Jbentz

I think your answers are going to depend on the plans that are offered to the covered employees. Copays, deductibles, etc... are going to make a huge impact. The dental and eye plans are also going to affect your findings, along with lasik, ortho, etc.... I agree with apribe about the higher comped do the extras and i would add that it also depends on how educated the employees are about the plan and what they can get reimbursed for. For instance, our rep told us during OE that we could get massages reimbursed if they were certified and our doctor had recommended it. Of course, those of us with back problems increased our amounts.

I am brainstorming, but i think you could set up a separate class for them under your group health plan and pay only for the RXs and have that be your only benefit. It will complicate things, but then you get out of any discrimation issues. Possibly you could have it just be another employee benefit, also, kind of like tuition reimbursement. I would check with your attorney, because since to see what other issues you will have, SPDs, COBRA, etc.....

If you have someone on COBRA, check the regs. I beleive you can only raise their premiums once in a 12 month period, regardless of what the regular employees are paying.

I suggest you treat your client to a movie and go see "John Q".

You are correct, you can always go above the law. I would stress that your decisions are agreed to by the company and the carrier and documented. It is then much easier to think outside the box.

You are correct, you don't want to promise them something you can't offer. Have you asked the new carrier about these employees? Didn't you say the original plan was self-insured? Do you have anyone else who is on COBRA now? Are they exempt or non-exempt? Are you having them move plans, or are you leaving the self-insured plan in place until the COBRA runs out? What does your new plan document say regarding current COBRA participants? Did you declare them? I think i would first decide with the new carrier, if it is a COBRA event. Let us say it is not. Then you would have some decision making to do regarding your choices. Are you going to say "Sorry, no coverage," or are you going to try to find something short term for them? There are many different scenerios that could play out here. Do you have anyone who has left in the last 60 days before the effective date? They will be able to elect COBRA after the new plan is in place. This needs to be addressed in your plan. Are you going to extend the self insured plan? That could get expensive and you would need to look into the reinsurance agreement. Is it worth all this? can you set them up a class on the new plan with minimum coverage? I would work very closely with the new insurance carrier and see what can be done and whatever scenerio you decide to go with, have them approve it also and put it in the contract. You also need to check state laws.

I have a complete checklist from an excellent seminar i went to regarding what should be included in the initial notice; i however, forgot it this morning. I will be happy to send the info to you tomorrow if you would like to contact me off-line.

Were you on an approved FMLA? If you were, they can terminate you after your 12 weeks of approved leave ended. It sounds by the dates that you gave, this is the scenerio. I am generalizing, but per the FMLA regulations, they only have to hold your position for you for 12 weeks and it sounds like they did. You need to call your old supervisor or an HR rep from your company. Ask if you can be rehired if you are released to work again in the future. Ask for a time line regarding the COBRA paperwork, depending on how the company is set up, they have approximately 30 days to send it out to you. It is always continuous coverage, so when you follow the timeperiods in the notice they give you, it will retro back to 3/1/02.

EAPs plans are covered under COBRA with the thinking that they are a health benefit plan. The last two COBRA seminars i attended, while not really saying "yes, you need to offer your EAP program," did strongly "suggest" doing so due to discrimination of offering medical and dental, but not mental coverage. I don't know if it matters about what kind of a plan it is, we had a very hard time coming up with the rates because we paid per employee per month, not per session. We found out what the rate would be if it were per session, mulitplies per the number of sessions they would get as an employee, added our 2 percent, and divided it by 12 to get a monthly cost. Look at how much it costs you and how much the company you are outsourcing it to would charge for the same service. We decided to offer it because if someone was going through something stressful that we were not aware of and they terminated employment, either voluntary or involuntary, we did not want them to cut them off from the benefit. Plus, once we got it rolling, it was not that difficult to administer.

I know nothing of Florida state laws, but do you have a copy of the SPD or plan document? It should address their conversion provisions. If you are still unsure, ask them to give you the exact wording from the plan document or from their policies where the conversion would be excluded. If they quote mumbo-jumbo to you, send a letter and ask for written documentation. Send a copy to your Department of Insurance. (Make sure you note on their copy that it is being sent to them.) Those letters usually have a time constraint on when they have to respond and it will get their attention.

Alexa48: Much of the help you are looking depends on what type of business you are in: if you are already a covered entity under HIPAA (in short, a health plan, clearinghouse, or provider), then you have to look at your responsibilities as a covered entity. If you are not a CE, then you need to look at your responsibilites as a plan sponsor. I suggest starting with www.ebia.com as a great source of information. I also suggest you look at the regs under164.530(k) for the information regarding health plans. You can find this under http://www.bricker.com/attserv/practice/hc.../hipaaindex.asp. This is also a great place to view the regs in an organized fashion. Your carrier may or not be a CE also, depending on if they meet the requirements of the definition of a group health plan. For instance, TPAs may or may not be; they need to make that decision and you need to be asking them. Since it is your consultant, i would do more research with your carrier, especially since you are self funded. If you need a sample of any BA contracts, contact me offline and I can provide them to you.

I can't find it in anywhere in my COBRA information that it qualifies; however; I would be careful how you handle this and look at the big picture. How many employees will TRY to file a suit, go to the EEOC (to try to find a discrimination problem), find other employment? How many employees will quit before the plan end and then you will have to offer them COBRA? You might be better off to offer it and see how many employees take you up on the offer. Even if you do not offer them the plan, (and you might want to rethink that offer), you might see if you can't help them find other individual coverage. Can you offer them, as a separate class, less benefits and have them pay more than the carve out managers?

