tsrl01

We have an employee who has moved from a full-time position to a part-time position mid year. Under the ACA, do we have to keep this employee on our benefits for the remainder of the stability period? Or, can we terminate benefits because the employee is no longer in an eligible class?

Thank you for your reply - I am referring to the reporting obligations under CMS which require that settlement agreements with Medicare-eligible individuals be reported to the government.

If as part of a severance agreement, employees are given funds to purchase COBRA, is that reportable to CMS? I understand that if a settlement, severance, etc. payment to a Medicare - eligible individual if the payment relates to past or future medical expenses, but if the settlement just includes funds to use for COBRA (we don't know whether they actually purchased COBRA or not), do we have to report?

If a voluntary vendor offers a premium discount for other benefits (1% discount for our life coverages). My concern is that this would constitute "consideration" and therefore would not satisfy that prong of the safe harbor exemption. Any thoughts?

If a voluntary vendor offers a premium discount for other benefits (1% discount for our life coverages). My concern is that this would constitute "consideration" and therefore would not satisfy that prong of the safe harbor exemption. Any thoughts?

We submitted our plan to the IRS under VCP about 6 months ago and just found an issue completely unrelated to the VCP submission. I do not see any requirements that we can't still self correct the recently identified problem, but wanted to see if anybody had a different opinion. In my mind, since there isn't a specific exclusion, as long as the issue would otherwise qualify for self correction, I can. Any insight would be appreciate - because maybe I completely missed an all cap requirement that says differently....

Looking for thoughts on whether the Virta diabetic add on program would be subject to COBRA. I'm inclined to say no, that it is an independent, non-coordinated benefit (disease-specific, excepted benefit, but wanted to see what everyone else's thoughts are. Thank you!

One of our carriers inadvertently sent us a file for another client of theirs. We sent an internal email to all those who received the email by mistake notifying them that it was sent to them in error and requested a response back that the email had been deleted. We also notified the carrier and informed them of the same. The carrier is now requesting that we sign a certification that we in fact deleted the email and did not view it. Are we under any sort of an obligation to sign this certification? We notified them of their error and confirmed via email that we deleted the file and did not keep it, but they have said that isn't sufficient, they need a certification signed by us. This just seems a bit overboard.

We have a situation where a participant in a plan has died. His brother has provided a POA naming him. He doesn't have any letters of testamentary because he's saying he doesn't need one - he's the POA. Our process is to require a letter of testamentary to show who was appointed the executor. Are we ok distributing to the estate without a letter of testamentary - just distribute to the estate - paid to the estate, etc. I think we still need one - we need something to show that this person has the authority to sign on behalf of the estate. Any help would be appreciated. Thank you,

Thank you!

We have an individual who wants to rollover their SIMPLE IRA from a previous employer into our 401(k) plan. I do not see anything which would prohibit this, but want to check. A SIMPLE IRA is treated like any other IRA for distribution purposes - so as long as the SIMPLE IRA has satisfied the 2-year requirement, it appears to be ok, but I'm afraid I'm missing something. Does anybody have any other information?

This probably sounds elementary, but what is the significance of subscriber to member ratio when negotiating contracts with vendors. Is a higher ratio (3.5) better than a lower (2.0) or is it the other way around. I would think lower is better if my understanding is correct.

We've received a divorce decree from a participant in Nebraska. Pursuant to the signed decree: 'For the purposes of continuation of health insurance coverage, the Decree shall become final and operative six months after the Decree is entered." Question: Has anybody dealt with this before? I have seen mention of this situation on Benefitslink threads, but curious how it was resolved practically... because the plan is self-funded would ERISA preemption apply? Or because of the manner in which it is worded - that for health insurance, the divorce isn't effective until six months, the COBRA qualifying event doesn't happen until 6 moths? Nebraska Statue Below: 42-372.01. Decree; when final. (1) Except for purposes of appeal as prescribed in section 42-372, for purposes of remarriage as prescribed in subsection (2) of this section, and for purposes of continuation of health insurance coverage as prescribed in subsection (3) of this section, a decree dissolving a marriage becomes final and operative thirty days after the decree is entered or on the date of death of one of the parties to the dissolution, whichever occurs first. If the decree becomes final and operative upon the date of death of one of the parties to the dissolution, the decree shall be treated as if it became final and operative the date it was entered. (2) For purposes of remarriage other than remarriage between the parties, a decree dissolving a marriage becomes final and operative six months after the decree is entered or on the date of death of one of the parties to the dissolution, whichever occurs first. If the decree becomes final and operative upon the date of death of one of the parties to the dissolution, the decree shall be treated as if it became final and operative the date it was entered. (3) For purposes of continuation of health insurance coverage, a decree dissolving a marriage becomes final and operative six months after the decree is entered. (4) A decree dissolving a marriage rendered prior to September 9, 1995, which is not final and operative becomes operative pursuant to the provisions of section 42-372 as such section existed immediately preceding September 9, 1995. Source:Laws 1995, LB 544, § 2; Laws 1997, LB 434, § 1; Laws 2000, LB 921, § 34.

