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Found 14 results

  1. 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!
  2. I have an individual client who's employer is stating he voluntarily terminated employment because of job abandonment. However, he did not abandon his job but left (with the employers permission) on a Tuesday after they refused to pay him a commission on a large deal which violated his employment agreement because he was very upset. His attorney sent the employer a demand letter the next day requesting how they were changing his prior employment agreement and indicated the employee would be taking vacation days until the employer responded. The issue is that employer is stating he voluntarily resigned when he didn't and wanted to remain working there but couldn't get them to agree that they were changing his employment agreement. He elected COBRA, (the employer has less than 20 employees so it officially falls under the state continuation plan) but without knowing the monthly premium cost. When he received the amounts($3,400/month for he and his family), he did not proceed with COBRA and didn't make any payments. He is still within his COBRA eligibility window and therefore submitted his request for treatment as an AEI, but the employer returned it to him denying coverage due to "loss of employment was voluntary". The DOL/EBSA cannot assist because they don't have jurisdiction over state continuation plans and his state department of insurance is indicating they can only help with Insurance Company or Agent issues. Does anyone have any suggestions on how he can either get this resolved or where he can get legal assistance? Most of the law firms he has spoken to deal with employers and not individuals so he's at a loss of where to turn. Thanks in advance for your thoughts! C
  3. Scenario: Employee's spouse's employment was terminated. She is eligible for 12 months of fully subsidized COBRA continuation coverage followed by an additional six months of unsubsidized coverage as required by COBRA. The spouse is nearing the end of the 12-month period of subsidized coverage and the employee wants to enroll the spouse in his employer's plan effective at the end of subsidized period. HIPAA's special enrollment rights would, in general, permit the employee to enroll the spouse in his plan in lieu of her electing COBRA (i.e., 12 months ago) and again at the end of the 18-month COBRA period. But there is, in general, no special enrollment right to add coverage in the middle of COBRA continuation coverage. In the COVID-19 relief (which in my view was not the previous Administration's best effort), the requirement that a participant inform an employer of a special enrollment right within 30- or 60-days (depending on the event) is tolled until basically the end of the pandemic. Must the employer permit the employee to enroll his spouse in the plan as he requests because the notification requirement is tolled? Or did the employee's special enrollment right for his spouse go away when she elected subsidized COBRA? Any thoughts are appreciated.
  4. If an employee who his 66 years old and on Medicare retires on Jan. 1, and his spouse is not yet eligible for Medicare wants to carry COBRA, how long can the spouse carry COBRA?
  5. Can an employer offer longer COBRA duration, for example 30 months instead of 18 for a class of employees - executives, or salaried but not hourly? Assume that the employer does not subsidize the premium.
  6. Company acquires sub of seller via an asset purchase transaction and decides to employ certain of the sub's employees following close of the transaction. Buyer is an ALE. There will be a lag time until Buyer gets plans in place for the acquired employees (it's putting separate plan in place for the acquired employees). Buyer is considering paying for acquired employees' COBRA under Seller's plan on a tax-free basis. Any thoughts as to whether this will work, or what issues it may raise? What about the ACA concerns? Thanks in advance.
  7. Can anyone provide some guidance on how (or whether) a employer sponsor of a self-insured plan reports on Form 1095-C with respect to employees who terminated employment prior to 2015 but participated in the plan by reason of COBRA for all or a part of 2015? Are they reported the same way as employees who terminated in 2015 are reported for the portion of the year in which they were on COBRA? Thanks.
  8. This is the first sentence of the text of the model COBRA Election Notice as revised by the DOL to incorporate information about the availability of coverage in the Marketplace. I am copying it verbatim from the DOL website: This notice has important information about your right to continue your health care coverage in the [enter name of group health plan] (the Plan), as well as other health coverage options that may be available to you, including coverage through the Health Insurance Marketplace at www.HealthCare.gov or call 1-800-318-2596. (The underscore/underlined text after "call" is as in the original.) It seems to me as if there are words missing after the word "Marketplace" because the sentence does not make grammatical sense as written (although the intent of the sentence is obvious). I have not seen any discussion of this. Has anyone encountered this? If so, what, if any changes did you make to this language when customizing it for actual use? Thanks.
  9. Employer has an existing severance pay plan covering all employees for both involuntary and voluntary separation from service. Plan does not qualify for 2 /2 separation pay plan exception because it pays on voluntary termination as well as involuntary. Lump sum severance benefit is service-based and terms comply with 409A. Plan also provides that employer will pay COBRA premiums (again for ALL employees) for the period used to determine severance (and this is always shorter than COBRA continuation period). They now want to eliminate the health coverage continuation premiums and instead pay an additional lump sum benefit at the same time as the existing lump sum benefit. Not trying to get out of paying employees, but want to make it easier to administer and they envision that the company may stop offering health insurance altogether as it winds down operations. The medical coverage should be exempt from 409A - meaning it isn't deferred compensation because it is a nontaxable benefit (or in the alternative, qualifies under the Medical benefits exception for separation pay plans that limit reimbursements to the COBRA continuation period. So I am thinking that eliminating this benefit and replacing it with a lump sum benefit would not be a substitution of deferred compensation that would result in an acceleration because it wasn't deferred compensation in the first place. Any one see any problems with this approach?
