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The following question comes up all the time, when employers have an employee who is out on an extended Workers Compensation or other leave of absence: "When our employee is out on workers compensation benefits for an extended period of time, and he/she is not 'actively at work' as specified by our Group Health Plan and thus not eligible under the plan for coverage, what do we do - how do we maintain health insurance coverage to our valuable staff?  Do we have to terminate the employee and risk all that follows in that termination?" The answer is relatively simple, yet complicated enough to cause confusion:   CalCOBRA & COBRA. An employee does not have to terminate employment to qualify for COBRA or CalCOBRA benefits. A reduction of work hours is also a qualifying event. But therein lies the trap: Many employers don't understand that family time off and workers compensation time off and maternity leave, etc., resulting in a reduction of work hours that can then be used against an employee's eligibility criteria, are considered to be a qualifying event, and thus may trigger a coverage shift.  Most medical plans state that the employee must be actively at work to be eligible for benefits.  The medical insurers will check, in the event of a serious claim or if they discover that there may be an issue of eligibility, to verify employment status.  If an employee is off more than 3 days, he or she may no longer qualify.  Generally, your insurance company will cover terminated or ineligible employees  through the end of the month in which the employee's status changed, but that should be verified by the insurance companies' representatives and your company's HR coordinator (that may be you).  Then, the employees need to be offered CalCOBRA or COBRA or FMLA benefits.     So, when the event - termination or simply a reduction in hours - occurs, contact your health care provider to convert the employee to CalCOBRA or COBRA  status; once the employee returns to work, then notify the insurer of the employee's back to work (full time) status.  Then, the employee begins the process to return to the status of a regular participant in the group plan.   This process can vary with Federal laws regarding Family Medical Leave Act and other issues governing employment.  Which group do you fall into?  Note:  When we say "employees", we mean total number of employees - full & part time - not just the number of employees insured under a plan: * Under 20 Total Employees:  Remember, this means total employees, not just under 20 employees eligible for insurance. This employer is subject to CalCOBRA rules. *Over 20 but under 50 Employees:  This employer is subject to Federal COBRA rules. *Over 50 employees, you bought the entire program: Federal COBRA and Family Medical Leave Act (FMLA).  *Are you in a pooled benefits program?  You may have only 14 employees, but if you are pooled with several other businesses in an association or trade group, you may be subject to all State and Federal regulations regarding COBRA and FMLA.  For sure, this would apply if you belong to a PEO, or it may possibly apply to an ASO structure - check with these administrators. Family Medical Leave (FMLA) brings new issues to the table, and these can at times conflict with group health eligibility conditions. If you are large enough to qualify for FMLA status, you need help if you don't have your own, specialized HR department; and perhaps you still need some assistance. The best thing you can do for yourself, if you have more than 20 total employees, is to retain the services of a COBRA administrator.  We recommend Conexis, which operates from Orange County and has other offices as well.  Call our agency for more information on this subject and how to access Conexis: Our phone number is 562-594-6541 or 800-400-3224; go to Stan's extension #15. If you have less than 20 employees, many of your small group medical insurance companies will provide assistance in meeting some of the notification requirements under CalCOBRA.  But, it is best to check with the insurance company; call the company's customer service line to find out what they will and will not do - that's the best medicine.   Stan Dreckman,  HYPERLINK "mailto:stan@hdinsure.com" stan@hdinsure.com PS:  Coordinating your workers compensation with medical benefits can be a beneficial thing.  Contact me to ask about getting insurance quotes for workers compensation and group medical under one plan.  _hlЫщ  „ Љ ‡ в д е ѓ ћ 2 4 F ]  Ї29ѓє,-љњђсђнгЧПнКнгнЖнАнЖнАнАнЈн н š н–hШ63 hHи0JjhHиUhHиhHи5 hHи0JhPVf hHи>*hHиB*phhHи0J>*B*phhHи0JB*phhHи hHи56>*B* CJ(aJ(ph€hHи5B* CJ(aJ(ph€l ‡ ч { У rяВmс ŠфљњєяяяяяяяяяяяяяяяяяэgdPVf $[$\$a$gdPVfњ§21h:pPVfАа/ Ар=!А"А#а$ %ААаАа а†œ@@ёџ@ NormalCJ_HaJmH sH tH DA@ђџЁD Default Paragraph FontRiѓџГR  Table Normalі4ж l4жaі (kєџС(No ListB^@ђB Hи Normal (Web)ЄdЄd[$\$*W@Ђ* HиStrong5\4U@Ђ4 Hи Hyperlink >*phџњ џџџџl‡ч{Уrя В  m с Šфљќ˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€l‡ч{Уrя В  m с Šфљќš@0€€€KШ00Ш›KШ00›KШ00›KШ00›KШ00›KШ00›KШ00›KШ00›KШ00›KШ00›KШ00›KШ00›KШ00›KШ00›KШ00€IШ00€KШ00€ 0”њ њњѓ,њXџŒ№8№@ёџџџ€€€ї№’№№0№( № №№B №S №ПЫџ ?№џџUљn„НщVљnещWљnєЗННФќУЪЪќ=*€urn:schemas-microsoft-com:office:smarttags €PlaceType€=*€urn:schemas-microsoft-com:office:smarttags €PlaceName€9*€urn:schemas-microsoft-com:office:smarttags€place€ P˜Ўен19IQљЂ Њ ” –  Ї292:ќ]f[ ` ќ33l__††ЌЌдеии24ЋЋЌ­зк  6 6 ў ў ” ” ш ш щ ъ jmno9;<=lmИИЙКљќ” – ќj@-4~c хF+Ш63PVf‚;iDc†ъ9)™—ЪHиџ@€” ” ˜#Сдд” ” њP@џџUnknownџџџџџџџџџџџџG‡z €џTimes New Roman5€Symbol3& ‡z €џArial"qˆ№аhуќЃІяќЃІ ЎL  ЎL !№аДД24dёё2ƒ№HX)№џ?фџџџџџџџџџџџџџџџџџџџџџHиВџџhUnder Your Company s Group Health Plan, Are All of Your Employees Covered Right NowStanStanўџр…ŸђљOhЋ‘+'Гй0а˜ (4@P `l Œ ˜ ЄАИРШфlUnder Your Company’s Group Health Plan, Are All of Your Employees Covered Right NowStanNormalStan3Microsoft Office Word@М e@ŠA=UЦ@в=ю>UЦЎLўџеЭеœ.“—+,љЎDеЭеœ.“—+,љЎ”P hp|„Œ” œЄЌД М 1ф  ёц iUnder Your Company’s Group Health Plan, Are All of Your Employees Covered Right Now TitleД 8@ _PID_HLINKSфAl$mailto:stan@hdinsure.comи ўџџџўџџџ !"ўџџџ$%&'()*ўџџџ§џџџ-ўџџџўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџRoot Entryџџџџџџџџ РFц?UЦ/€1TableџџџџџџџџaWordDocumentџџџџџџџџ4 SummaryInformation(џџџџDocumentSummaryInformation8џџџџџџџџџџџџ#CompObjџџџџџџџџџџџџqџџџџџџџџџџџџџџџџџџџџџџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџ џџџџ РFMicrosoft Office Word Document MSWordDocWord.Document.8є9Вq