French

I was advised that an married employee has enrolled in our Dependent Care FSA effective for January 2010 as he is expecting his first baby in May. At this time, he does not have a qualified dependent so I have said that he is not eligible to participate in the plan (and have deductions withheld from his paycheck) until the birth of the baby. Am I incorrect?

In the past, employees who have been declared disabled whether by our LTD carrier or by SSDI have remained in our records as active and have been eligible for the same plans and subsidy as an active employee. We recently changed the criteria so that if you are only receiving SSDI, then you will be terminated and no longer have access to any of our health plans. We have an employee who has been on LTD and SSDI for 2 years but his LTD benefits will end this March. At age 63, he is eligible to retiree from our company but obviously only eligible for Medicare due to his disability. He is also eligible to enroll in our retiree health care plan(s) until age 65. If he were to select our standard PPO plan, is Medicare primary and this PPO plan secondary just like as if he was over age 65?

Thanks. Having reviewed the language of the legislation, I agree with your comments. Do not understand how/why our broker interpreted it to read "when part of" so glad that I asked.

I asked the question because we had received a "compliance alert" from our broker that contained the following language: This law applies to fully insured and self-funded (ERISA and non-ERISA) Group and Individual medical, pharmacy, behavioral health and, when part of the health plan, dental and vision coverage.

Does Michelle's Law apply to a Dental or Vision plan when it is NOT part of a health plan?

I meant the annual Part D creditable coverage requirement. In addition to my initial question regarding an actuary, I am also wondering whether or not charges to provide this service by an actuarial firm are payable from a VEBA. Thanks.

Does the Creditable Coverage determination have to be made by an Actuary?

Can an employer require pre-tax deductions only? We currently allow employees to elect pre or post-tax deductions for the health plans but wondered whether or not we could change to pre-tax only.

Thank you. That is exactly what I've been looking for.

Perhaps my question wasn't clear. We currently have inpatient (60 days) and outpatient (30 days) limits on our MH/SA services. We have no inpatient limits on Medical Services but do have outpatient limits for Chiro, OT, PT etc. With the passage of the Federal MH Parity Act, it was my understanding that group health plans that offer coverage for any mental health or substance-use conditions cannot impose treatment limitations and financial requirements on those benefits that are stricter than for medical and surgical benefits. Therefore I knew we would be removing the 60 days limit but thought that we could retain 30 days limit since they already exist for some medical services. Based on your response, it would seem that all limits must be removed for MH/SA services.

Does the Federal Mental Health Parity Law apply to outpatient behavioral health services if a plan has outpatient limits on Chiropractor and short-term Therapy services like OT, PT?

Thanks for your comments. I may not have clarified my specific question which perhaps is even more complicated as the attorney references both the subscriber and his spouse in the appeal package. So should the salutation be addressed to the dependent, subscriber, subscriber and spouse or the attorney? This happens to be a somewhat contentious appeal so we are trying to be very careful.

We have a question about how to address a response to a 2nd level appeal that has been sent to us (the employer) for a self-insured health plan. The appeal package was prepared by an attorney on behalf of the subscriber who is appealing a denied claim for his dependent (age 17). Should the response be addressed to the member (the dependent) and sent to the attorney with a copy to the subscriber? Should the response be addressed and sent to the subscriber since he is the one appealing with a copy to the attorney? The initial claim denial through the health plan was addressed to the member (the dependent) but sent to the attorney. Appreciate any advice.

Thanks for your thoughts. I like the idea of creating a list of goals/objectives in advance and getting written responses. That will certainly help us to focus on the purpose of this summit which is to enhance our "health initiative" (encouraging employees to take charge of their wellbeing).

We are considering holding a "vendor plan summit" this fall. We have ~15 large vendors (health, dental, vision, Rx, EAP, retirement) that we want to bring together to discuss resources, tools etc. to assist us in our health strategy initiative. Has anyone done a program like this and if so, what has been the reception? Any advice? Thanks.

On the DOL website, the sample Election form for the premium reduction contains 5 questions. According to the form, to qualify a person must answer "yes" to all questions - including the Medicare ineligibility. An employee involuntarily retired, is currently and was previously Medicare eligible, and has elected dental and vision COBRA. Is this former employee eligible for a subsidy of their COBRA?

Our self-insured plan covers stepchildren. One of our employees is getting a divorce and wanted to know if his former stepchildren could continue to be covered since the plan allows for coverage of an ex-spouse. If we were to receive a QMSCO must those children be covered?

We have an employee who is covered under his spouse's health plan along with a dependent. Apparently the dependent is no longer eligible under the spouse's plan - we are assuming that it is due to aging out but we don't not yet have all the details. We offer several self insured plans that allow coverage until age 25 without being a student. The employee would like to enroll himself and his dependent in one of these plans now. Is this considered a special enrollment? We think the dependent should just be offered COBRA. Thanks.

We offer single and family coverage An employee is currently covered under his spouse's health plan along with his dependent (she is a currently a student at a local university). He wants to enroll himself and student dependent in one of our health plans during OE to be effective 1/09. On 2/09, he wants to delete his student dependent as she will be enrolling in a health plan at her university (I am assuming that the semester begins again in Feb). This seems to be a qualifying event but we don't specifically state this in any of our documents.

We are an employer located in MA with a fully insured dental plan that is issued in NY. Does anyone know whether or not we are required to provide dependent coverage until age 25 for non-students? We have placed a call to our acct mgr but he is unavailable for several days so I thought I would try this venue. Thanks.

Any one on medical leave is considered in active status and eligible for the same subsidy for medical/dental and vision benefits as an active employee.

An employee on medical leave of absence is eligible for subsidized health coverage as long as the premium is paid. If deliquent in their payments, they are sent several notifications warning of potential cancellation. We recently cancelled coverage for someone who went out on medical leave in 2000 after they fell behind over 2 months. This person contacted the TPA for our self-insured plan and was told she was eligible for COBRA. We disagree as we do not feel that this is a qualifying event. Are we wrong?

Do you have any idea how they determine the $ amount? Is it based on a particular plan? Thanks.

We are going to evaluate moving from a flat percentage to a fixed dollar subsidy of our health plans. Is anyone else doing this currently? Any comments or lesson learned that you would be willing to share. Thanks.

It is a possibility that the SAS70 from our former TPA was the reason. Are there any audit guidelines that I could use as reference for our new TPA and/or is it just SOP based on the SAS 70?