irenesmsaclaims
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HIPAA prohibits discrimination due to health conditions; HIPAA also prohibits screening (underwriting) of individuals in a group plan. This affects eligibility, rates, etc. If you charge smokers a higher contribution in your self-funded plan, you…
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If, under your plan, coverage ends when employment is terminated, then COBRA would be offered at that time, the end of employment. As part of the severance you may pay for COBRA for the retired employee for so two months. You can't delay the onset…
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Is it your intent to exclude all use, as it is currently written? Standalone STD is not subject to HIPAA, but some medical plans have altered this kind of provision with "except for a medical condition, ie., depression". You may want to add the wo…
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I hope we're not confusing the original poster. Pearce is right, one of the status changes required in order to change elections in a Section 125 plan is a change in premium. This does not carry over to a medical plan, for special enrollment even…
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The husband cannot get COBRA from the wife's plan, since there is no qualifying event for COBRA for him. Voluntary dropping other coverage does not give rise to a special enrollment (not qualifying event, that's COBRA terminology) for him to get on…
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It is 60 days after the LATER of: the date the QB would lose coverage on account of the QE, or the date notice is provided to the QB of his/her rights to COBRA continuation.
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How does your STD plan define "disability"? Normally it is "the inability to do one's job" due to injury or illness. Why wouldn't these over 15-year people use sick leave to go to the doctor? There should be a clear difference in criteria for sic…
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Just to straighten up some terminology issues with this. A fully insured plan will have a master contract, which is the policy, which is the plan document, (for the employer/policyholder). It will also have an SPD, or a certificate (for the partic…
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Agree with all but to clarify - if any of these coverages is insured, ie., life insurance, the carrier can provide the master contract(policy) and SPD. If you have a TPA, then I assume that the plan(s) they administer are self-funded. Possibly, th…
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It's Revenue Ruling 2003-102. You can find the text at [url]www.ustreas.gov/press/releases/js695.htm[/url], or another website with resources like this.
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MrsBowden, the ruling is permissive. Plans do not have to add OTC drugs to their FSA plans, but they CAN. You should amend the FSA plan document prior to allowing the new benefit, if you're going to. A 10 year old plan document should definitely …
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Reaching the limiting age gives rise to a 36-month COBRA continuation, not 18.
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This may be a little late, but remember that under HIPAA, the new coverage must recognize creditable coverage (to reduce the pre-ex) if it's GROUP, but individual coverage does not, and underwriting is very strict in individual. Her condition would…
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Just do not offer COBRA for a FMLA leave. The taking of a FMLA leave is not a qualifying event under COBRA.
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With a staff of 38, you are not subject to FMLA (50 employees) and if the employee has not worked the required number of hours over the last consecutive 12 months, she is not entitled to FMLA. Lastly, the employee would have to approach the employe…
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No, actually, reduction in hours during a FMLA leave is NOT a qualifying event under COBRA. There are other threads about this subject. During other types of leave, possibly, but not FMLA. It's special. The COBRA QE occurs when the employee does…
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FMLA leave is for a "serious medical condition" of the employee or certain family members. Has anyone experienced this scenario?
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Even though dental and vision are considered "non-core" still, I see no rule which allows an employer to NOT offer COBRA for these. Core/Non-Core Coverage. The new regulations will allow more flexibility to configure the COBRA package of health…
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I am not an expert on Workers' Comp., but when the 12-week FMLA expired, the protection of keeping the benefits in force went with it. Unless I'm missing something about WC, you could terminate the benefits (due to reduction of hours as a qualifyin…
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Why is she going on COBRA?
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If the person does not return to work, then it is a qualifying event. Reduced work hours during FMLA is not. There are special rules with COBRA and FMLA.
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There are previous threads about this. The employer may terminate coverage during FMLA for non-payment of premium. The COBRA qualifying event only occurs when the employee notifies that he/she is not returning to work, or does not return to work…
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Since FMLA is unpaid leave, how would they get the increase during it anyway? Unless you pay during a FML.
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It is my understanding that disabilities or infirmities or risk connected with childbirth exist BEFORE the birth, not after. A person can return to work prior to the 6-week check-up by the doctor. Have you asked for the documentation during this p…
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First he asks if he can take off to babysit because his wife has the flu. Then he asks for FMLA to take care of her serious illness from two years ago, after they say no. I've seen such "stretches" of FMLA on this forum that would frighten the ori…
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The Act requires you to allow a FML (if the ee has worked for at least 12 months and for at least 1250 hours during the 12 months prior to the leave) for a spouse, parent or child. The spouse (if qualified) of your employee wouldn't get the FML eit…
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[font size="1" color="#FF0000"]LAST EDITED ON 08-12-05 AT 06:45PM (CST)[/font][br][br]I don't think it's an August 15 deadline either. My understanding is that Medicare participants have to enroll after November 15 for the Part D prescription cover…
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COBRA begins on the later of the date of the qualifying event (termination) or the date coverage is lost. If your policy has coverage terminating at the end of the month during which the employee terminates employment, then that is the date COBRA c…
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Hi Carol, 8AM to 10PM is 14 hours, not 10. You didn't ask, but in Colorado you have to pay overtime over 12 hours in a day. With these hours, you will have to look at the statutes very carefully in terms of rest and meal times, and do some calcula…
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The final COBRA rules from 2004 did not require a new election form. They clarified and specified notification provisions for qualifying events, added early termination of COBRA and the disqualification of COBRA initially, effective the first day o…