Linda Michaelsen wrote:
Based on HIPAA (wpc-edi) ANSI 834 document...
Reason 8 for INS 08 says Bankrupcy of A Retired Employee. Is
this code used when the company files for bankrupcy for only
the retired employees, i.e. the active employees would use 1
for termination and the Retired would use reason 8?? If not,
what is the usage?
Dear Linda:
Surely a question like this will cause eyes to glaze over for anyone not
acquainted with America's byzantine health care system, which by
historical accident is mainly tied to one's place of employment.
Rather than INS08, you're undoubtedly referring to INS07, D.E. 1219 -
the Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying
Event - in TS 834 (Benefit Enrollment and Maintenance). Code '8' is
defined as "Bankruptcy of a Retired Employee" - surely a misnomer (on
X12's part) since the event is the bankruptcy of the retiree's former
employer and not that of the retiree himself. That leaves the geezers
free to fire up the old Winnebago and head off to Vegas to gamble their
pension away and still keep their former employer's group health
insurance.
But is yours really an EDI, or even an application, question? Probably
the HR department is a better place to ask, or somebody who knows how to
read IRS regulations or case law regarding COBRA. Whatever the business
expert told you was the qualifying event would be codified using one of
the X12 codes - there'd be no decision on your part: e.g., if they say
"Termination" was the reason, then you would blindly use code value 1
(Termination of Employment - The termination or reduction in hours of
the employee's employment, excluding termination due to gross
misconduct. Maximum coverage period is 18 months).
Whether active employees could call themselves "terminated" for the
purpose of COBRA would depend on the nature of the bankruptcy; if the
company's carcass is sold, along with the employees, to another company
which has no (or crappy) insurance, then you might say this was a
�termination� of employment as far as COBRA is concerned. Go ask a
lawyer.
COBRA coverage usually lasts only while the employer continues a health
plan for active employees. In general, if there's no longer a health
plan, there is no COBRA coverage either. Code '8' in particular would
seem to apply only to the special exception of retirees and their
dependents (and then only if the employer provides coverage for retired
employees at all), and certainly not to active employees of a bankrupt
concern which dropped its health plan.
Rest assured that XML/EDI doesn't make this question any easier to
answer; though some of the extreme XML bigots would have you just code
the following so everyone would auto-magically know what you were
talking about:
<COBRAQualifyingEvent>
like, y'know, company went bust. Know what I mean?
</COBRAQualifyingEvent>
William J. Kammerer
FORESIGHT Corp.
4950 Blazer Memorial Pkwy.
Dublin, OH USA 43017-3305
(614) 791-1600
Visit FORESIGHT Corp. at http://www.foresightcorp.com/
"Commerce for a New World"
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