irenesmsaclaims
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You might take a look at the thread "COBRA Help ASAP" last December. It's a discussion of the COBRA/FMLA interaction, regarding premiums and the LOA employee not returning.
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Is it possible that FMLA may be involved here, either running concurrently or presumed to be? If so, it may change the process with respect to the back premiums owed during the leave. The COBRA qualifying event would be when she notified you of he…
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If you're thinking about offering continuation, even though you don't have to under COBRA, I would check the policy or plan document for dependent eligibility. If the child is not eligible as a dependent of your employee, a big claim could prompt t…
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You would need to look at the plan document for the Section 125 medical spending plan. These vary according to the plan. Usually, the plan allows 30, 60 or 90 days to file claims for the previous plan year.
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Under COBRA, each person who was covered the day before the qualifying event has a SEPARATE right to elect continuation coverage. You have to give the wife the right to elect separately from her husband, regardless of his circumstances.
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I would be real cautious with this one. ADP is probably giving their endorsement, or label, but is not actually the underwriter assuming the risk. There have been a few of these "multiple employer" arrangements which have been put out of business …
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If it's an insured plan, no insurance company is going to allow a broker to write the SPD. Brokers typically do not have legal departments or ERISA experts, unless they are one of the big benefit consulting firms, and even then will not be writing …
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The certificate is the SPD in an insured plan. You do not have an additional obligation to provide a document, all of the enrollment information should be in the SPD. In fact, it's probably not a good idea for the employer to write something more,…
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Normally, the SPD (certificate) is sent to the employee at home, at least that's what they do here. The master contract (with the employer) should be at your office. If it's insured, they have to provide these.
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If your plan offers conversion, you are required to provide the conversion notice within 180 days of COBRA ending. Not all plans have conversion rights, (nor do they have to) unless your state requires it. Some do. Conversion or not, it is a good…
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You can do this as long as the classes are clearly defined in the plan document or master contract.
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Yes, Section 125 is a body of law encompassing flexible spending, dependent care and premium payment plans (a Cafeteria Plan). There is a part of it which allows participants to change their elections when a certain family status change happens. I…
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Ok, let's say the application says that the employer is to pay a certain percentage for dependent coverage. Then the eligibility part of the contract says that dependents include domestic partners who may not be legally married. If the employer th…
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If this is a fully insured plan, you would want to look at the application, which is part of the contract. There should be a section where the employer states how it is going to contribute for employees and dependents. Then look at the definition …
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Oops, I'm sorry, I just re-read your part of this. You could have terminated her coverage for non-payment during FMLA, but did not. You are entitled to recover those premiums, but unfortunately the law has no teeth to allow you to do so. You may …
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I'm not sure why I didn't think of this before, but when you terminated coverage during FMLA for non-payment of ee contributions, you should be able to get a credit adjustment on your bill for this person. They won't go back forever, but they will …
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It would be like any other COBRA transaction. The person has 60 days to elect; then the person has 45 days from the election to pay the premium (back to the first day of COBRA continuation). If they don't pay, then you can terminate back to the f…
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Even if coverage lapses during a FML, the employee must be offered COBRA at term. of employment or notification that he/she is not returning. If COBRA is elected, it must be put in force, regardless if the employee does not pay the premiums due BEF…
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Failing to pay premiums while on a FML is not a qualifying event under COBRA. You may terminate their coverage, but the QE doesn't occur until they don't return from FML, or notify you of their intent not to return. If you terminate their employm…
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I must respectfully disagree that a reduction in hours QE occurs during a FML. FMLA has its own continuation rules, and coverage must be kept in force (with ee premium contribution) as it would be if the person were not on leave. Another kind of u…
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You can require the back FMLA premiums to be repaid to your company, but I would keep this separate from the COBRA bill, as they are really two issues. You wouldn't want an inadvertent violation of COBRA (premiums, billing). She is entitled to COB…
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No, actually what triggers COBRA is termination of employment, (or notice of intent not to return), not termination of coverage during FML. The latter is not a qualifying event under COBRA
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The taking of an unpaid FML does not trigger a COBRA qualifying event. If the person doesn't pay the premium during the leave, coverage can be terminated, and if they come back, reinstated with the gap during which no benefits are available. If th…
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The nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Public Disclosure Room, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Av…
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OK, this is a little different, if they are new COBRA Qualified Beneficiaries, but no worries. The company that your SO's people left have the regular 14-day obligation to provide the COBRA notice within 14 days (44 if they have an outside administ…
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Did this happen kind of fast? If it's a new plan with a new carrier, the new carrier (although technically an employer responsibility) should have notified the COBRAs along with the actives of new rates, cards, etc. If the premium needs to be sent…
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If a company changes carriers, the COBRA people go to the new carrier. The old plan is terminated and "no Plan, no COBRA". If the company stays with the same carrier but adds to the plan and premiums increase, the COBRA people have to have the sam…
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Ok, see last sentence. Can you still test the smokers in the program?? Can plans charge smokers more than non-smokers? Under the bona fide wellness proposed regulations, a plan can only charge smokers more than non-smokers if the plan provides an …
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A Private Letter Ruling from the regulatory agency governing the Plan ie., the IRS. It's a statement in writing sanctioning a plan or provisions. This can come in handy... I admire your efforts in combatting health care costs, but it seems to me …
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Hmmm, I had to think about this. In the absence of something akin to a PLR on this exception, I would be hesitant to recommend that anyone do this. Would the plan also require people 100 or more pounds overweight be enrolled in a weight reduction …