loss of a loved one do to some sort of accidental death. The people in the Oklahoma bombing didn’t get the financial attention that the survivors of the WTC are getting. Is this that more of a tragedy, or is it because of how the tragedy occurred? Don’t get me wrong I think the outpouring of sympathy and money is great, but don’t look a gift horse in the mouth and kick it in A--. An entitlement mentality is what has gotten this country into major political and financial turmoil. You’re only entitled to what you earn or what someone out of generosity wants to give you, and when it’s given and not earned don’t complain that it’s not enough. Dave, I couldn’t get to the letter that you referenced, but let me say this about the so-called inequities in the health care system. Employers and insurers were the organizations who developed group health care coverage, employers out of a sense of compassion for its employees and insurers to make a buck. The U.S. government started the ruination of the health care system by creating HMOs and requiring employers to implement them in the late 70s. There is no empirical data that I have ever seen that suggests HMOs have reduced the cost of health care. It only covers up the real cost. Contrary to what the general public would be lead to believe there are no people dropping in the streets for lack of health care. Even the punks in the streets who shoot each other are getting medical care for free. There are so many federal and state funded health care programs today that if a person really cared about having coverage it’s available, but even here in New York with the Child Health Plus that’s advertised on TV and web sites many people don’t enroll their children. Finally, the mentality that employers are responsible for your family’s health care is absurd. You are responsible for your family’s health care. The fact that employers offer health care coverage does not make it entitlement. Other than the socialistic federal program appropriately called COBRA (the fangs of which are stuck into employers long after an employee decides to quit, or gets fired) employers have no obligation to provide health care coverage to anyone. Do we want the federal government running our health care program like they run Medicare and Medicaid that’s fraught with mismanagement and fraud? That’s what you get with entitlements. If anyone reads this diatribe they have more time on their hands than I do. Happy New Year.

I’ve never heard of an intermittent STD plan that allows employees to take a day at a time. Typically an STD plan has a waiting period (1 week) before benefits are even paid unless disability is due to an accident or a person goes into a hospital and then sometimes benefits are paid day one. The 90-day benefits typically are during a twelve-month period. It could be a calendar year or a 12 consecutive month period beginning with the disability. Most STD policies require a person to be totally disabled from performing the duties of his/her job before it will pay. Taking one day at a time for illness is a sick day policy and typically payroll continuation. Even if an insurer would write a day-at-a-time STD policy the premiums would be prohibitive.

actualy 502 does say that if the wig is recomended by a psychiatrist for the mental health of the patient it can be covered.

Under at least one state insurance law in the north east it would qualify, I can't recall the state, but it may be Mass. or Conn. It really does not provide a cure or prevention of an existing disease so I wouldn't allow it. It's a nice compasionate thing to do, but in my opinion it doesn't count. Maybe it has been approved by the IRS but I've never come accross a ruling like that.

I agree with the DOL. She should be able to enroll in your group plan. My question is, why would an over age 65 active employee be using Medicare and an HMO supplement plan as her primary medical coverage when she could have used your group plan as a primary medical plan in the first place?

I give up. What kind of census data and for what type of plan(s)? Used for what purpose? We can prepare our own census data for all plans in house. Our actuarial census data is prepared by our actuary for the pension plan in his annual statement.

My point only is that they are not a medical necessity. Night guards may be. I don't think that just in case is a medical necessity. UV rays are harmfull to yourskin. Should OTC sun screen be reimbursable?

Doesn't sound reasonable to me. What's medical cure for wearing sun glasses?

I agree with all the previous responses. In addition, if we are talking about a 401(k) Plan the litigants can come up with any agreeable dollar amount that they want to calculate form the last valuation date to the date they are wanting to use. Have the QDRO give you the dollar amount. This is not uncommon.

