mroberts

The employee has 60 days from notification to decide whether or not he wants to elect COBRA. Because he or she was never notified, you could run into a problem by simply cutting off his or her medical insurance. I would send out a COBRA letter as soon as possible and allow the employee to continue benefits for 29 months if he or she is still disabled. Better safe than sorry.

If you check out your dental booklet certificate, it should indicate when a procedure is deemed completed. For example, any time you are talking about prosthetic devices (crowns) or bridges it's usually on the date the service was completed. However, in your employee's situation, it appears that the dental carrier deemed the procedure completed as of the date of the impression. You may want to double check your booklet/policy just to make sure it was billed properly. The employee might have cancelled the appointments in December so that she could claim the expenses in 2001.

Cha1 - are your active employees being charged a composite rate? If they are, then I don't see a problem here. If they are not, then that would be a problem since you can only charge up to 102% of premium and this would obviously throw the individual rate well over what was being paid for an active rate.

If employees pay at least a portion of the medical benefits your company offers, then an open enrollment period would have to be offered. Perhaps the employer may not want to call it that, but employees have to be able to opt out of coverage if they no longer want to pay from premium. If your company picks up the entire cost for medical benefits, I suppose they wouldn't have to offer one since the employees would have no reason not to accept the coverage. With respect to the section 125 plan, yes, employees do have to make annual elections. When it comes to non-medical lines, it's going to depend on your carriers contracts. Some carriers will allow you to make changes at any point during the year and some will only allow you to make changes at an open enrollment period as designated by the employer. Shoot me an email if you would like to discuss further.

Just out of curiosity, is there a reason the employer is against having an open enrollment period?

I wouldn't cover the whole mouth getting bleached because it isn't necessary. If the price was going to be the same whether two or three teeth were done or whether 25 teeth were done, then I would say knock yourself out, however, I would find it hard to believe this would be the case. No one is going to pry the person's mouth open and compare the color of the front incisor to the back molar. What should be done is trying to blend the colors of the teeth that are in question. As far as your example goes with the car, I've been in two accidents. When I just brought my car in for the most recent repairs, the claims examiner noticed that there was a slight difference in color between the trunk and back panel. Apparently the first time it was fixed, the color was slightly off and I didn't even notice it since it was probably buffed and waxed to seem perfect. He indicated that once the trunk was repaired I could pay the auto body repairman extra to get it blended so that the difference wouldn't be noticeable.

Tobacco teeth would be a different set of cirumstances. I'm aware of the Flex regs that pertain to what is and what is not covered, however, I think this should be viewed differently. For example, if you had a cavity in one of your teeth, dental plans standardly will only pay for a silver filling unless the cavity was in one of your front teeth. In this case, it would pay for a clear filling. Additionally in this example, the employee probably did not decide to run to the nearest kitchen counter and slam her teeth into it hoping to chip one so she could use FSA dollars to pay for the eventually bleaching of this tooth. Everyone knows that smoking makes your teeth yellow. You can but over the counter stuff to mitigate that problem. I would limit this laser bleaching stuff to the tooth or set of teeth in question, not the whole mouth.

Sounds a lot different than just getting all your teeth bleached for the heck of it. As Kip pointed out, because it's a front tooth, it sounds good to me.

Since the employee in this example elected family coverage when going on to COBRA and since the company has an open enrollment period, I am sticking to my guns and feel that changes should only be allowed during the open enrollment period as designated by the employer or if another qualifying event were to occur. The employee obviously had to know the costs going in. Furthermore, if you standardly allowed changes like this, your medical plan costs are going to increase more than normal since it's pretty obvious the wife is staying on because she needs some form of medical treatment. At least you can recoupe premium from the two healthy bodies for the rest of the year to offset any damage she is doing to your experience.

Even if you have an open enrollment period?

