SECTION 125

QUALIFYING EVENTS

DEPENDENT ELIGLIBITY AND AUDITS

SECTION 125

Health Insurance premiums deducted on pre-tax basis fall under Section 125

Employees must opt out of Section 125 if they do not want to participate

Opting out allows the employee to terminate their medical and dental enrollments at anytime

QUALIFYING EVENTS

Marriage

Divorce

Birth/Adoption

Change in employment status for employee or spouse to include termination, employment or employment category change

Spouse Open Enrollment Period different timeframe

Approval for enrollment into State sponsored benefits

QUALIFYING EVENT FORM

Qualifying Event Form (MCCS FORM 510) is required when an employee is updating their health plans during a qualifying event.

Form 510 should be kept in the OPF along with the 499 and provider forms

SAD is exempt from the HIPPA Portability Rules and does not fall under the qualifying event rules.

DEPENDENT ELIGIBLITY

Dependent Eligible Family Members

Spouse

Children up to age 26 (medical & dental)

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

Parents do not qualify as eligible dependents, even if the employee is financially or legally responsible them

DEPENDENT DOCUMENTATION

Dependent documentation and verification is required for all dependent enrollments.

The employee is required to provide evidence of that dependent’s relationship to the employee.

The following list are acceptable documentation to add Children:

Birth Certificate

Adoption Papers

Official Court Guardianship Designation

DEPENDENT DOCUMENTATION CONT’D

The following list is acceptable documentation to add a spouse:

Most recent 1040 reflecting spouse as a dependent

If new marriage and no 1040 is available, however marriage certificate is required

2010 AETNA DEP AUDIT RESULTS

Total Number of employees Affected – 115

Total Number of Dependents removed – 197

Estimated Financial Savings for MCCS for the Aetna Plan Audit only is $420,000 per dependent

2011 LIFE AUDIT RESULTS

Total Number of Employees Affected - 19

Total number Employee Removals – 6

Total number of Dependent Removals – 15

Numerous enrollments allowed erroneously

Employees forced to terminate

Employees forced to make up missed contributions