irenesmsaclaims
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Hunter, wow, I really have never thought of the PBM getting rebates from the drug manufacturers. I have reviewed many PBM contracts with clients, and the usual drug MAC, discounts and fees, but these rebates must not be in the contracts, and an arr…
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Since you are self-funded, what does your current TPA charge PEPM? $100 PEPM is EXTREMELY high. Depending on the typical number of claims per month on average, the norm is about $12-20. It's not a viable comparison if the alternative is unrealisti…
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I've been a broker for 22 years and have never heard of Liberty Benefits Group. My hunch is that they will take over and become "broker of record" and move you to a TPA and other carriers for PBM and receive a cut/commissions from the arrangements.…
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Do you mean the CFO wants to retain the contributions paid since the QE, even though COBRA is not to be offered?? Is this because of the claims paid? Look in your plan document; recovery of overpaid claims should be in both Coordination of Bene…
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I've been thinking about this. The spirit of the final COBRA rules is to make it easier for people to get COBRA. Divorce and legal separation are events for which the EMPLOYEE has to notify the employer, or forfeit the option of electing COBRA. T…
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Don't shred yet!!! I further researched and if your state has statutes regarding the time limits on claim appeals, you would want to check that. An enrollment form could contain information relevant to a claim appeal (misstatements), and the stat…
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If your company is subject to ERISA, it's regulations require that any documents which support the 5500 filings be kept for at least 6 years; this also applies to plan documents, SPDs, etc. and administrative forms, which I would consider enrollmen…
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I'm thinking that maybe the original poster was thinking about the HIPAA rule that a plan cannot deny or delay coverage due to a health condition. It would be different to delay the coverage due to a specific health condition than to add a day to…
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In order to have an HSA, you HAVE to have an HDHP, according to the rules. Also, the rules allow the money to be spent on non-medical expenses, but then they would be taxable to the participant. During my study of HSAs, it also occured to me that i…
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Yes, COBRA applies to flex plans, and there is the uniform coverage/always available rule, but they still have to have qualified expenses/receipts to be reimbursed. If the surviving dependents elect COBRA, they have to continue making contributions …
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I don't think that you can refund the contributions just because of the death, absent qualified expenses. The dollars can be reimbursed with receipts of expenses incurred prior to the death and during the current plan year. There may be case law re…
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Mid-year changes are subject to the election rules in the Sec. 125 plan if the voluntary coverages are a part of that. The status change (not qualifying event) must be in compliance with the rules, and the change in coverage mid-year must be consis…
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I am corrected, I wasn't connecting it to the cafeteria plan and salary reduction agreement; however, it seems to me that it should go with the Section 125 plan, and not the insuror's rules as to the timing of the annual enrollment period.
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This does not sound right to me. These coverages are not group insurance, and do not have the same enrollment/termination restrictions commonly associated with group insurance. I would suggest that you read the contract (policy) provided to one of…
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Since insurance laws are state laws, it could be different, but traditionally, at least in my state, only agents can complete applications and ask the questions face-to-face (a purist approach). It could be different in Nevada. You may want to che…
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Any enrollment should be done by the AFLAC agent, not the HR department. In fact, in general, a non-licensed person cannot take an application for insurance. As far as the waivers are concerned, this looks like they are just trying to expand the e…
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The high deductible and out-of-pocket aspects of the HDHP and an HSA are scary on the surface, but there are so many really good benefits to this arrangement. The balances carry over from year to year, the money can be used for non-medical expenses…
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If she elected COBRA timely and properly, you have to continue coverage without a gap. She will owe for all back premiums to the effective date of 9/1/04. If it's an insured plan, the company may terminate retro to a certain point.
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Ok, I see that no one has answered this post. Often this information is proprietary, and you have to pay for it. The initial notice should be sent to a person eligible for benefits within 90 days of eligibility for benefits. This comes from the f…
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All of the above responses are correct except that the qualified beneficiary has 60 days to elect, from the time the election notice is sent, and 45 days from the date of election to pay the first premium for COBRA. Each qualified beneficiary, incl…
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The general interpretation historically seems to come down to something which would be illegal, but the previous poster is correct, there has been no definitive clarification for this.
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The employer is the plan sponsor whether it's insured or self funded. If there is ambiguity as to enrollment/waiver, the chances of the employer being sued for a large claim are equal. The insurer could claim employer error in the process of enrol…
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HR Calico, the reason that companies want proof of other insurance/coverage is so that there is no misunderstanding in the event of a large claim, as to who is responsible for the expenses. It is the employer's business to protect itself because i…
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Does your insurance contract or plan document state that after 6 months of non-active status benefits terminate? Under COBRA (federal law), the person would have to experience a qualifying event of termination of employment or reduction in hours (l…
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The expense was incurred in Sept. 2003. Section 125 rules are clear that it is not when the participant is billed or when he/she pays the bill.The date of the services is the date the expense is incurred.
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When people retire, it is the same as termination of employment as far as COBRA is concerned. You cannot NOT offer COBRA; so it becomes a choice for retirees of COBRA or retiree coverage under your plan, and your plan must be written this way. Yo…
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Here is the website where the text of the final rules can be found. It's pretty clear. [url]http://www.dol.gov/ebsa/regs/fedreg/final/2004011796.htm[/url]
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Never, I thought the original poster said that this employee chose to waive coverage.
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I'm a little confused. The one employee who is causing the high rates is voluntarily waiving coverage? If a person waives coverage, you should ALWAYS get a written waiver, so there are no problems with potential claims in the future. Health statu…
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Actually, I believe it's an effective date of May 26, 2004 for the final COBRA rules, but plans would have to comply on the first day of a plan year beginning after November 26, 2004. Correct me if I'm wrong. I don't think any of these final rules a…