mroberts

As long as you can class out the group of employees being offered the group policy, then I don't see any discrimination here. The reason agent "A" is most likely complaining is either because he's losing a decent chunk of commissions or he is not familiar with many of the aspects of group insurance. A lot of agents that sell individual products focus on those rather than group policies since they are more lucrative.

Was there a question you were asking? Most LTD insurers do offset for Social Security Benefits and have both Primary and Family Integration. I don't see how the insurance carrier could offset for SS benefits if the employee and spouse are divorced with the child residing with the other parent. In the case of a separation, it may very well be that they can. If you want to ask some further questions, I can try and help you out.

If the employee signs up for the medical plan being offered, yes. If he is simply offered the coverage in a group setting, he or she has the right to decline the coverage and continue his or her coverage through COBRA.

If a person were to participate in an employer-sponsored health plan, why would he or she continue COBRA coverage for health care? It's not really correct to say the employee loses eligibility if he or she were to sign up for another health plan. Eligibility for COBRA is determined at the time benefits are lost and the type of qualifying event (remember, coverage could be continued for 18, 29 or 36 months). If the employer were to set up only a dental or vision plan, why would the employee cancel his or her health insurance?

Just because an employee is eligible for another health plan does not mean that he is forced to terminate his COBRA benefits. 99 times out of 100 the employee will take the group plan since the employer usually pays a portion of the premium. However, if the employer's does not contribute much to the plan or if the group plan has very low benefits, it's conceivable that the employee would want to continue his current medical insurance under COBRA. It sounds like the employer made an agreement with this employee, so I would check and see if anything has been signed indicating the parameters of the agreement.

I would say the ex-employee would have to wait until your companie's next open enrollment to pick up dental coverage since he is not losing any coverage. Where do the regs say anything about having an inferior plan taking the place of the superior plan being a qualifying event to change benefits?

Agreed. If she is eligible for COBRA, the company can not deny her the right to elect coverage.

I don't see any discrimination here since we would be talking about 2 different classes - union vs. non-union. Employers can have different benefits for different classes. What they can't do is have different benefits for different employees in the same class.

This sounds a little shady. If someone had this insurance, wouldn't it be conceivable that they would go out of his or her way to get fired? Not that the person would do something that would be considered gross misconduct like start the buidling on fire or punch someone, but what would stop a person from coming in and paying on the Internet all day until he or she got fired?

The provisions of the contract are going to determine whether or not your pregnancy is going to be considered pre-existing. Pregnancies are usually subject to the same rules as any other injury or illness, so whoever informed you that pregnancies wouldn't be considered a pre-existing condition probably misinformed you. Since you are just signing up for insurance is it safe to assume that you were a new employee back in August? If you were covered under a different short-term disability plan through another employer or via an individual policy prior to signing up for this policy, the carrier may view the coverage as continuous, and thus your pregnancy would not be considered pre-existing.

Maryland does not have a state mandated disability plan and therefore, it would be up to the employer and insurance carrier as to the provisions of a short-term disability plan. Pre-existing conditions would be specifically laid out in the summary plan description and you should therefore reference that for further information. Lastly, as far as termination goes, I don't see why an employer would fire a person for having a disability, especially if they knew about it before they hired the person.

For state laws in general, California would probably be up there. For insurance matters, however, California does not have a lot of extra-territorial issues. They have a state mandated disability plan and that new paid FMLA plan, but that's a little different than what I interpreted the poster's question to be. You have to follow state law in every state when it comes to wages, taxes, worker's comp........ What I thought he was asking is if I have a medical or dental policy issued in Illinois, what needs to be changed if I have employees in different states. That's usually what is being asked when someone mentions extra-territorial and insurance in the same sentence. Most states let the policy in which the contract was written in govern. However, certain states like Florida and Texas have their own laws that may require the insurance contract to be altered.

