Conflicting clauses in HRA Plan Adoption Agmt

[WalkingAssets]

We have an employee whose last day of work occurred mid-September.  He was participating in both our group health plan and our HRA. He remains covered by the health plan through the end of the month. The question is if he is also covered by our HRA during that time?

In our plan adoption agmt, we have one clause that states that "an Employee is eligible to participate in the Plan under the same terms and conditions as under the Company benefit plan" - and our group health plan is then specified as the "Company benefit plan". However, later in the agmt, we have another clause that specifies "Permit Eligible Employees to participate in the Plan after Termination" and the "No" box is checked.

So our TPA is saying that the ex-employee's access to his HRA ends on his last day of work (or technically, the next day). But that seems to conflict with the first clause and in addition, it seems, shall we say, asymmetrical to allow an ex-employee to continue to accrue expenses under the health plan, while denying him access to the HRA at the same time. 

I am not sure which clause should take precedence or whether it is up to us, as the plan administrators, to override our TPA's interpretation if we so wish. Or should we just check with an ERISA lawyer...

Thanks in advance!

[leevena]

If push comes to shove, the findings will always favor the employee.  Having not read your documents,  I am guessing at some of this.  

The plan adoption agreement means nothing, what does the SPD state?  This is the key document.