jrodgers221
Junior Member
What is the name of your state? VA
My employer, a Virginia municipality, has 3800 employees. The municipality decided to change its health plan in the middle of its fiscal year. Prior to the change it offered BCBS and Kaiser. Kaiser was retained, and BCBS was dropped and Cigna was added. Employees covered by BCBS were offered the choice of changing to Cigna, changing to Kaiser, or waiving coverage. All employees were invited to change their FSA election, whether or not they had changed coverage. The new plan, Cigna, was a little bit more expensive for employees than BCBS in terms of copays, and some doctors were not included in the Cigna network that were in the BCBS network, and also some that were not in BCBS were in Cigna.
My FSA election for the year is $5000. I have submitted, and been reimbursed for, $5000 in claims already. I asked to revoke my election, and not have the FSA premiums deducted from my pay. My employer has refused to change the election, though my employer said that it would have reduced my election had my claims been less than my premiums paid to date, about $2500. I have examined the Summary Plan Document for the cafeteria plan carefully, and can find no mention of such a situation. My understanding, however, is that the qualified nature of a cafeteia plan requires the employer to have a substantial risk of forfeiture, which they seem to be evading in my case.
A separate matter is whether the municipality has endangered the qualified nature of the cafeteria plan by allowing everyone to change their election. The SPD and IRC 1.125-4(f) specifically prohibit changes in an FSA election for reasons of changes in cost. This does not even take into account the fact that the municipality allowed people to change their FSA election who had no change of any kind (those who were on Kaiser or who had previously waived coverage).
My questions: Must the municipality allow me to revoke my election? Has the municipality violated the rules governing cafeteria plans? Do I have a Qui Tam case?
Thanks very much.
My employer, a Virginia municipality, has 3800 employees. The municipality decided to change its health plan in the middle of its fiscal year. Prior to the change it offered BCBS and Kaiser. Kaiser was retained, and BCBS was dropped and Cigna was added. Employees covered by BCBS were offered the choice of changing to Cigna, changing to Kaiser, or waiving coverage. All employees were invited to change their FSA election, whether or not they had changed coverage. The new plan, Cigna, was a little bit more expensive for employees than BCBS in terms of copays, and some doctors were not included in the Cigna network that were in the BCBS network, and also some that were not in BCBS were in Cigna.
My FSA election for the year is $5000. I have submitted, and been reimbursed for, $5000 in claims already. I asked to revoke my election, and not have the FSA premiums deducted from my pay. My employer has refused to change the election, though my employer said that it would have reduced my election had my claims been less than my premiums paid to date, about $2500. I have examined the Summary Plan Document for the cafeteria plan carefully, and can find no mention of such a situation. My understanding, however, is that the qualified nature of a cafeteia plan requires the employer to have a substantial risk of forfeiture, which they seem to be evading in my case.
A separate matter is whether the municipality has endangered the qualified nature of the cafeteria plan by allowing everyone to change their election. The SPD and IRC 1.125-4(f) specifically prohibit changes in an FSA election for reasons of changes in cost. This does not even take into account the fact that the municipality allowed people to change their FSA election who had no change of any kind (those who were on Kaiser or who had previously waived coverage).
My questions: Must the municipality allow me to revoke my election? Has the municipality violated the rules governing cafeteria plans? Do I have a Qui Tam case?
Thanks very much.