Forums
Health Care for Medicare Eligible
Benefits & Compensation
Health Care for Medicare Eligible
Exchange ideas about health plans, retirement, work/life benefits, and employee assistance.
We are a small investment firm of under 20 in NY State. We currently have on payroll two elderly former firm Directors who are semi-retired (though more retired than not). The two men and their spouse
0
Cat:Topic ForumsForum:ForumId52
Cat:Topic ForumsForum:ForumId52Discussion:DiscussionId36822
Forums » Topic Forums » Benefits & Compensation » Health Care for Medicare Eligible
|
Health Care for Medicare Eligible
posted at 11/26/2010 5:23 AM EST
|
Posts: 34
First: 8/2/2000 Last: 6/22/2011 |
We are a small investment firm of under 20 in NY State. We currently have on payroll two elderly former firm Directors who are semi-retired (though more retired than not). The two men and their spouses participate in the firm's health insurance plan -- a POS plan that is very expensive. The firm does not offer retiree health care benefits to its former employees. Both men and their spouses are on Medicare and our health care insurance is secondary to that because we have fewer than 20 employees. My question is this: Is it legal to remove them from the regular health care plan and instead pay for Medigap coverage for them and their spouses? I have spoken to the the NY State Health Division, two insurance brokers, an attorney and another HR person and no one seems to be able to give me a definitive answer -- some say yes and others say no. The company President would really like to do this and I've been trying to get an answer, to no avail. My feeling is it's probably not legal. I'd appreciate any help. |
|
|
Health Care for Medicare Eligible
posted at 11/26/2010 5:41 AM EST
|
|
Posts: 562
First: 11/12/2009 Last: 9/14/2011 |
Are these individuals eligible for your health insurance under your Summary Plan Description? If not, you would probably be well advised to terminate their coverage (providing that this is what you have done in the past for employees who did not meet SDP definition of employee).
If they are directors (as in board of directors), do you have separate insurance provisions for board members? |
|
|
Health Care for Medicare Eligible
posted at 11/26/2010 12:58 PM EST
|
|
Posts: 2146
First: 2/15/2006 Last: 9/14/2011 |
It is my understanding that if they are eligible for your plan (based on your specific contract), you can NOT force them off of the plan and directly pay for a supplement. This falls under Medicares' laws not under benefits laws. I know I have found it multiple times when searching "medicare working aged rules"
https://www.cms.gov/ProviderServices/06_grouphealthinsurance.asp. They CAN opt out, but you can NOT pay them an "opt out" bonus...in other words, they can NOT benefit from not being in your plan. What you can do is change your eligibility to require more hours. Or make BOD's not eligible. Then you can give them a supplement to make up for the difference. However, that will be taxable to them. But only if they are not eligible (and they must be if they work enough hours -- they can't "age" out as long as they are working enough) |
Forums » Topic Forums » Benefits & Compensation » Health Care for Medicare Eligible
