QUESTION: I have a typical medical plan in which the employer-paid benefit is equal to premiums minus participant contributions. However, the participant contributions are paid by the employer until a medical savings account balance is depleted. How can I code this in ProVal?

ANSWER: Set up 2 Benefit Definitions with these Formulas:

Benefit #1: Premiums minus participant contributions:

Gross Benefit Definition.................... Premiums

Participant Contribution .................. PartContrib

Benefit #2: Employer-paid premiums (until medical savings account depleted):

Gross Benefit Definition.................... PartContrib

Participant Contribution ...................<none>

Premiums and PartContrib are the Benefit Formula Components for the medical premiums and participant contributions towards the premium, respectively.

Then, in the Plan Definition, apply a lifetime maximum limit to Benefit #2 equal to the medical savings account balance. For current retirees, specify the lifetime maximum limit using the original account balance and employer-paid premiums to date, or if you don’t have this information, using the current account balance and payments to date of 0.