I would go along with what the doctor is saying as far as being medically necessary. Sometime you have to appeal a claim a few times to an insurance carrier to get them to pay for it. I would allow the procedure to be reimbursed under your Section 125 plan. I would also tell her to appeal the claim to the insurance carrier since most of the cost could be picked up by them.

I agree with Kip. What's driving this request? From underwriting experience, the states with the most extraterritorial regulations are Texas, Florida and Mississippi.

Ditto. Going the employer route is going to be easiest. If you need to escalate it within the company, do that. If that doesn't work, then you may want to touch base with legal counsel or the agency in your state that deals with insurance and/or employer matters.

Good point Maverick. I'm an underwriter by trade as well and I've gone down this road before. Fortunately I have not had any carriers push back on me. With smaller groups, we have to realize that 19 out of 20 are going to get ripped off by the insurance carrier. A lot of sales reps at carriers feel this way too and work with you. If a group comes up with a good game plan such as this, they should reap the reward. The way my administrator and I have worked it out is through a different funding mechanism, so I've never used individual accounts through a Section 105 plan before. I would be interested to see what others post just in case I try a similar plan outside my region.

You should do this plan under a Section 105 plan, otherwise it would be taxable. As far as if this is an HRA, then answer sounds like no. This is something your company is doing behind the scenes to save on premium. A plan needs to meet certain requirements to be considered an HRA. Additionally, any money left over in a Section 105 plan at the end of the year does not roll over. It would go back to the employer. I would consider carefully drafting the 105 plan as to not allow the moneys being put into these accounts to be used for any reimburseable medical expenses listed in the regs. You should limit them to amounts associated with the deductible.

Certificates of Credible Coverage get generated once you are terminated off a medical plan. If you get coverage within 63 days, you should be fine and not subject to pre-existing conditions. As far as how to answer a questionnaire, truthfully of course. It's not like the insurance company isn't going to figure out you were pregnant before filling out the questionnaire when you have the baby less than 9 months later.

Ummmmmm, ok. First of all U and I are next to each other on the keyboard. My bad. Secondly, I didn't mention the word numskill in the email at all. A magazine like Time should do a lot of analyzing before printing an article like this. It does a lot of harm since it is generally a credible publication that people believe in. In my opinion, and this is what I'm typing, he's a numskull, bonehead, ......... whatever you want to call him.

I just wrote the writer an email pretty much calling him a numskill with a copy to the editor of course.

As long as they are classes, no. If the employer was making a case by case decision, then yes. One problem I do see with this, however, is whether the carrier will allow the plan to be offered like this. Most carriers have participation requirements and when a medical plan is offered to employees at 100% of the cost, the only people that sign up are the sick employees.

I would think you are going to have a problem with this. Carriers present their rates based on certain underwriting standards such as a participation requirement. If your group falls below this participation requirement, the carrier would most likely have to re-rate your case. Another reason I can see the carrier not going for this is because it could bring up adverse selection, i.e. you don't want to pay for health coverage any more because your company can't afford it, however, you know of a couple very sick employees currently being covered and want to make sure benefits are still in place for them.

When's the last time you contacted your employer? Why are you waiting for a call back? As indicated in the other benefits forum you posted in, check back with the employer every 2 days. I agree with Demo that it is a serious situation based on your son's health, however, I disagree about contacting a lawyer right now. The company has acknowledged the mistake and is working with the carrier to rectify the situation. Call back your employer right now and explain the seriousness of the situation and indicate that if you are not reinstated shortly, you will have no other recourse than to contact a lawyer. If you don't get resolution by Monday or Tuesday of next week, then I would go ahead and contact a lawyer.

I agree with papogi, unless the increase in cost is going to be significant. Based on your email, however, you indicated the difference in cost was slight and most vision plans are very inexpensive. Therefore, a significant increase doesn't seem likely.

In this example, it sounds like the employees would be eligible for COBRA since the policy is going to still be in existence. Nonetheless, I would still read the policy/contract for your insurance carriers to see how the group was set up.