irenesmsaclaims
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Ok, each LTD contract has many components, which need to be compared with each other from product to product. These will make a difference when a participant is "on claim" in terms how the contract will perform. Most, if not all, will offset its b…
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I hope it's not too late, but if you are comparing quotes from insurance companies, LTD can be a bit of work. You would need to look at the following: the elimination periods, the benefit periods, (including those for mental disorders), the residu…
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To the last post, continous is best, but not mandated by HIPAA. It can be when enrollment form is received, first of month, date of event, etc. It does vary. The request must be made within the 30 days of the event. (Check plan document or policy …
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I doesn't matter if the ex-employee elects COBRA; all qualified beneficiaries have a separate and independent right to COBRA continuation. All plans and providers of coverage must comply with COBRA rules and regulations. They don't have a whole l…
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The dependent children, if covered under the plan on the day before the qualifying event, are qualified beneficiaries, and have separate and independent rights to 18 months of COBRA continuation, if the event is termination or reduction in hours. I…
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If you terminate her coverage effective as of the paid-to date of March 1, then she would not have been covered on the day before the qualifying event (March 10); therefore, she would have no COBRA rights, nor would the baby (not covered on the day…
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[font size="1" color="#FF0000"]LAST EDITED ON 03-03-04 AT 07:09PM (CST)[/font][br][br]Typically, an insurance company will require 100% participation if the employee contribution is 0. It's because of adverse selection. They want all of the healthy…
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There is a statutory penalty for late COBRA notices to former employees of $110 per day (after the 14 or 30 [44] days as previously posted). However, there have been court decisions denying the penalty if the former employee is not harmed (doesn't …
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If they are terminating the plan, there would be no COBRA rights. No plan, no COBRA. They probably need to see if their plan was subject to ERISA, as there are rules regarding notice of amendment/modification and termination under ERISA.
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[font size="1" color="#FF0000"]LAST EDITED ON 02-10-04 AT 07:01PM (CST)[/font][br][br]Simply stated, HIPAA is a body of federal law dealing with the portability and accountability of health coverage and privacy. Notification requirements reside in …
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The prior employer has to contact the COBRA people at their last known address. If the employees provide a newer address to do the COBRA business, it would seem reasonable that the prior employer would use it. Again, to avoid any lapses of coverag…
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Yes, the old company has the right to charge the 2% administrative fee, by law, even though the new company is doing all of these things for the people. They are the COBRA-offering entity. Since they are probably accustomed to receiving a check fr…
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Many plans exclude marriage/family counseling. Check your plan document exclusions. It sounds like this employee is asking you for tips on how to file a fraudulent claim. Sometimes providers will code something with a different code to ensure tha…
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Two come to mind: CEBS (Certified Employee Benefit Specialist, about as difficult to achieve as a CLU in the life arena) and RHU (Registered Health Underwriter).
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Section 125 FSAs are subject to COBRA, and you must offer COBRA; terminating employment is not a status change allowed under Section 125 (events which allow change in annual election). That is, people cannot change their election amount because th…
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The COBRA offer would be for the medical spending in the cafeteria plan, not for the individual health policy, if in fact the employee is the one maintaining the coverage. It can get tricky if the employer is involved in the policy, and could be co…
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There are no COBRA rights with an individual health plan paid for by the employee, with no employer involvement. There are COBRA rights, however, with the FSA (health spending part of the cafeteria plan) and COBRA must be offered for that.
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Forgive me, but I must amend my previous post. I do not sell anything, except to family, and the other posters are exactly right about the quality of the agent that the employer allows to come into the business.
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Ok,ok, I'm sorry, but I can't stand it anymore. I was the sole HR/Payroll person at a company of about 100, and my own, one-time experience with AFLAC (although the duck is cute)was that an agent came in and signed up several people, left the state…
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A self-funded plan is a plan set up by an employer or union where the entity actually pays the claims (usually they are reinsured by a stop-loss carrier after a certain amount, ie., $30,000 or more). A contribution is calculated for the employee to…
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It is the later of 18 months from the qualifying event (1/30) or the date coverage is lost due to the qualifying event.
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I'm not sure I'm following. The employee isn't losing coverage due to retirement because retirees can stay on the plan. The wife (I don't know their definition of dependent) has no qualifying event (divorce, separation, dependent child reaching th…
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Under the COBRA rules, no. She doesn't fit into any of the qualifying events. The QE about Medicare entitlement has to do with the employee.
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If the retirement does not cause a loss of coverage since you allow retirees to stay on, then there would be no COBRA qualifying event. Are there other factors not in your post?
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Yes, she is able to do that, by not paying for them; however, I would tell her that once she drops them, they cannot get back on, as COBRA. Each covered person has an individual COBRA right.
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One caution: HIPAA's "discrimination on the basis of health condition" prohibition has affected a plan's ability to restrict coverage only to "actively at work" employees.
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"COBRA rights are not affected if an employee fails to pay the employee portion of premiums for coverage under a group health plan during FMLA leave. Any lapse of coverage under a group health plan during FMLA leave is irrelevant in determining whet…
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There is no qualifying event for COBRA until you term. employment, or the ee notifies you of intent not to return from FMLA. Other kinds of LOA could be a qualifying event (reduction in hours), but not FMLA. See previous discussion called "COBRA H…
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Ok, the original letter didn't say his employment would be terminated, which would be a qualifying event. The insurance company cancelling his coverage (non-payment) is not a qualifying event for COBRA. You must maintain his coverage contingent up…
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There's no reason why you can't give him notice that when the 30 days are up, coverage will be terminated; but, if he's still on FMLA, and hasn't notified you of his intent not to return to employment, there is no COBRA qualifying event. You would…