Frequently
Asked Questions
How
do I enroll new hires/additions?
How
does an employee enroll a newborn?
How
does an employer terminate coverage?
Can
I make changes to my health insurance bill?
What
constitutes a qualifying event?
Who
qualifies as an employee for group coverage?
What
are my COBRA responsibilities as a group administrator?
What
is a Preferred Provider Organization (PPO)?
What
is a Point-of-Service (POS)?
What
is a Health Maintenance Organization (HMO)?
What
is a Section 125 Premium Only Plan?
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How do I enroll new hires/additions?
New hires are guaranteed coverage if enrolled when they first become
eligible for coverage. Spouses and dependents are also guaranteed
coverage providing they are added within 30 days of becoming eligible
for coverage. Special enrollment periods are allowed for individuals
who have a qualifying event, which typically are granted to those
individuals who waive coverage on themselves or their spouses and/or
dependents because they are covered under their spouse's plan, COBRA,
etc., and involuntarily lose that coverage. Qualifying event recipients
are guaranteed issue of coverage providing they enroll within 30
days of the event.
Standard
enrollment/change forms should be submitted to Colleen at The Cornerstone
Group. They will be reviewed for accuracy and completion and then
forwarded to the insurance carrier. If additional information is
required, she will contact the group administrator. In the event
of an enrollment problem, you should contact Colleen, who will attempt
to resolve the situation.
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How does an employee enroll a newborn?
A standard enrollment/change form for a newborn should be completed
and submitted to Colleen at The Cornerstone Group within 30 days
of the birth of the baby.
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How does an employer terminate coverage?
A standard enrollment/change form should be completed to include
the date last worked. In most cases, the effective date will be
the end of that month. If the employee wants to terminate coverage,
the employer needs to indicate the effective date. The form needs
to be submitted within 30 days of the event.
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Can
I make changes to my health insurance bill?
Each
health carrier is different, but generally you cannot make any changes
to bills. You are encouraged to pay the bill, as adjustments will
be made by the carrier the following month. If there is concern
about an error, please call Colleen. With terminations, most carriers
allow the employer to delete the employee's name from the bill.
However, please check with your carrier first.
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What constitutes a qualifying event?
Some of the more common qualifying events are death, loss of employment,
reduction in hours from full time to part time, a dependent child
ceasing to be eligible for dependent coverage through spouse due
to termination of employment, spouse takes a leave of absence and
divorce/legal separation. Documentation is required within 30 days
of event.
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Who qualifies as an employee for group coverage?
Owners, accountants, consultants, independent contractors are not
eligible for coverage under the group contract unless they are actual
employees of the group who draw a regular paycheck...compensation
is usually reported to IRS on W-1 forms, not 1099 forms. Such persons
must work for the group the minimum number of hours required.
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What are my COBRA responsibilities as a group administrator?
In order for a group to qualify for COBRA, it must employ 20 or
more employees 50% of the time within the last calendar year. Upon
being notified of a qualifying event, the employer/group administrator
has 14 days to provide the necessary COBRA information. (COBRA brochures,
enrollment forms, rates…the employer can charge up to 2% additional
for administration fees) and notify the former employee he/she is
eligible for coverage under COBRA. Such notification should be sent
by certified mail. The former employee must then provide notification
before the 60th day from the date the employer sends the information
to elect COBRA and another 45 days to pay the premiums. If you have contracted a Third-Party Administrator, the administration of COBRA can be different. In such cases, call Colleen at The Cornerstone Group for assistance.
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What is a Preferred Provider Organization (PPO)?
A Preferred Provider Organization (PPO) is a managed care health
plan with a network of physicians from whom plan members can receive
care to get the highest level of benefits. Participants receive
maximum benefits when their care is provided by the many hospitals
and the thousands of physicians and other professional providers
in a network. Participants can elect to use providers not in the
network, but must pay a higher percentage of their health care costs.
With a PPO, you do not have to select a primary care physician or
need referrals.
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What is a Point-of-Service (POS)?
A Point-of-Service (POS) gives you access to network or out-of-network
services......out-of-network services having a higher deductible
and costs. Members are asked to choose a Primary Care Physician
(PCP) from the network. In network POS plans operate like an HMO...you
need referrals. Out-of-network level of benefits are lower. Each
family member can choose a different PCP, who will coordinate the
patient's healthcare by providing treatment, arranging for tests,
and making referrals to network specialists. With a POS, you have
the freedom to seek treatment from providers that are not in the
network, although at a higher out-of-pocket cost.
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What is a Health Maintenance Organization (HMO)?
Under a Health Management Organization (HMO), you must select a
Primary Care Physician, which must be picked from a designated list
and then you receive all non-emergency care from network providers
and must be referred for specialty care by your PCP. HMO programs
generally show a strong emphasis in preventative care and provide
coverage for routine annual physicals and other preventative services.
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What is a Section 125 Premium Only Plan?
Section 125 of the Internal Revenue Code allows employees to pay
for their portion of employer-sponsored group insurance premiums
with before-tax dollars. Employees will no longer pay federal tax,
state tax (if applicable in employer's locale), or FICA on money
they earn which is applied to the cost of their benefits. The result
is an increase in employee take-home pay. Only firms in which employees
contribute to the cost of their employer-sponsored benefit plans
are eligible for POP. If employers pay 100% of the cost of these
plans, there is no need for POP. It also enables the employer to
save taxes, as you will save FICA matching contributions on all
funds which employees are contributing towards their qualified benefits.
For further information regarding this benefit, contact Gary Oblak
at The Cornerstone Group.
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