When you look at the remaining seven in question, do not forget to irequest information regarding waiting periods. These are not considered a break in coverage and can really change the outcome of the pre-existing time period.

It is Thompson Publishing Group and they are a great source of information. I have only used their COB guide, but it is the best. Thier website is www.thompson.com.

Is it a separate plan altogether, or a separate class under the same plan?

I believe so, i don't think their is anything in the regs singling out this kind of plan. On the practical side, I can see where they would need one if they were going to work somewhere else that might have benefits. Why do think you would not? I always error on the side of conservative-ism and i would.

It is wedi.snip.org and www.hipaadvisory.com. Sorry about that. I am not sure you are going to be able to find a single location for this info. You might also try hipaasummit.com and look through the past presentations for the information. I know they have addressed this issue with some states in the past, i just don't know if they are all included.

I would try the American Hospital Association web site (www.aha.org). I have heard that they have a state by state list; however, we are not a hospital, so i have not seen it. I would also try www.wedi.snip.org and www.hipaadvisory.org. Contact me if offline if you would like anymore information.

The 1974 Privacy Act concerns only the use of SSNs by the government, not an insurance company or provider. I had our privacy attorney review our use of them under Indiana and federal laws a few months ago, and we can require a patient to provide it to us. It falls under the HIPAA definition of Protected Health Information (PHI) and therefore would be protected along with all the other information and not disclosed outside the clinic's use without the information being posted in our Notice of Privacy Practices or without written authorization. Without posting a huge HIPAA sermon, i do not think there is any recourse for the employees. I do not know about the any possible legislation, however. I agree iwith mroberts and think some burden is on the person carrying the card.

Gloria, it certainly sounds like you have had the runaround and have had horrible customer service from your HR department. For HR professionals everywhere, i can assure you we are not all like this, nor do we always try to blame the employee. I don't know the size of your company or who in HR you have been dealing with, but in your shoes, you might want to do the following: Wait until this is straightened up, it sounds like they are finally on the right track. Once you are sure that your flex is correct, your taxes, etc.... then file a formal grievance per your handbook. Address the concern to whom your greivance policy states. If it is not that detailed, address it to the head of HR and their boss. Document everything, be very professional and follow the greivance policy to the letter. Hopefully, you can sit down with them and talk to them about this and try to see each others' point of view. It sounds like you were outraged (as you should have been) and they were defensive. Take the grievance process as far as you need to be satisfied or as far as the policy lets you. At that point, hopefully you all can put this behind you. Keep an eye on them during your next open enrollment. Have them initial your copy of everything, etc.... I am also concerned that you stated your check did not show any other deductions. Check to make sure that the rest of your benefits are in place and they have not been accidently cancelled. It is easier to check now than when you are trying to use them for healthcare, dental appointments, etc... i am not an attorney, nor do i know what agencies outside of your employer you have to choose from if you wanted to make a formal complaint (some of that depends on your state), but i wish you well.

You can look in the HIPAA regs under 164.504 for the information regarding plan sponsors and what they can and cannot do in regards to Protected Health Information (PHI). You can contact me off-line if you need help finding the regs on-line. Keep in mind that the regs are a huge piece of legisation and it is a "work in progress". The date for compliancy is 4/2003, so things they are doing now might have to change, but it might not be illegal. Also, check with the state laws, they too, can have a say in this. I do encourage you that if you are uncomfortable with the information that is being shared, do your research. You will be much more in-tune with the information they will be giving you about HIPAA in the future and you will be a better consumer. Good luck!

That is a tough one. Have you spoke with your HR department, either your current one or your future one? I think it would depend on the "joint venture" between the companies and the arrangement they are making. Questions to ask your HR department: Will i be switching plans to the new company? What is the plan year for the upcoming FSA plan? January -February? January -December? How are they planning to role out the transition, are you going through the new hire process for your benefits? (this might effect your other benefits depending on any waiting period.) Keep asking questions and getting answers in writing. I am sure you are not the only employee in this boat. If you speak to an attorney, I would get a benefit attorney. Or ask to speak to the attorney who is handling the joint venture of the companies and the FSAs.

While i cannot point out the law to you, the FSA amount an only be changed because of a qualified change of life and terminating this does not qualify. We had a similar discussion about this earlier in the week. If it meets HIPAA guidelines, they may COBRA.

This is appealing if you want to sign up for another year and make one contribuiton, then stop. The entire amount that you have elected can be paid out to you. For example, I quit today and I elect to COBRA my FSA. I pay my last December premium and then elect to take it for the next calendar year. I have laser eye surgery on January 3rd and put my claim in for reimbursement. I make one payment for January, and then stop. I fall under the same guidelines for the FSA and the company takes a loss. i get my surgery for 1/12 of the cost. I agree, it is sneaky, but legal. This is the way of FSAs.

In COBRA seminars, FSA's are considered a health plan and are, therefore meets the COBRA requirments. That means they must be offered just like health and dental. They can continue the contribution even though they lose the tax savings. Some employees may consider this if they know they have a large balance of unused funds. Others may want to take advantage of the situation. Either way, in the past, I have always offered the plan with the COBRA paperwork.