mroberts

As far as what the plan looks like, contact a local insurance company. They usually only have a couple of different individual plans that you can purchase to keep things simple. In Maryland, BCBS is a big player. I think they're called Freestate up there or something like that. If you want, you can send me an email and I can work with you on it a little. I have a contact at that BCBS and I'm sure we can get something worked out. As far as the tax implications go, I'm going to hand this one off to someone else. I would assume that since you only have one employee that it would not be considered taxable if you were to pay his insurance. If you have several employees, however, and do not pay for their insurance, it would probably be a different story. Take Care! Matt matt.roberts@bbinsurance.com

At worst, your group contract should allow changes if someone still experiences a qualifying event whether your plan is a Section 125 or not. If you check out your group contract, as Kip pointed out, and there is no provision regarding changes, talk to your carrier and get one added. Most carriers aren't going to put up a beef about it, as long as the times that employees can change benefits is logical. Take Care!

I have never heard anything about them being taxed. Like I mentioned, it is a very inexpensive policy so if there were any tax implications, they would have to be minute. I wish I could be more help!

Travel Assistance programs usually go a little further than that. They will also provide treatment for employees while out of the country which is obviously huge since being a member of BCBS doesn't mean diddly squat if you're in Brazil. This doesn't mean the coverage will pay for the expenses, but it in essence, gives you a line of credit until you can work with your insurance when you get back. As far as taxation goes, I'm not exactly sure what you're asking. It sounds like you're wondering if your employees get taxed on it. A policy like this is very inexpensive and employers usually pick up the tab. With some AD&D policies it actually comes attached with no extra cost.

I agree with Kip. Don't over complicate it. The equivalency rates should be sufficient. After all, these are roughly the rates that you would be paying if your plan wasn't self-insured.

As far as pitfalls go, this just doesn't sound too good. Who wants to keep track of a bunch of individual policies? Is there any reason why the employer does not want to purchase a group plan? As Kip pointed out, getting group coverage would be far more advantageous from a group perspective since it's far cheaper and much more comprehensive.

This would seem to me as a loss of dependent child status, so I would say yes.

The problem is if you ever had a bad claim, you will not be able to get stop loss coverage or it will triple or quadruple. At that point, you would have no choice but to then go fully-insured. The carrier would also realize this and totally take advantage of the situation. It's always better to make the move to fully-inusred rather than having it forced upon you. I would never recommend self-insuring unless you had at least 250 lives. If you would like to discuss a little further, just send me an email from my profile and we can talk about it. Thanks!

I believe you would be eligible as well. My question would be would you want to elect it if you are a visitor? I mean, are you going to stay in the country for six months? You can elect COBRA within 60 days from your date of termination. If you are only planning on staying in the country a couple more weeks or even less than two months, don't elect it unless something happens or comes up. If you are planning on going back to Canada relatively soon, you would be covered there.

All health plans are subject to ERISA unless they are only covering the owners. Even though you are self-insured, the medical plan you are offering is deemed an employee benefit plan. Just out of curiosity, why are you self-insured if you only have 25 employees? One bad claim and you're done.

It could simply be a mistake in the SPD. I previously did contracts for North America's largest insurance carrier, and let me tell you, some people just don't care. I would say contracts are wrong 95% of the time they go out the door by whoever is preparing them. It's sad, but true. I would contact the administrator and see if this can be revised since it seems to be pretty obvious that something was left out. Take Care!

jeanine: thanks for the input on wc. i should have been more specific than just std. matt

First, do you have short and long term disability? If the carpel tunnel syndrome is severe enough to cause her to go out on STD, then go ahead and file the claim. When it comes to LTD, it really depends on which carrier your plan is with. A number of carriers look at her job title in the national economy, while others look at her job as it is in your company. Regardless, if she can not perform the material duties of her job, she could be out on disability for awhile. However, most carriers will work with both you and her on trying to modify her job to get her back to work. Is typing and writing all she does all day or is it just one part of her job? If you have a number of employees doing similar things, maybe switch her away from the typing and writing to acoomodate her disability. As far as a lawsuit goes, I'm not aware of any lawsuits filed by employees getting CTS, however, it doesn't mean that it hasn't happened. I would find it hard to imagine for her to file a law suit unless she somehow proves neglect on your company's part. Note, there are law suits that occur every day for employers who do not try to accomodate an employee's disability. Your best bet - work with her and see if her job can be modified.

Being a former employee of MMC, I feel that the company takes care of its employees, especially when it comes to benefits. The decision to pay for medical coverage out of the Fund probably wasn't the best decision, however, why should these employees be 3 years of medical benefits free? As Kip pointed out, people die every day and their dependents don't get medical benefits for three years. The outpouring of American generosity following the tragic attack was great. One thing that many of us may not have realized, however, was that the majority of those people who died in the tragedy hardly needed the extra money. The funds that were set up to help the families of these people are more than enough. Let's face it, most of the families involved are going to be getting hundreds of thousands of dollars one way or another. I'm not sure why the lady in the article is griping over medical benefits worth $15,000 over three years.