I concur with Kip. Employees who elect COBRA have the same rights to coverage as your regular employees and would therefore need to make changes at open enrollment. This employee could definitely decide to drop coverage altogether, but if he is trying to keep another dependent on, he will have to wait until your open enrollment period to do so.

That's interesting because I sat through a legal class on this approximately a year ago and they didn't outline it this way. It's possible that everyone wasn't 100% clear as to what is going to be needed since we were discussing the propsed regs which were approved just after the class. Is there a possibility that there's more than one way to skin the cat although the info you just gave is pretty clear? What is the company supposed to do when providers are added and providers are lost?

For the listing of providers, I believe you can make note of the insurance carrier's website since that has the most up to date listing. The government realize this listing changes daily and that giving everyone a complete hard copy would be a waste of paper and time.

When it comes to dependent child eligibility, you can define it any way you'd like. Sorry to be so general, but it differs from company to company. What I've seen most often is exactly the way you have it - primarily dependent upon the employee for support.

I apologize if I'm off. I asked the guy next to me and he works on flex plans 24/7/365. I will have to beat him with a stick when he comes in.

If your company is not located in a major metropolitan area and has a parking lot and you don't have to pay to park, is that a benefit? What about being a drop off center for your clothes to be dry cleaned? Or what about having an ATM on your first floor? These are all benefits that employers can provide, as well as about 100 others, that do not impact the employee adversely in any financial way.

Thanks Cathie.....I always notice CA come up, but never hear too much about the other states.

If the day care is free it would be no different than their mother watching them, so it would not take away from the $5000 cap for the year. A change form should be filled out so the regular daycare is not paid for that time.

You would 1099 them before taxes have to be filed for the year 2001.

Kirk: Do you have a couple of those case names? I would just like to review them for my records. As indicated, I've seen companies offer COBRA in these situations. Perhaps they did this just to be more generous rather than being required by law. Thanks!

This should cover what you are responsible for: Notice From Employer to Plan Administrator When an employer does not administer the health plan, the employer must notify the plan administrator of certain qualifying events. The employer must send this notice within 30 days from the date coverage ceases or the date of the following qualifying events: the death of the covered employee, the covered employee's termination for causes other than gross misconduct, the covered employee's entitlement to Medicare, and the employer's bankruptcy. Notice From Administrator to Beneficiaries The plan administrator must notify qualified beneficiaries of their COBRA rights when a qualifying event occurs. Such notice must be provided within 14 days of receiving notice of any qualifying event. If you need anything further, please let me know!

Why not just have the service credit section as an endorsement and keep it on file for the employees to peruse if they want? This way, it will keep the plan document to a reasonable length. My thought is that the longer the plan document, the less likely an employee is going to read it. I'm a staunch believer in educating your employees as much as possible and if you give them a plan document that deters them from looking at it, the less educated they are going to be. Playing devil's advocate, you could always include the service credit section at the very end of the plan document so that employees who are not concerned about those provisions need not have to weed through them. Email me if you would like to discuss further.

You should be able to make the change as long as you have the documentation of the events. The university probably issued a letter indicating that the student will not be considered a full-time student due to academic inadequacies. The employee would then have 30 days from the date of the letter to elect the change. Also, I'm sure just explaining this to the carrier will correct everything. If you were talking about making a change in flex plan deductions, it's one thing. Removing a dependent child from the medical plan who no longer satisfies the definition of eligible dependent is another thing. Coming from a carrier, we would have no problem accepting this change even without documentation.

I'm not an expert on the costs that are associated with Internet advertising, but unless it's close to zero dollars, I think it's a waste of time. Many internet providers, like mine, have junk email protectors set up so that most advertisements don't even make it to my in-box. For any that do, I simply junk them myself, as does every single person in the universe I know. I'm not saying that no one has ever bought something through junk mail, but it's not the same as getting the junk mail in your real mailbox.

Are they terminating you because you should have been approved for LTD already? Are you considered permanently and totally disabled with the condition you have? If you aren't, chances are you're not going to be approved for LTD.