mroberts

One of the things that you should always look for is quick reimbursement from your FSA provider. Therefore, your employees will not have to come out of pocket for any expenses and have to wait until the plan reimburses them. A lot of companies actually have it set up so that the funds are automatically taken out of the FSA to cover any incurred expenses so that the employee doesn't get a bill at all. In answer to your question, no the employee does not have to pay the amount first.

Although COBRA participants are allowed a 30-day grace period for premium payments, the carrier can request that they be paid the same time as your active employees. If it's not going to cause your company dire straits, just go ahead and slip the premium to the carrier and wait for the COBRA participant to pay you. Make sure you charge the extra 2% you can for administration and that should more than cover any interest you're losing out on. If a COBRA participant doesn't pay and coverage is terminated, just take a credit on the following bill.

Most plans that utilize a network (HMO, POS or In-Network for a PPO) usually have an unlimited medical benefit or some high number like $5,000,000. I've also seen plans that have a $1,000,000 limit as well. I believe this is going to vary somewhat by region. As far as your second question, I'm a consultant, so I can advise you based on your population what you should have. Let me know if you would like to discuss further.

If it truly is going to be two separate plans, with two different owners and two different tax ids, you're probably going to be SOL. Carriers are going to view this as an association plan. Therefore, if the experience starts going downhill, one of the companies may decide to leave the arrangement and leave the carrier left with some very undesirable claims it has to pay off. You can always try and plead your case to the carrier, however, I'm not sure how much luck you're going to have simply because it's not your sales rep making the call. I'm sure he or she would love to write the business, however, underwriting will not permit it. I would do a side-by-side showing all the things the company is going to have in common and go from there.

North American does a very good job. I believe they are more of a NE operation and therefore, might not have as much name recognition as Great West since they are national. I'm in Rochester, NY and have worked with NA before. On a side note, the nickname Great Waste came into play because this was one messed up company several years back. They lost half their medical network due to poor negotiating tactics. It sounds like things have been somewhat patched up, however, I would put them a little closer to an Aetna than a UHC or CIGNA as far as administration goes, so be prepared to have some problems. As always, you could put your medical coverage with any carrier and it could run smooth as silk, but it may be something to think about.

There's going to be a few variables here. Medical plans are treated a little bit differently than say a life or disability plan. First, how was your group rated by your medical carrier? Did it assume 100% participation? Check your policy out, if it does, then yes, every employee has to participate. It is fairly common to have at least some employees opt out of group sponsored health plan even if the company pays the entire cost. Most of the time it's because the spouse has a better plan. If the carrier requires 100% participation, also check and see if an employee can waive coverage due to having coverage through his or her spouse's plan. Carriers usually do not look at this as a decline, so it shouldn't hurt the participation requirement.

I'm not familiar with any special rules for COBRA under Chapter 11 bankruptcy, however, the maximum period of continuation that any employee or dependent could be entitled to under COBRA is 36 months. Additionally, if Company A is going out of business and will no longer sponsor any health plan, employees wouldn't be eligible to continue their health plan since there is no longer a plan to continue. Is somebody else aware of any special rules for COBRA and Chapter 11?

I also agree to contact the state fund for the specifics. I have worked with many accounts with employees in CA, and they have all left it to the state to handle the disability. Trying to coordinate the benefits with both the state and carrier can sometimes be a headache.

Is there any possible way that the claims experience for your group of employees can be ascertained through the PEO? Usually companies are identified separately in a PEO for tracking purposes.

Under ERISA, an employer can be fined up to $110 per day for any violation. There really isn't any ERISA police out there, however. If you are in violation of ERISA and a case goes to court, this is usually where you will find yourself in trouble.

And why exactly would an employer rack of thousands of dollars in fees for a lawyer to review the booklet when a carrier can create it for free, while assuming 100% liability concerning what's printed in it? Additionally, you would probably have to contact an employee benefits lawyer, since most companies do not have one on staff, and hope that a competent one is picked. Exactly how much is your software?

