August 9, 2012
Authored by: benefitsbclp
As we near the first anniversary of benefitsbclp.com, it is a good time to reflect on the past, such as one of our first posts on the importance of clear eligibility terms in a self-funded health plan. This is a particularly timely reflection because the case discussed on that post was just upheld by the Sixth Circuit Court of Appeals in an unpublished opinion.
For those unfamiliar, in the case, an employee who was participating in a self-funded medical plan went out on FMLA leave. When that leave expired, she did not return to work and the employer put her on short-term disability, but continued to allow her to be eligible for the medical plan. After her short-term disability period expired, the employer offered her COBRA, which she elected.
However, the terms of the medical plan provided that eligible employees were those regularly scheduled to work a