mroberts

This is not being handled properly regardless of what she signed. If you have flexible spending accounts, you can not recoup amounts that employees are getting reimbursed above what they have already contributed. If an employee has allocated a $1000 into a calendar year flex account, he or she has the $1000 available Janaury 1 and upon termination, any amounts that were reimbursed above what the employee had already contributed, up to $1000 total, needs to be eaten by the employer. Otherwise, the plan will not satisfy the requirements to be pre-tax.

If state and federal laws aren't being followed, then I wouldn't be surprised if someone filed a complaint with the DOL or any other agency that could come into play. As far as the HR department just not getting back to people on general questions, there's nothing illegal about it, but good luck retaining employees that get a cold shoulder from the company they work for.

Since the SPD does not indicate that WC awards can be used as offsets, that's probably what this new negotiator is talking about. If it's not in the SPD, you can't force the employee to give any funds back. I would suggest updating your plan document so that the next time this happens you can offset some of your LTD liability.

No it does not. I not sure where it is in the regulations, however, all state mandated STD benefits, whether it be NY, CA, RI, NJ or HI, are intended for only those employees working in that state and are not extraterritorial. With that being said, many employers HQ'd in NY state that have employees elsewhere do cover them under the DBL policy for consistency. The company may then have an enchanced STD policy or internal salary continuance plan that provides greater benefits.

Is the company terminating its health plan? If not, then COBRA will still need to be offered. I would recommend taking the COBRA plan since it should be less expensive than a comparable individual plan. If the company terminates its health plan down the road while you are on COBRA, then go the individual policy route.

I have a client who has this in place and her employees love it. I tend to agree that there is very little information out there on it, but not because it wouldn't be highly desired by employees. If communicated properly, this benefit would probably be more important than medical insurance to most of your staff. But as lschaab points out, the administration could be a real burden. Additionally most companies do not have a cafeteria plan set up to handle such an election. Creating a true cafeteria plan (giving employees a fixed dollar amount to purchase whatever benefits they want) is fairly costly, thus most employers do not have plans like these.

Yes, as long as active employees have the ability to do so. Is your medical plan run through a Section 125 plan? If so, you should be fine as long as you are applying within 31 days of the qualifying event. If not, it will depend on the insurance carrier contract.

The determination of whether or not part of the $45,000 can be recouped is determined by your LTD plan. First, does your LTD plan consider any amounts paid out under WC as other income amounts that can be deducted from any monthly benefits? Secondly, since the WC carrier paid out $45,000, this employee is probably going to be out of work for awhile. How LTD carriers usually handle situations like these is that they will take the $45,000 and prorate it over the amount of time they figure this employee to be out on LTD. This monthly amount will then offset any future LTD payments. For example, if the LTD carrier figures the employee is going to be out another 45 months, the LTD carrier would offset any monthly benefits going forward by $1000. If this employees is no longer out on LTD, this point is moot. Lastly, as far as the recovery of overpayments go, once again the LTD plan document is going to determine what needs to be done. You're probably not self-insured for LTD, so I would touch base with the insurance carrier and let them work through the mess. If you'd like to discuss further, please let me know.

PEO's tend to be fundamentally unsound, especially when it comes to benefits. True, they can save a little firm a decent amount of premium on medical insurance in the right instances, however, I've also found that many are operating in complete chaos. Kirk may have hit the nail on the head.

Why not just ask your benefits consultant/broker about this provision? A survey really isn't going to mean anything unless hundreds of people respond. Anyways, the standard is to age 19, 23 if a full-time student. However, with that being said, age 25 if a full-time student is common. I've also seen up to age 26 before as well. My suggestion would be to leave it at 25 if you can. Dependent students are participants that you typically want on your health plan since they tend to incur little to no claims.

It's going to come down to how the MEWA plan was drafted and what the underlying contract says can be done. Looking at an employer/employee relationship, yes a COBRA participant would be SOL in the case of his or her company no longer offering medical benefits or going out of business. Since a MEWA is an association plan, the guidelines of that plan may permit a COBRA electee to remain on the plan for the full 18, 29 or 36 months. I would carefully review the plan document and see what the case is.

Is this fee is for an actual cafeteria plan and not just a POP, I would say it's a very good fee. Some administrators charge a lot to set up cafeteria plans since there's a fair amount of work that needs to be done to get one off the ground. What are the maintenance fees after the first year set up?