Once a Plan Administrator has obtained consent to distribute documents electronically - where does the burden of proof lie? Say the plan administrator emails to the address on file, but does not request a return receipt, but the email does not kick back as invalid, if the participant then claims to have not received the document, who has the burden? I've been looking for cases, guidance, etc., but the only thing I've found is the Thomas case wherein the employer posted on a website, but did not inform the individuals that it was posted. Any further information/guidance/cases, etc. is greatly appreciated!

Can someone point me to the statutory authority (or an IRS publication, etc.) which precludes passive enrollment for FSAs? Can the spousal surcharge roll over? What about any tobacco surcharge?

So then, I guess what I'm trying to find is where in the regulations does it state one can't submit expenses after termination of employment (unless they elect COBRA)? Is by definition of "period of coverage," but that's defined as the plan year (whether 12 months or a short plan year), so is it just the plan document?

I know this seems like an elementary question, but where in the regulations does it state that an individual's coverage must end in a Health FSA upon termination and therefore no expenses incurred after termination may be reimbursed (unless COBRA)? I may be making this more difficult than it is, but the definition of Period of Coverage does not provide that the Period of Coverage ends upon termination. And under the Uniform Coverage rule, amounts must be available during the entire Period of Coverage, but 1) if one is on a LOA and doesn't make the required contributions or 2) terminates employment, I realize expenses incurred when not a participant aren't eligible expenses, but my brain is a not helping me find the specific regulation language/section and I'm drawing a blank.

We want to allow participants currently in a DB to elect whether to stay in the plan at the current multiplier or go to a DC plan. Those who elect the DC will have their DB benefit frozen and get an increase in their non elective contribution rate while the ones who stay in the DB do not receive the nonelective in the DC. Can we do this? Guidance? Thank you!

We have a situation where an entity is requesting documents/appealing a denial of a claim. The entity attached a form whereby the participant designed and assigned his/her rights to the hospital. However, the hospital was not the entity making the request, so we told the entity sorry, you aren't the authorized rep, the hospital is, then the entity sent us the fee arrangement between it and the hospital for collections, etc. I'm still inclined to say sorry - this is not sufficient to demonstrate the participant named your entity as the authorized rep... in fact, participant named hospital, not you. Thoughts??

Do the change in status rules apply to employer contributions to an HRA? It's all employer money, so no employee pre-tax dollars are going in. I get that the employer can always write it in as a requirement to follow the change in status rules, but is it a requirement under the Code?

That's part of the issue - we have not received the new QDRO. The administrative process is that when the pension plan receives a QDRO, we put a hold on the employee's 401(k) plan, just in case... So now that we know there's going to be a new QDRO, should we put a hold on the 401(k) account? The participant wants his 401(k) - arguing he didn't have a balance at the time of the divorce, but I'm a little concerned - could the new, revised QDRO entitle the ex-wife to a portion of his 401(k) even though they were already divorced and hadn't been married for 5+ years by the time he began participating in the 401(k) plan? It doesn't make sense/seem fair, but common sense and fairness don't always come into play...

The 401(k) plan actually did exists in 1995, he just didn't participate. Not sure if that makes a difference.

We have a situation where a participant divorced in 95, notified us of a QDRO for the pension plan, is getting ready to retire now, sent in the QDRO, it is not valid, so it has to be redone. The question tho is around the 401(k) plan. In 95 when the divorce occurred, he did not participate in the 401(k) plan. Didn't begin until 2003. I don't see a reason to hold the 401(k) money until the valid QDRO for the pension comes through, but I wanted to make sure i wasn't missing anything??? Thoughts? Okay to distribute the 401(k) proceeds? Or should we wait until the valid QDRO is received.

The way I read the definition of Electronic Data Interchange, those standards apply to computer-to-computer interactions - no human intervention is required to process the message... so, if we email an excel eligibility file to a vendor who then has to upload the information to its system, a human interaction has occured and the EDI standards do not apply? Am I on the right track here?

For various reasons (increase in retiree contributions, splitting off of some benefits such that not paid through the VEBA), the VEBA has accumulated some money (unbeknownst to anybody except the accountants). Now we are trying to figure out a way to get the money out of the VEBA. It seems that it would be acceptable for the VEBA to "reimburse" the employer for benefits/premiums paid by the Employer for the provision of benefits to participants that could have been paid by the VEBA... is this correct? I assume there would need to be some sort of documented agreement to demonstrate the proof of the reimbursements, etc? Any help/guidance would be appreciated! Thanks!