Massachusetts Health Care Reform

[Guest Ira Hayes]

Question 1: are employers whose healthcare benefits are self funded exempt from requirement to establish Section 125 cafeteria plan with liberalized eligiblity provisions for full-time employees resident in Massachusetts (e.g., 60 days from hire)?

Question 2: are employers whose healthcare benefits are self funded exempt from health care minimum coverage mandates effective January 1, 2009?

Citations would be welcome!

[QDROphile]

Question #3: The regulations say that the 125 plan must provide for eligiblity within a certain time, even if the individual is not yet eligible for the health plan at that time. How do we make sense of eligibility that has no benefit associated with it and will make it impossible to have a mid-year election when the health benefit becomes available?

[Guest mjb]

Under ERISA 514(b) self funded plans are exempt from state insurance requirements. For example self insured plans are exempt from Mass requirement that a plan provide lifetime health ins for an ex spouse after divorce under ERISA preemption. Insured plans must provide health ins for ex spouses.

[Don Levit]

mjb:

You are correct.

Would including self-funded plans in the mandate, which is done, by the way, preempt the legislation?

Don Levit

[Guest mjb]

No. It would only make the legislation invalid as to self funded plans. This was the result reached by the Fed courts who construed the MA legislation mandating health ins coverage for ex spouses. See Bergin v. Wausau Ins co. 863 F Sup 34.The law was held to apply only to insured plans. Cellilli v. Cellilli, 939 F Supp 72.

[Don Levit]

mjb:

Thanks for providing those 2 cases.

Can you tell me which circuit they are in, and the year of the decision?

Thanks, Don Levit

[Guest mjb]

MA Fed district ct. 1994 and 96. know exact dates

[masteff]

the last two posts are commercial spam and should be deleted (I found this because the last person added spam today to a different thread)

[Dave Baker]

Thanks, masteff! Nuked 'em.