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Product ID: 391298EAU
 
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Why Is This Guy Still on My Health Plan?

OnDemand Webinar (73 minutes)

There are numerous reasons an individual may be participating in your health plan, from their having a legal right to participate due to their (former) status as an employee or an employee's spouse, domestic partner, or dependent, to the wording of the individual policy, to mistake or fraud. The longstanding federal statutes, known as COBRA and HIPAA come into play, as does the 2010 enacted ACA, the recently revised Defense of Marriage Act, and several other federal requirements. This on-demand webinar will address these reasons, cover how you might formally investigate whether the right individuals are participating in your plan, and discuss how to address a participant or beneficiary who should not have been initially enrolled.

Learning Objectives:

  • You will be able to review the Internal Revenue Code and Employee Retirement Income Security Act of 1974.
  • You will be able to discuss Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
  • You will be able to review Family Medical Leave Act.
  • You will be able to explain eligibility audits.

Authors

Lowell J. Walters, Gray-Robinson, P.A.

Agenda

Health Plan Document

• Active Employee (Employee's Spouse, Dependent or Domestic Partner)

• Former Employee (Employee's Spouse, Dependent or Domestic Partner)

Federal Defense of Marriage Act (DOMA)

• Domestic Partner vs. Same-Sex Spouse

• Domestic Partner vs. Opposite-Sex Spouse

• Effect of State Law

Internal Revenue Code and Employee Retirement Income Security Act of 1974

Patient Protection and Affordable Care Act (PPACA or ACA)

• Active Employee

• Former Employee

• Active Employee's Spouse, Dependent or Domestic Partner

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

• Active Employee, Spouse, Dependent or Domestic Partner

• Former Employee, Spouse, Dependent or Domestic Partner

Health Insurance Portability and Accountability Act (HIPAA)

• Active Employee

• Active Employee's Spouse, Dependent or Domestic Partner

• Active Employee's Former Spouse, Dependent or Domestic Partner

Family Medical Leave Act

Uniformed Services Employment and Re-Employment Rights Act

Medicare Secondary Payer Act

TRICARE Nondiscrimination

Eligibility Audits - Assessing Who Should Be on My Health Plan

• Sample Size

• What to Look for

• What to Do When Ineligible Individuals Are on the Health Plan