I'm not totally sure what census data you mean, but I'm guessing it's to give to insurance carriers to figure out your rates. If I'm right, then I'm guessing you either have a TPA or someone not in your organization preparing this info. There should probably be something set up in the contract you have with this person or company acknowledging overall performance. And if you don't feel this person is doing a good job, find someone else that can help you. If you provide some more info, I can help you out some more. Take Care!

This is what floating holidays are for. If you give your employees 3 or 4 days per year, then it's up to them to schedule them so they can reflect their religious ideology. While I'm not an expert in legal advice in this area, it doesn't seem like it would be illegal - just a bad employment practice since some employees are going to feel gipped.

I've worked on companies that cash out any unused vacation at the end of the year and they do not distinguish it from ordinary income. If your company does want to make it seem more like "benefit dollars", it can always figure out what amount needs to be paid so that after taxes, the amount comes out to $50 in the given example. I would definitely wait until the end of the year and not the end of each month however.

It would seem to me that increasing the deductible to $1000 on a health plan, but then giving employees $3300 to spend on medical would offset any gains from the action. I'm not sure if a separate plan needs to be set up, but if the school does decide to do this, it should the money in a Section 125 Plan. That way, any unused portion will go back to the employer rather than just cutting employees $3300.

Since most of us have already received our 2002 rates and gone through our enrollment periods or will be soon, I was just wondering if anyone has either had rate hikes that they felt were not justified or had some bad experiences relating to these topics in general. I work on finding solutions to employer and employee problems, especially when it comes to benefits. Usually I'm able to save groups 20% on the cost of ancillary (non-medical) benefits and can work with groups on choosing the right carriers when it comes to medical and dental. These days, with costs rising significantly, it's important to make sure your benefits program is on the right path and doing what you want it to do. There are more and more alternatives out there today and would be more than happy to discuss them with anyone who is interested. My benefits division's focus is also not strictly on price, but also service. We strive to combine the two and truly deliver customer service above and beyond expectations. I look forward to hearing from any one who is interested! Feel free to email me at matt.roberts@bbinsurance.com.

I agree with many of the points that Kip made. I was an underwriter for MetLife and worked on many voluntary (employee pay all) dental quotes. The problem is, if employees have to pay the full cost for dental, most people are not likely to sign up. Minimum participation is generally 25% on a voluntary dental plan and the 25% or so that signs up generally needs dental work. The bottom line was that the plans just really didn't work. Even if we quoted decent rated the first year, there was usually a sizable increase the second year because of adverse experience. Many times with dental, unlike medical, employees can also wait to get a procedure done. Therefore, even if an employee found out he or she needed a root canal in July or August, it could most likely be put off until early January after open enrollment comes up. I have constructed, qouted and implemented just about every kind of dental plan imaginable, so if you would like to discuss further, do not hesitate contacting me at matt.roberts@bbinsurance.com. Take Care!

Aleister: I would assume you have a TPA if you have a self-funded plan. Wouldn't they be able to produce it? Additionally, a lot of times whoever the medical carrier's network you are using will produce one for you as well. There is of course a fee associated with that type of transaction, but as far as what it is depends on the complexity of your medical plan. Coming from MetLife, we charged $250 per hour in the creation of a plan document that was containing information not being insured by us. While this price was mainly a deterrant so we wouldn't have to do it, I wouldn't be surprised if someone preparing these would charge about $100 per hour. Do you have a broker? Your local broker should know who to contact. If you want, feel free to email me and we can discuss. matt.roberts@bbinsurance.com

Not unless it is offered through the employer. There are a number of carriers that offer individual type plans at the employer's request.

Kip: I agree. I basically meant that if the old plan is entirely going away and several new options from a different carrier are being put in, this would be justification. However, if you are changing from a BCBS $15 Copay HMO to a United Health Care $15 Copay HMO, then no, that doesn't allow for an automatic change. Matt

motor: employee can also change health plans if you are changing health carriers at any point. if however, they want to change plans once they are terminated, they can not, unless as jeanine indicated, they are moving to a different area. something tells me that you should touch base with your carrier on this one since medical communities differ greatly from region to region. matt

If I'm not mistaken, premiums paid for medical insurance on an after-tax basis can be deducted on the employee's tax return. I'm not an expert on this, but my family has many accountants and I believe I've heard this at the dinner table before. I don't beleive 100% of the premiums are tax deductible, but at least a portion of them should be. Have this person get in touch with their accountant.