Phia Group Media


Phia Group Media

The Gap Doesn't Stop At the Document

By: Jen McCormick, Esq.

We frequently talk about the various types of gaps in coverage – gaps between the plan document and the stop loss policy, the network agreement and even the employer handbook.  The mission for gap-less coverage should not stop there however.  Recently, we have seen situations where employers have gaps in between their documented practices and their payroll practices. For example, an employer may allow continuation of coverage after a leave of absence for up to 3 months.  The problem, however, is that the employer’s payroll system does not allow for manual adjustments and coverage must end after a specified (i.e. two week period).  This creates an issue as an employee is paying for coverage but is not eligible for that coverage under any plan materials.  As a result, employers should not only double check that their plan materials are in sync but that their plan practices (i.e. payroll and otherwise) are aligned with those materials.

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