I'd be weary of this kind of software as well. Sorry to be skeptical GAnderson, however, I used to create contracts for a large insurance company and whenever you input information into the checklist, what was usually spit out was about 80% correct. Things probably have gotten better by now, however, I wouldn't want to take the chance of creating my own booklets and being on the hook for what's in them. I can't tell you how many court cases I read about where the court sides with te plaintiff because of ambiguity in the SPD/booklet certificate. If you're fully-insured, by all means have the carrier create the booklet cert. If you're self-insured, once again, have the carrier or TPA create the booklets since it will be the one on the hook if someone drags you to court with respect to something in the booklet.

That's the main disadvantage as casey points out. Just choose a reputable one, like COBRAServe or COBRA Source, and you shouldn't have anything to worry about. I would be a little weary if someone named Corey's COBRA Service was knocking on your door. There's not going to be much of a difference in cost between service providers unless you're looking for additional reporting requirements and other bells and whistles.

I don't see a problem with it, just like there wouldn't be a problem with salaried employees having their coverage paid at 100% and hourly employees paid at 50%. As Kirk pointed out, you do have to take a look at the overall picture, however, from your post, it doesn't seem like you were asking about that.

When you say contributions, are you talking about premium contributions to the plan or contributions to the FSA?

There's not going to be too much difference between the 80th and 90th or 70th and 80th. Even if you're comparing 70th to 90th it isn't that much. I believe the standard is 90th, however, that may change a bit since employers may be able to save a couple bucks by lowering it down to the 80th.

This doesn't sound likely. Remember, employees already have the right to look at the policy and see what the rates are under ERISA.

Does everyone in your company get $40,000 per year? Does everyone in your company receive 3 weeks vacation? Is everyone in your company subjected to the same bonus schedule? As you can see, there are different forms of discrimination in basically every facet of an organization. As long as your company can clearly distinguish which group or class is getting the overtime calculated that way, then no there isn't anything illegal about it. I understand your frustration, but who said life was fair?

It's a federal mandate that overtime be paid out to non-exempt employees who work over 40 hours per week. Companies can require employees to get authorization before working overtime so that employees aren't just hanging around being unproductive to get some extra dollars. That being said, however, even if an employee doesn't have authorization to work overtime and he does so, the company would be required to pay him the OT. The company could probably discipline him since he did not get the proper authorization, however, they cannot choose not to pay him. Now, on to your question, it appears that it's the company's decision as to how they are calculating the overtime. Most companies do not allow vacation time to be included in this simply because the employee isn't truly working those hours. Nonetheless, companies can always do better than state or federal law, but never worse. For example, a company could pay employees triple time for working overtime if they really wanted to. What it sounds like here is that they are choosing a certain class of employees to be subject to a different calculation, which would be fine as long as the decision wasn't based on a protected charicteristic. For example, all white employees can calculate overtime this way and all other employees this way.

Does anyone know roughly want piece of the pie diagnostic visits make up as far as total costs go for medical insurance? For example, Rx makes up roughly 20% of total costs. I have this information somewhere, but just can't locate it at the moment. Thanks in advance!

I don't agree that even one day would be considered discriminatory. I believe an employer has every right to set up different probationary periods for different classes. Therefore, if all the HCEs fall under the classification of executives, they should be able to have a different probationary period than say salaries employees or hourly employees. Anyone else have any thoughts on this?

The question then must be asked is what is considered discriminatory when comparing different eligibility periods for different classes? What if the HCE's probationary period was 1 month and all other employees were 6 months? 3 months? 2 months? I agree that 1 month versus 12 months does seem discriminatory, but is there anything else in the regs that would help clarify this?

You won't lose coverage if you are working on intermittent FMLA so if you can go ahead and work 1 day a week, you may as well do so.

As much as I wouldn't want to, it appears that you have to offer this spouse COBRA. The gross misconduct rule only applies to the termination of an employee or spouse, which doesn't seem to be the case from what you provided. I would assume that health plan provides coverage at other facilities other than Clinic X, so the Clinic should be able to not treat a patient due to his behavior.

Doing a 16-month contract is a good idea simply because the stop loss market is a mess right now because of what happened on 9/11. A lot of the carriers that handle stop loss insurance rely on re-insurers and the re-insurers are the companies that took a bath last fall, thus some pretty significant renewal increases are coming out. If the renewal increase seems in-line, I would go with the 16-month guarantee.