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Table of ContentsBusinessPlans has provided answers to some of your most frequently asked questions below. If you do not see what you're looking for please call us at 937.865.6501 to discuss your question in greater depth.
The IRS requires that elections must be irrevocable for the Plan Year. However, if our Plan Document allows, there are circumstances specified in the regulations that allow a change of election without violating the irrevocability requirement called "Change of Status" events. Examples include:
No, only drugs or biologicals which require a prescription of a physician for its use by an individual are reimbursable. The exceptions are insulin and contact lenses solution. The charge must have been incurred (you must have been provided with the medical care), but it is not necessary that you have paid the bill. An orthodontic treatment period usually spans more than one plan year. In order to be reimbursed the expense must have been incurred during the period of coverage (the Plan year). "Expenses are treated as having been incurred when the participant or participant's dependent is provided with the medical care that gives rise to the medical expenses, and not when the participant is formally billed or charged, or pays for the medical care." The entire expense cannot be reimbursed "up-front" because this violates the "expensed incurred "requirement. The orthodontist may require a down payment for the initial application of the braces which can be reimbursed in the applicable plan year. The remaining expenses should be submitted monthly as they occur because of the requirement that reimbursement cannot be made for future dates of service. No, cosmetic surgery is defined as any procedure which is directed at improving the patient's appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. Yes, pregnancy is covered the same as any other illness. Following a specified waiting period (if applicable), you have 30 days to enroll in the company's group plan.
Yes, your spouse's employment would constitute a qualifying event which would allow you to switch from one plan to another. A list of qualifying events include:
COBRA stands for Consolidated Omnibus Budget Reconciliation Act. It is a law that provides employees and their covered dependents, who have experienced a "qualifying event" with the right to continue their group healthcare coverage. All employers (except church and government) who offer a health plan with 20 or more full-or part-time employees on 50% of its typical business days during the calendar year. Cobra information must be provided to all plan participants at the point in time the employee is first covered by a plan subject to COBRA. After a qualifying event, the qualified beneficiaries must be informed by the plan administrator of their rights to purchase a continuation of coverage within 14 days after the plan administrator is informed of the event. The qualified beneficiary must pay the premium due within 45 days following his date of election for coverage. This will allow the employee sufficient time to evaluate whether to purchase COBRA coverage. The 60 day election plus the 45 day payment period is 105 days. If divorce, separation, or child's loss of dependent status, the qualified beneficiary has 60 days to notify the plan administrator. The plan administrator is then allowed 14 days to give proper notice before the 60 day election period begins. This allows the employee 179 days to evaluate whether to purchase COBRA coverage. Normally, the continuation of coverage will last a maximum of 18 months, if a beneficiary lost group health coverage because of a covered employee's reduction in work hours or termination of employment (excluding gross misconduct). Their are cases when the continuation of coverage can be a maximum of 29 months and 36 months.
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