It appears to me that you have several issues that may or may not be related. Your first statement is that your husband is mentally ill. Then you indicate that he was on sick leave for 4 weeks due to surgery, prior to, I assume his mental illness. If his employer has a short-term disability plan, it would require medical evidence that he is totally disabled from performing his job, first off, due to the surgery. The next issue seems to be that he has bipolar disorder, which most short-term disability plans would require an expert to diagnose before paying benefits. They will not take a surgeon’s diagnosis for Bipolar disorder when it should be diagnosed by a specialist. You could contact the Department of Labor in your area and talk to them about this situation, or contact a good lawyer. Your husband may also be covered by the Americans With Disabilities Act, which the Department of Labor should be able to give you some information on.

Since you are probably not subject to state insurance law on a self-insured dental plan my guess is you can. However, the biggest concern with association plans is adverse selection. Those who know they will use the plan will join the plan. Unless you can make the premiums attractive to everyone, you will not get enough participation to make a plan worth while. If, for example, you figure the monthly premiums to be $29.00/mo. for single coverage and $50/mo. for family coverage, which is not unreasonable, who is going to join if all they know they will get reimbursed for is two cleanings per year? If the participants are going to pay 100% of the cost of the plan are you going to asses them at year end when there was not enough premium during the year to cover costs? It’s generally not a good idea to provide insured or self-insured dental to an association unless you make participation mandatory for every member, and that isn’t very likely. Lastly, if you insist on doing this plan, plan design is the key to any success, so get some professional advice.

I don’t think changing Carriers is an automatic reason to let a COBRA participant change plans. An employer can change carriers and not change benefits, in which case I don’t believe COBRA participants can change because of this.

If the plan allows for the purchase of an annuity then once the annuity is purchased from an insurer, I presume, then the administrator has nothing else to do. It's my assumption that the libility becomes the insurer's and the plan has discharged its duty to the beneficiaries.

Did the attorney’s really use the word “promised’? Sounds like a play on words to me. Did you promise anything or just inform incorrectly? Get an attorney to respond. It’ll cost less than paying the additional $11,000.

Good Idea Christine

OK, I give up Theresa. How does one monitor sick leave for a telecommuter? Does one just wake up one morning and decide that he/she doesn’t want to work? Does this person call in and say I’m sick I can’t work today, or just not work?

Pentex: The states that require STD plans are New York, New Jersey, Rhode Island, California and Hawaii. I believe that all of these mandated plans are governed by the Workers’ Comp. Boards in their respective states. The plans do very and you must provide at least the mandated level of benefits for employees who reside in each state. Some states allow you to insure these benefits through commercial insurers and others, like California, I believe requires you to use the state fund. If you go to the Google search engine and search under the Workers’ Compensation you will find a site that will lead you to state WC sites that will give you the details.

Christine: I’m not a tax accountant, but I seem to recall that the employer is only required to automatically report a certain IRS assumed amount of tips in an employee’s income. If this is still true, and all of the wait staff is making well in excess of this amount wouldn’t it make sense that the amount the wait staff gives to the sub-wait staff should be given before tax and then it would have to be reported by the sub-wait staff and not the wait staff ? I don’t understand how they are giving the sub-wait staff after tax tips?

Why would you? My guess is that if the plan document doesn't allow it it can't be done. If the beneficiary wants an annuity he/she can buy one.

I assume that you have a disability-waiting period that is less than 6 months, because it is my understanding that LTD benefits are not FICA taxable after 6 moths of disability? If your payments are subject to FICA then the third party payer is required to report disability payments to you and you are required to file your portion of FICA on a quarterly report like you do now.

It’s not uncommon for employer group medical plans to have a prescription plan that is part of the medical plan and not a separate plan. If this is the case with your employer plan then prescription coverage is not a take- it- or- leave- it option, and my guess is that if you want your husband in your plan you are going to have RX coverage for him in your plan.

Are there mitigating circumstances, i.e., does the employee not read, was the employee unconscious for 120 days, did the employee’s dog eat the original paperwork, is this a responsible employee in all other respects, does the employee have an advisor that didn’t advise him/her? The plan is what the plan is and it states what the perimeters are. Maybe he/she should get his/her TS card punched and chalk it up to a responsibility lesson.