SMace
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There are some instances where they could get burned with the coordination of benefits. Our health insurance waives the co-insurance limit when someone has other insurance coverage. Otherwise we would get stuck with the entire bill once they hit t…
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[font size="1" color="#FF0000"]LAST EDITED ON 02-09-04 AT 11:39AM (CST)[/font][br][br]Yes. If they are eligible for FMLA, we run it concurrent with WC. We do not file STD, because it is offset by other income, thus they would not get paid due to W…
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Chari, I still cannot believe they can do that. The logic is flawed. Are they charging the 30 year old with the co-morbidities of diabetes, high blood pressure and high cholesterol more? No, but they are charging the 50 year old that exercises 3…
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I'm surprised that you can do that. Would that not be considered age discrimination?
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Our health insurance TPA administered our STD plan until this year. We are now using Jefferson Pilot. They have an "advice to pay" system that looked really good on paper. We'll see.
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Welcome to the forum! I do not have a clue and honestly I hope I never find out about section 132. Ireneclaims is very savvy in this field. Maybe she or someone else will know. Sorry I cannot be any help.
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You don't want to kick off the healthy people, only the sick ones. x;-)
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I think wisdom from me is debatable. However, our focus has changed from plan design (still important, but we've done all we can do) to trying to help people become healthier and to change ee's mindset from "Insurance will pay for it" to "I want to…
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Sounds like you have some execs that want to retire at 55 but don't have ten years in. They will be doing a disservice to your organization in the future. Retiree health benefits are killing organizations. My dad retires at age 57. If he did not…
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We are self-insured. I pass any class action info on to our TPA's subrogation department.
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Interesting idea. I think I might have to start smoking, just so I could quit. x}>
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>I do think you need to get some legal advice, >especially for your state. > >With that said, some companies are not charging >smokers more, but are rebating back to >employees, that do not smoke, a portion of what >the…
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We are self-insured with stop-loss. Our savings are bottom line savings for the company
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>Let me clear things up for you Smace. > >First, I am asking a lot of questions right now >and they are rhetorical - it's called a >conversation. I cetainly don't think that >everyone here has all of the answers, but I &g…
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You didn't ask me but...... You can exclude this in an ERISA plan, however if it is the result of a physical or mental medical condition, it's paying. I'd have a hard time believing that anyone who tries to kill themself doesn't have a mental cond…
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>[font size="1" color="#FF0000"]LAST EDITED ON >03-03-06 AT 02:47 PM (CST)[/font] > >Hi SMace > >I didn't walk into your point - you missed mine. >x:-) As employers, I agree, we can't just sit >back and not do anythi…
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Reply #17 was to Wild, not you. It's too much info to type. If you would like more help, it will be easier to talk about it. Email me and I'll give you my #. If not, good luck. You can do it.
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You walked right into my point. "Since it's the tip of the iceberg and it's kinda scary, let's not do anything." Sit and back and watch your rates grow. Bottom line- tobacco is bad for you. It causes/contributes to significant health problems. …
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We are fairly comfortable that the note is a good way. It is not perfect, though. I may not have made this clear, but ee's and spouses have incentives to comply. If a spouse and ee both use tobacco, they pay $14/week more for their insurance. …
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Yes, we do. See above. If ee's want to qualify for the non-tobacco rate, they have to pass a urine test. Spouses only have to supply a letter from their physician that they are tobacco free. We have a system set up if someone wants to quit. You…
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Thank you Balloonman.
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There is no federal protection for smokers other than HIPPA that I know of (again providing reasonable accomodation prevents the "discrimination" in the cost of health insurance). I think there are some state and or local laws that deal with smoker…
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I do not know what you mean by PLR exception. You are exactly correct about follow at your own risk. Our thoughts were are we going to sit here and take 20% hits on premiums for years or are we going to try to do something about it. We are doing …
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We charge more for smokers. The other poster is correct that you cannot discriminate because of a health condition. Smoking is a health condition. However, if you offer a reasonable alternative for the person not to be charged more, you can do it…
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Why do they hate them?
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Just read this today. Probably to late. Anyway two key components are good wellness benefits (you don't want them trying to save money by not having preventative health care) and great education and education resources for how to spend their healt…
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Does this summary of benefits give the ee's their COBRA and HIPPA rights? How about claim review and appeal process, or exclusions, or precert requirements, or eligibility requirements, or pre-existing condition rules? I would not feel comfortable…
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You said you contacted "some" of your TPA's for a plan document. You should only have one TPA that processes your claims. You must not have called the correct one. As others have said a TPA CANNOT process your claims without a plan document or S…
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In my opinion the key to this type of insurance is EDUCATION, EDUCATION, EDUCATION! IF you give them money with no info on how to use it, it will not work. Also, you should cover preventative health care at 100%. You do not want to incent them to…
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Your plan document has not been updated since the early '90's??? Yikes. It should be done any time benefits change or to be in compliance with any new laws. As I understand there is a lot of compliance info regarding HIPPA that must be in plan do…