SECTION 125 QUALIFYING EVENTS DEPENDENT ELIGLIBITY AND AUDITS
SECTION 125 l Health Insurance premiums deducted on pretax basis fall under Section 125 l Employees must opt out of Section 125 if they do not want to participate l Opting out allows the employee to terminate their medical and dental enrollments at anytime
QUALIFYING EVENTS l Marriage l Divorce l Birth/Adoption l Change in employment status for employee or spouse to include termination, employment or employment category change l Spouse Open Enrollment Period different timeframe l Approval for enrollment into State sponsored benefits
QUALIFYING EVENT FORM l Qualifying Event Form (MCCS FORM 510) is required when an employee is updating their health plans during a qualifying event. l Form 510 should be kept in the OPF along with the 499 and provider forms l SAD is exempt from the HIPPA Portability Rules and does not fall under the qualifying event rules.
DEPENDENT ELIGIBLITY l Dependent Eligible Family Members Ø Spouse Ø Children up to age 26 (medical & dental) Ø Children up to age 19 or 23 if a full-time student • Children may be biological, adopted, step children or other children who are not biological but depend on the employee financially or are legally considered a dependent Ø Parents do not qualify as eligible dependents, even if the employee is financially or legally responsible them
DEPENDENT DOCUMENTATION l Dependent documentation and verification is required for all dependent enrollments. l The employee is required to provide evidence of that dependent’s relationship to the employee. l The following list are acceptable documentation to add Children: Ø Birth Certificate Ø Adoption Papers Ø Official Court Guardianship Designation
DEPENDENT DOCUMENTATION CONT’D l The following list is acceptable documentation to add a spouse: Ø Most recent 1040 reflecting spouse as a dependent Ø If new marriage and no 1040 is available, however marriage certificate is required
2010 AETNA DEP AUDIT RESULTS l. Total Number of employees Affected – 115 l. Total Number of Dependents removed – 197 l. Estimated Financial Savings for MCCS for the Aetna Plan Audit only is $420, 000 per dependent
2011 LIFE AUDIT RESULTS l Total Number of Employees Affected - 19 l Total number Employee Removals – 6 l Total number of Dependent Removals – 15 l Numerous enrollments allowed erroneously l Employees forced to terminate l Employees forced to make up missed contributions
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