Tag: mistake

WARNING: Keeping an Employee on Benefits When They Are Not Actively at Work Is Risky

On By Michelle Turner, MBA, CEBSIn COBRA, eligibility, leave of absence, self-insured1 Comment
Employers who are trying to be generous by keeping employees on their benefits plan, may be making a costly mistake.

There are eligibility rules known as “actively at work clauses” for employer group benefits including medical, dental, vision, life, and disability. These provisions allow the insurer to exclude coverage for employees who are not working a minimum number of hours each week, such as when they are on a leave of absence because of an illness or furloughed.

If you have a fully insured plan, the carriers define the rules on how long an employee who is on an unprotected leave of absence (e.g., not out due to a reason covered by the Family Medical Leave Act (FMLA)) may remain on the plan before coverage must be terminated and continuation coverage (e.g., COBRA) offered. If you are self-insured, it is a conversation that should have been discussed when creating plan documents with the stop-loss carrier.

If an employer does not follow this provision and fails to terminate an employee and offer them continuation coverage, then the carrier may not cover any claims, leaving the employer financially responsible. It has been my experience, although the carrier leaves eligibility verification up to the employer, before paying a large claim, many carriers are thorough and review an employee’s status by asking for payroll records.

There is no standard rule for when an employee who is not actively at work must be terminated from active coverage. Often, for ease of administration, carriers will permit an employee to remain on the plan for up to 12 weeks to be the same as a protected leave of absence under the FMLA. However, an employer must check their plan documents and never assume. Once the employee no longer meets the definition of actively working, the employer should terminate the employee and offer continuation coverage. This includes providing port/covert paperwork for life and disability coverage.

If you have questions about the above, or need help with another employee benefits administration question, please contact The Compliance Rundown. We would love to hear from you!

The Compliance Rundown is not a law firm and cannot dispense legal advice. Anything in this post or on this website is not and should not be construed as legal advice. If you need legal advice, please contact your legal counsel.

Common Medicare entitlement (enrollment) COBRA mistake…are you making it too?

On By Michelle Turner, MBA, CEBSIn COBRA, Medicare1 Comment

 

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Medicare entitlement (i.e. eligible & enrolled) is only a COBRA qualifying event (QE) if it causes an employee to lose group health coverage (i.e. under 20 lives, or retiree plan). Otherwise, due to Medicare Secondary Payer (MSP) rules, Medicare entitlement is not a COBRA QE for the employee.

Likewise if the employee voluntarily drops group coverage because they enroll on Medicare and as a result, the dependents (e.g. spouse) then lose employer coverage, this also is not a COBRA QE for the dependents. Medicare entitlement didn’t “cause” the loss of eligibility, rather the employee deciding to drop the employer’s group coverage did.

In other words, when an employee drops their employer’s plan because they enrolled in Medicare, the spouse should not be offered COBRA coverage, but it happens all the time.

Although this is something often incorrectly administered, it is a potential MSP issue because it could be viewed as an incentive for the employee to drop the group plan in favor of Medicare (knowing the spouse will have continuation coverage).

Employees who are turning 65 may also need additional education, to allow them to make an informed decision when deciding whether to enroll on Medicare in lieu of their employer’s plan.

Mistakes happen!

On By Michelle Turner, MBA, CEBSIn Cafeteria plansLeave a comment

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Even HR & Benefit professionals with excellent processes in place to follow the rules for cafeteria plan administration, may stumble upon a mistake.  I probably receive a question at least monthly, on some type of oversight.

For instance, most recently I received an email from an employer who discovered during a payroll audit, they failed to take the correct amount of premiums from an employee’s paycheck per the terms of the salary redirection agreement (e.g. enrollment form) signed by the employee during open enrollment. The employee was enrolled in the correct benefits with the carriers effective 1/1 but somehow the wrong employee pretax deductions occurred and too little premium withheld.

Unfortunately, there really aren’t IRS regulations or guidance addressing what to do when a mistake like this occurs (they only address a few narrow areas). However, my understanding of “cafeteria plan administrative errors” corrections is generally, an employer will want to correct the mistake so the employee and the plan are put back into the position they would have been in had the mistake never occurred.

For example, knowing there hadn’t been enough money withheld, the employer would want to let the employee know an oversight occurred and depending on the amount of the money needed to be made up, either ask for the employee to pay the entire amount or perhaps have double-premiums deducted until the shortfall is corrected.

However, whenever a mistake is discovered, and yes mistakes do happen, the best course of action is to contact an experienced benefits attorney, who can provide legal advice before implementing corrections to ensure all federal & state wage/tax laws are considered. (Let me know if you need one. I can refer you to the best!)