COBRA/FMLA Compliance

Recently, a court case ruled on the how FMLA, STD, and COBRA work.

The Family and Medical Leave Act (FMLA) ‘provides certain employees with up to 12 weeks of unpaid, job-protected leave per year. It also requires that their group health benefits be maintained during the leave.’ This act ‘applies to all public agencies, all public and private elementary and secondary schools, and companies with 50 or more employees. These employers must provide an eligible employee with up to 12 weeks of unpaid leave each year for any of the following reasons:

·         for the birth and care of the newborn child of an employee;

·         for placement with the employee of a child for adoption or foster care;

·         to care for an immediate family member (spouse, child, or parent) with a serious health condition; or

·         to take medical leave when the employee is unable to work because of a serious health condition.

Employees are eligible for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles. Whether an employee has worked the minimum 1,250 hours of service is determined according to FLSA principles for determining compensable hours or work.’

In the court case, an employee went on FMLA. Once FMLA had run out, their employer put them on STD without offering them COBRA coverage. At the end of STD, the employer offered the employee COBRA coverage. However, the carrier refused to reimburse the employer for medical expenses incurred during the employee’s STD coverage. The employer argued that the requirement to be on FMLA, work 40 hours a week, or be on COBRA was only a condition for initial eligibility, but the court ruled in favor of the carrier, and the carrier was not responsible for reimbursing the employer for the employee’s medical expenses incurred while on STD.

For more information on this case, check out Plan Sponsor. For more information of FMLA, check out the United States Department of Labor.

Pregnant? Check out United Healthcare's Healthy Pregnancy Program!

Pregnancy can be one of the most exciting time of a woman’s – and couple’s – life. At the same time, it can also be a time full of questions, concerns and confusion regarding medical care, the options available, and what steps should be taken to ensure a healthy baby and mother.

In order to make this process easier, United Healthcare has created a site healthy-pregnancy.com that can be accessed by anyone as well as a program for expectant mothers on their plan.

At healthy-pregnancy.com, you can utilize tools such as a due date calculator, week by week baby growth explanations, fitness and nutritional tips, descriptions of the types of delivery available to women, and resources such as an appointment tracker and links to sites that can help you know more about the care your planned hospital offers. Make sure to check out the birth plan checklist (which is printable) so that you can easily communicate your birth plan to your entire labor and delivery team.

The program that United Healthcare has created also provides additional resources to their members. By enrolling for the Healthy Pregnancy Program during the first 33 weeks of their pregnancy, expectant mothers are given access to 24-hour toll-free access to experienced pregnancy and childbirth nurses, educational materials and resources, as well as one-on-one support. Currently, over 41,500 high-risk pregnancies has been identified and supported by the nurses of this program, helping expectant mothers to be more informed throughout their pregnancy.

Aetna eEnrollments and System Outages

Now through July, Aetna will be rolling out enhancements for its eEnrollment users. This staggered rollout will impact one or more states each week, and users for those states will experience a system outage, typically from Thursday to Monday. eEnrollment users should receive email reminders during the week prior to their outage as well as a reminder on their eEnrollment website.

Enhancements to the site will include the ability to support multiple waiting periods for a group, plan and eligibility support, as well as screen screen enhancements for Small group plan sponsers.

As always, you can access Aetna's enrollments site at www.aetna.com/enroll.

Tour Your United Healthcare eServices site!

Utilizing employer eServices sites can be a wonderful tool for HR Administrators. With just a few clicks of your mouse, you can have the ability to enroll new hires, order ID cards, and ensure that your employees' benefits are processed in real time!

Although this option can be a blessing for many administrators, sometimes the systems can be difficult or confusing to navigate at first. Thankfully, United Healthcare is one of the carriers that has been proactive in ensuring that groups feel comfortable using their eServices websites.

If you would like to take a guided tour or use an interactive site demo, United Healthcare has created these options to ensure that your can confidently utilize the eService site. We have even added a link to the guided tour on our video tutorial page for you to go back to should you ever need a refresher!

Change Forms

Have employees needing to make changes to their benefit elections throughout the year due to qualifying events? It is important to supply them with the correct form so that the carrier can process the change request.

To simplify this process for you, you can now access change forms for many of our carriers here on our blog!

Application Quick Checklist

Insurance applications can be a daunting task. Even the simpler health coverage applications can include 47 important fields that need to be completed for processing.

As a new employee with a stack of paperwork to complete in order to receive your benefits, completing your applications may seem like a task to rush through. For an HR Administrator, double-checking forms before submitting them may seem like a task that does not rank highly on your long list of work to complete. However, if you go through our quick checklist, you can potentially save yourself mass amounts of time and effort in the long run!

Make sure all health applications have correctly filled in the following fields: