 |
|||||
 |
|||||
| SelectHealth www.ihc.com
Address: Main Phone: |
Member Service Phone: (801) 442-3599 (800) 660-3599 Fax: (801) 442-5610 Claims Sales /
Enrollment Billing . |
||||
Listed below are frequently asked questions relating to SelectHealth and how their insurance works. Review down the list of definitions to find assistance to your questions. Disclaimer:
. |
|||||
A . B . C . D . E . F . G . H . I . J . K . L . M . N . O . P . Q . R . S . T . U . V . W . X . Y . Z |
|||||
| Additions: Add New Employee: A new full-time, eligible employee may apply for insurance after they have met their "new hire waiting period". They should complete the application forms and return them to: SelectHealth, SE New Hire Dept., PO Box 30192, Salt Lake City, UT 84130-0192. This should be done within 30 days of when the waiting period is to be completed. If the new hire has had insurance prior to their employment with you, then they need to include with their application a "certificate of prior credible coverage" (see below for details). Remember to have the employee complete both sides of the application form and answer each and every question to avoid delay. Add Newborn: All newborn children or adopted children are eligible from their date of birth or date of placement for adoption on group plans. However, a signed change form must be completed and returned to SelectHealth within 30 days of the birth or adoption placement. Step-children or children from a "live-in" companion are NOT eligible. Grand-children are not eligible unless legal custody or guardianship is given. Add Spouse: A newly eligible spouse may be added to the employee's policy by completing an application form (not a change form) and the health questionnaire and returning it to SelectHealth within 30 days of the marriage date. "Common Law" marriage or "Live ins" are NOT eligible. Any pre-existing conditions would apply unless the new spouse can include a "certificate of prior credible coverage" with the application forms. A copy of the marriage certificate is also required. If the new spouse is not added within the 30 days period then they must wait until the group open enrollment period. The effective date of coverage will be the date of marriage. Certificate of Prior Credible Coverage: The recent laws passed by Congress now requires an insurance company or previous employer to provide a "certificate" to any employee who has terminated off the plan. This certificate shows: the name of the prior insurance company, the name of the employee and each family member who was covered, the start and end dates of coverage. This certificate must be included with any application to show proof that prior coverage was in effect. For those who are listed on the certificate, any pre-existing conditions may be waived. Without the certificate, or if a dependent is not listed on the certificate, they would have a 12 month pre-existing condition period. Late entrants who apply would have an 18 month waiting period. The new employee should contact their previous insurance company to obtain a copy of this certificate. Change Forms: The "employee change form" is used to make changes on an employee's policy. This is used for an address change, name change, marital status change, adding newborn children, deleting family members off their plan, terminating an employee off the plan. If an employee is terminating off the plan, their signature is not required. However, if an employee is electing COBRA or the State Continuation then they need to sign the change form as well as the signature of the employer. COBRA requires a COBRA election form to be submitted along with the termination form. C.O.B.R.A/State Continuation: COBRA is a federal law which allows an employee and/or dependent the right continue their insurance. There are 5 qualifying events which allows an employee or dependent to continue: 1. Termination of employment or reduction in work hours 2. Death of an employee 3. Divorce or legal separation 4. Entitlement of the employee for Medicare 5. A dependent child ceases to be a dependent child. COBRA applies to all groups who have 20 or more employees on payroll on a average business day over the past 12 months. The "qualified beneficiary" has 60 days from the date of termination or date of notification (which ever is later) to make their election. They then have 45 days to make their first payment. They must have the proper COBRA forms completed and returned to the employer within their election period. Remember, IHC has specific "benefit sensitive COBRA forms" depending on which plan the employee has been on. The employer is allowed to charge them 102% of the premium. 2% for their administration cost. The employer is not required to contribute to the premium. Because COBRA is such a complex law, it is highly recommended that an outside COBRA Specialist be consulted. State Continuation/Mini-COBRA: This is a state law which is similar to COBRA in that an employee may continue their insurance upon termination. This is for groups of 2-20 employees. The employee has 60 days to make their election and the employer must notify the terminated employee within 30 days of termination of their right to continue. If the employee waits longer than 60 days to make their election, then their right to continue is forfeited. The employee must have been covered under the group plan for at least 6 months prior to the election and can only extend their coverage for 6 months (vs. 18 or 36 months under COBRA) Deletions: An employee may be terminated from the plan at any time. The employer needs to complete a "change form" and complete the appropriate sections which include the date of termination and the employer's signature. There is no need of the employees signature unless they are electing COBRA or State Continuation. In most cases the employee/dependent has coverage through the end of the month (or billing cycle) Example: If an employee is terminated from employment on April 20th, their coverage would continue through the end of April. Employers are required to notify SelectHealth within 30 days of an employee's termination. SelectHealth will not terminate an employee back beyond 30 days. (Remember it is important to offer COBRA or State Continuation to each terminated employee/dependent) Eligibility: Any full-time employee who works the minimum hours per week (30 hours) is eligible for insurance. Part time employees are not eligible. All children, legally adopted children, or children required through a court order, are eligible for coverage up to age 26 as long as unmarried and financially dependent past the age of 19. Foster children and parents are not eligible. It is important to have the employee either complete the application forms or sign a waiver and to do this in a timely manner. The application form must be submitted to IHC within 30 days prior to the completion of their new hire waiting period. Remember to have all questions answered on both sides of the application form. Late Entrant: If an employee fails to enroll in a timely manner then they would be a "late entrant". As such the employee would then wait to enroll during the group open enrollment period. As a late entrant they would be subject to an 18 month pre-existing condition waiting period (unless proof of prior coverage is provided) It is important that each eligible employee complete the application forms in a timely manner and return them to SelectHealth within 30 days prior to the completion date of their new hire waiting period. Life Event: This provision came as a result of a recent laws passed by Congress known as HIPAA. An employee and/or dependent may apply for insurance prior to the open enrollment if they have a "life event". A life event would be: marriage, new baby, divorce, loss of coverage (generally by a spouse). The employee can apply for coverage within 30 days of the life event. If they wait longer than 30 days, then they must wait until the group open enrollment. If they include with their application the "certificate of credible coverage" showing prior coverage for at least 12 months then any pre-existing conditions would be covered. New Hire Waiting Period: Each employer establishes their own "new hire waiting period". This is the period of time from when the employee is hired and when he/she can come on the plan. These waiting period generally range from 30 days to 180 days. Once the new hire waiting period is selected, it cannot be changed until the group open enrollment period. Also, the waiting period applies to all new employees. you cannot discriminate by allowing one employee to come on the plan earlier than another employee. The only exception would be if you select different waiting periods for salary vs. hourly employees (ie: 30 day wait for salary/ 90 day wait for hourly) This must be clear on all future application forms which waiting period they would have. It is important to submit the application forms to SelectHealth within 30 days of when the "new hire waiting period" is to be completed. If the application is received late then the employee must wait until the group open enrollment period. Open Enrollment: Each year on the policy anniversary, most groups will have an "open enrollment" period. This is when the renewal rates may change and any employee who has waived coverage in the past or was late in applying can reapply. Employees are guaranteed coverage but there may be a pre-existing condition period depending on whether they had prior coverage. Any changes to the plan or benefits may generally be made at this time. PPO vs Non-PPO: PPO (Preferred Provider Organization) is a list of providers (doctors, hospitals and others) who contract with the insurance company for lower fees. By using a PPO the employee receives a better benefit at lower costs. The provider "writes off" any amounts over the contracted fee. The employee is not responsible to pay the difference. Also, all paperwork is handled through the provider and the insurance company. It is highly recommended to use a PPO provider whenever possible. Recently SelectHealth changed their policy where you may use an out-of-network provider on any of their plans, but remember that a lower benefit will result of using these out-of-network providers. You may also be required to submit the bills for reimbursement. Any charges that exceed the normal contracted fees would also be the responsibility of the employee. Pre Existing Conditions: With the recent changes in the law, pre-existing conditions are generally covered. There are some exceptions: If any employee or dependent did not have prior coverage then they would have to wait the 12 month pre-existing condition time period. If an employee or dependent is a late entrant on the group plan then their PEC would be 18 months. It is very important to include a "certificate of credible coverage" to each employee and/or dependent applying for coverage. This "certificate" credits any portion of the PEC waiting period with the time you have had under the prior coverage as long as there was not more than a 63 day break in coverage. Waiving Coverage: If a new employee chooses to "waiver" coverage, then he/she must wait until the group open enrollment date (anniversary date) before he/she can apply. the exception to this is if they have a "life event". If they choose not to be covered when hired, then they should sign a waiver form showing the insurance was offered to them. Send this form to SelectHealth and keep a copy in the employee's file. |
|||||
Copyright © Ryan P. Thorn Insurance Planning Inc. |
|||||