Disabled Holder and Continued Medical Coverage

Discussion in 'Employee Benefits Forum' started by bluemarlin08, Jul 21, 2017.

  1. bluemarlin08
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    bluemarlin08 Well-Known Member

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    Sub s corporation, 63 father owns 51%, son ( who runs the company) 25% ownership, non worker investor owns 24%. Father's salary is 250,000. Father recently had major stroke, no disability coverage. Son is still paying salary and plans to continue although unlikely father will ever be able to work again. Can he continue to stay on group health although not working?
     
  2. leevena
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    leevena Well-Known Member

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    Highly unlikely. Read the plan documents for eligibility.
     
  3. LGilmore
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    LGilmore Well-Known Member

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    How many EEs? Cobra is a possibility for up to 36 months which would take him into medicare If you have 20 or more working on any given day. Are there 20 or more working on a given day?
     
  4. junkman
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    junkman Well-Known Member

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    Find out what the contractual eligibility requirements are. Ask on a hypothetical basis without disclosing the employer name. You don't want running your mouth to crash the case. You are only gathering information. You also don't want to lie to the carrier or take responsibility for your client's decision.
     
  5. yorkriver1
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    yorkriver1 Well-Known Member

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    There should be a guide from the plan carrier that agents can use to find the answer. Your group's carrier may differ, but here is a sample of eligibility rules, the wording from my state's BCBS small group underwriting guide found in the topic: "Ineligible employees":

    "Employees who have not worked full time for six months due to illness or injury (even if the person is covered by Workers Compensation) or for 12 weeks due to leave of absence (LOA) or temporary layoff.
    o A person must be back at work full-time for 2 consecutive weeks and released by his/her attending physician to return to full-time work before the six months recovery period can be restored. Otherwise, any related absences that occur will be considered part of the same absence.
    o A total of 12 weeks LOA or temporary layoff can be taken during any rolling 12 month period."
     

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