SECTION 125 QUALIFYING EVENTS DEPENDENT ELIGLIBITY AND AUDITS

1. SECTION 125 QUALIFYING EVENTS DEPENDENT ELIGLIBITY AND AUDITS

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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