  10. An employer was paying for the first month of a former employee"s COBRA. The former employee sent his COBRA election letter to the former employer instead of the administrator. The employer paid the first month premium. The administrator cancelled the former employee"s COBRA because they did not receive the former employees election. Does the election notice by the former employee to the former employer count as notice of the election? The election notice was sent to the employer 8 days after receipt of the COBRA notice.
  11. An employee is requesting information on the COBRA implications of her entry into a partial dissolution of marriage (or "bifurcated divorce") under California Family Code s. 2337, pursuant to which I believe a ruling on dissolving the formal marital status is made ahead of resolving other (eg financial) issues: http://www.leginfo.ca.gov/cgi-bin/displaycode?section=fam&group=02001-03000&file=2330-2348 Anyone have any experience as to whether a bifurcated divorce ruling would constitute a "divorce" or "legal separation" (both COBRA qualifying events under our plan)? Bonus points for Calfornia practitioners but any state would be helpful. Note this is a separate question from whether the employee will remain financially responsible for providing health coverage pending total dissolution - the CA Family Code suggests that this could be addressed in the ruling, so the only question in my mind is whether the coverage (if any) should be provided as regular spousal coverage or through COBRA. Thanks for any guidance!
  12. I know that under the FMLA, participants on unpaid FMLA leave have reinstatement rights immediately upon return to active employment, but what about other "terminations for nonpayment" -- For example, if someone is on non-FMLA unpaid leave or if someone's payroll amount is not sufficient to cover the employee share of the premiums? If that individual is terminated from coverage for nonpayment and later begins paying again... (1) Does that person have to pay up all arrearages before being reinstated? Or do they just have to pay going forward (and have their coverage canceled retroactively)? (2) What if that person has a qualified life event during the period he/she is not covered? For example, if that person got married during an unpaid LOA and seeks to be reinstated... would that person be eligible for an election change immediately upon reinstatement? (3) What if that person is terminated while on unpaid LOA and benefits were terminated for nonpayment... ignoring any other legal issues, would that person be entitled to COBRA if they were not participating on the date of termination?
  13. I was released from a large company on 8/31/13 and offered COBRA coverage accordingly. None of the notifications or the plan summary description make mention of a need for my 67 year old husband to become entitled to (sign up for) Medicare part B to receive identical coverage. In our coverage the day before I was released, he did not have Medicare B. At the end of December we learned my husband would need surgery. The first week of January, I called the provider to verify our coverage & maximum out of pocket for him. The reply I received that day was in line with what I understood our existing coverage to be. I called again a few weeks later to see why claims weren't being paid as usual. I disclosed that we were COBRA and that he had Medicare part A, but not part B. I was told that they would resubmit for payment, it would take 30 days. I called several times to monitor status on this. Until 3/11, the answers were that it was in process, it would be 30 days. After 30 days was up, the answer was that review was complete and that it would take an additional 30 days for full correction. Last Tuesday, on 3/11/14, I was informed that because he is "eligible" for Medicare, they will only be paying 20% rather than filling the gap for part B. He is indeed eligible for part B, but he is not entitled to part B. Since he was under my insurance plan 2 years ago when he became eligible, he declined, so is not entitled. Nevertheless, his coverage has changed from the day before I was terminated to a 20% limit. There is no indication of this possibility in any of the COBRA documentation or summery plan description. I have been searching for information on COBRA & Medicare. My understanding of the law is that it pertains to entitlement, not eligibility. If he had signed up for Part B, he would be entitled. Since he didn't, he is only eligible. I've talked with both the company (self insured) and the carrier about this. They are both sticking to the "eligibility" status as reason for declining coverage now although there has been a variety of answers to this from both of them. The first surgery was double hernia on 1/10/14 after my initial call to the carrier. During pre-op workup, we discovered he had a large dissected aneurysm and leaking valve. He had open heart surgery on 2/10/14. We are now being informed we are responsible for a gap mounting into tens of thousands of dollars. I think they are confused about entitlement vs eligibility. The last company rep I talked to said there have been other cases like this. My questions are: Is there a COBRA exclusion that allows them to require Medicare B entitlement or a change in coverage like this? If not, what recourse do I have? If there is a COBRA exclusion that makes this legal, do I have recourse with the carrier who gave me incorrect information for 2 months while we incurred extensive medical bills? Thank you, Sue B
  14. Can an employer automatically enroll terminated employees in COBRA? The employer wants to automatically enroll severed employees - the employer will pay for the COBRA coverage for a limited period. At the end of the period, participants could either opt-out or just not pay for continued coverage (at which point, the COBRA coverage would terminate). The employer's COBRA vendor has said they do this frequently with other clients, I can find no authority to permit this. Thank you in advance for any help!
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