The reason I brought up the employer eating the fees in the first place was as an alternative to charging the employees for particpation in the FSA. You'd be surprised what employers know/don't know when it comes to FSA's. I was simply looking at it from a different point of view, not as a moral issue. Anyway, the answer to the question apparently is that the fees can be taken out pre-tax per Lisa Hand. Does anyone concur with this? I'm simply asking since she is the only one that answered the original question. Thanks!

You could always go back to your carrier and change the eligibility definition to all full-time employees working 20 or 25 hours if you wanted to. It depends on how badly you want to keep this employee. Since you have indicated that she is a great employee, it might be worth amending your plan document. Otherwise, I concur with you - if she can't work the 30 hours per week, keep her on as a part-time employee and offer her COBRA.

What's her prognosis? Is this ever going to get better? What else does she say when she mentions she'll try and do better?Since she is not quite working full-time, I'm wondering if she's receiving partial disability benefits since a major health problem is the cause? Are you subject to FMLA and how long has this employee been falling below 30 hours? If she's taking intermittent FMLA, she could still be under the 12 total weeks allotment. Additionally, if you run your FMLA on a calendar year basis, she just got another 12 weeks starting last week. Lastly, how many hours below 30 is she working? 20? 25? Most carriers would not have a problem making an exception if she's working more than 20 hours per week since she's probably still considered a full-time employee. Just be careful since you're setting a precedent.

If there are legal reasons why an entity can not pick up the administrative costs, then that would obviously be a very good reason as to having to charge the participants to be in the plan. But the rest of your explanation is simply your opinion. Mine is that companies should pick up the tab.

It's poor consulting if this is the case. A broker has to explain why it doesn't make sense to charge a participant a fee for being in the FSA. Companies spend thousands per month on medical insurance and won't pick up a couple bucks for the FSA?

I've never heard of the fee charged that way either. Isn't the amount that the employer does not have to pay towards FICA enough to cover the costs? For example, if someone elected medical only and wanted $1000 in their FSA, why would you charge the participant? The employer would be saving $40 on the transaction (paying $36 for fees instead of $76.50 in taxes). I suppose it could cost the employer some money if enough employees elected small amounts to go into their FSA, but just think of the amount the employer is saving if someone maxes out the dependent care amount - $383. I would think that would more than make up for any shortfall. Charging participants a fee might end up costing the employer more than just eating the costs since it's going to dissuade employees to particpate. In regards to your question, I don't know. My feeling is that since it's a fee, it would be after tax.

Actually, I just read the detailed treasury regs that deal with this situation. In your example, the employee CANNOT have both. One of the parameters of the employee being able to be covered under 2 different health plans, with one of them being COBRA, is that they are offered through different employers. Since you offer both, the ex-employee can only have one or the other.

That I'm not sure about since I've never set up a plan that way. Just out of curiosity, which insurance carrier agreed to do this? The next time I have an unwritable medical case, I'll be sure to give them a call.

I just read a blurb on this and it states that a person "may" be able to be on both if the retiree coverage is less comprehensive. I'm not sure what this legal perspective is basing its opinion on, however. I always thought that once a COBRA participant becomes covered under another group health plan, you can terminate his or her coverage. Regardless, the question I have is why would a retiree elect both? If the other plan is better, why not just be covered under that one? Does he lose eligibility for the retiree plan if he does not elect it upon retirement?

As long as you can classify them out (i.e. managers) normally you're going to be ok. Where I do see a problem is finding a carrier who will want to write the business. If I was the underwriter and I knew only 30 out of 170 employees were going to be covered under the health plan, I would DNQ the case. Is there a possibility for the employer to offer all the other employees a PPO with a very high deductible and pay a good chunk of the premium? Unless you get 120 to 130 employees, I don't see any carrier willing to step up to the plate on this one.

Sure there's a contract. Perhaps I should have said agreement. A company just doesn't decide to go self-funded one day and start paying any medical bills that are incurred by its employees. You contract with a TPA, whether it be a carrier or independent administrator, and the agreement you sign with the TPA governs the plan. I'm sure somwhere in the agreement it oulines how much time you need to give the TPA before you cancel the plan and this amount of time can correspond with the amount of notice you need to or should give your employees.

The termination process should be spelled out in the contract. Notice to the employees should be either 30 or 60 days. Remember that you will be responsible for claims processed during the run out period, which is once again defined in the contract.

Check with your local Chamber of Commerce. They might have something for sole proprietors. I'm not sure how comprehensive it would be, but it's worth a shot. Otherwise, your best bet is probably going to be that individual policy.