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United HealthCare of Utah Address: Main Phone: |
Customer Service Claims U/W / Enrollment Billing . |
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Listed below are frequently asked questions relating to United HealthCare
of Utah and how their managed care coverage works. Review down the list of definitions to
find assistance to your questions. Disclaimer: . |
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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 |
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Add New Employee: A new full-time, eligible employee may apply for coverage after he/she has met his/her "new hire waiting period". They should complete the application forms and return them to: United HealthCare of Utah, 2795 E. Cottonwood Parkway #300, Salt Lake City, UT 84121 Attn: Group New Hire Dept. This should be done 30 days prior to when the waiting period is completed. If the new employee has had coverage prior to his/her employment with you, then he/she need to include with their application a "certificate of prior credible coverage" (see below for details). In addition to his/her application each employee must complete the health history questions and submit with the application. Add Newborn: All newborn children or adopted children are eligible from their date of birth or date of placement for adoption. However, a "Medical Change Form" must be completed, signed and returned to United HealthCare of Utah within 30 days of the birth or adoption placement. If you fail to add the newborn or adoption within the 30 day period then the child must wait until the group "open enrollment" (anniversary date). Children from a "live in" companion are NOT eligible (unless they are the children of the employee). Grand-children are not eligible unless legal custody or guardianship is granted from a court of competent jurisdiction.. Add Spouse: A newly eligible spouse may be added to the employee's coverage by the employee completing a "Medical Change Form" and returning it to United HealthCare of Utah within 30 days of the marriage date. The effecitve date will be the date of the marriage. "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 change form. A copy of the marriage certificate is also required. If the new spouse is not added within the 30 day period then they must wait until the group open enrollment period. Certificate of Prior Credible Coverage: The recent laws passed by Congress now requires an insurance company/HMO or previous employer to provide a "certificate" to any employee who has been terminated off the plan. This certificate shows: the name of the prior insurance company or HMO, the name of the employee and each covered dependent, the start and end dates that the coverage was in effect. 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 will 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 have an 18 month waiting period. The new employee should contact their prevous insurance company or HMO to obtain a copy of this certificate. Change Forms: The "Medical Change Form" is used to make changes to an employees coverage (ie: new address, changing a name, adding or deleting a dependent child or spouse, and also to apply for COBRA or State Continuation.) Have the employee complete and return this form to United HealthCare of Utah within 30 days of the event. If adding a dependent or spouse, this must be done within 30 days. If submitted later than 30 days the dependent must wait until the group open enrollment. C.O.B.R.A/State Continuation: COBRA is a federal law which allows an eligible employee and/or dependents the right to continue his/her current coverage. There are 5 qualifying events which allow an eligible employee or dependent to continue coverage: 1. Termination of employment or a 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 group who have 20 or more employees on payroll on an average business day over the past 12 months. The "qualified beneficiary" has 60 days from the date of termination or date of notification from the employer (whichever is later) to make their election. They then have 45 days to make their first payment to the employer. They must have the Medical Change Form completed with the COBRA box marked and returned to United HealthCare of Utah. The employer is allowed to charge them 102% of the premium. 2% for their adminstration cost. The employee pays the premium to the employer each month. The employer is not required to contribute to the premium. Because COBRA is such an complex law, it is highly recommended that an outside COBRA Specialist be consulted. State Continuation: This is a state law which is similar to COBRA in that an eligible employee may continue their current coverage 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, 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 by simply having the employer complete a Medical Change Form and marking the box to delete coverage. Return this form to United HealthCare of Utah upon completion. 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, his/her coverage would continue through the end of April. United HealthCare of Utah will not make a termination effective more than 60 days following the date on which it was notified by the employer. (Remember it is important to offer COBRA or State Continuation to each terminated eligible employee/dependent) Eligibility: Any full-time employee who works the minimum hours per week (generally 30 hours) is elgible for coverage. Part time employees are not eligible. It is important to have the eligible employee either complete the application forms or sign a waiver and to do this in a timely manner. The application forms must be submitted to United HealthCare of Utah within 30 days of the completion of their new hire waiting period. Late Entrant: If an employee fails to enroll in a timely manner then he/she would be a "late entrant". As such the employee would then wait to enroll during the group open enrollment period. As a late entrant he/she 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 United HealthCare of Utah within 30 days of their completion of the new hire waiting period. Life Event: This provision came as a result of a recent law passed by Congress known as HIPAA. An employee and/or depenent may apply for coverage prior to the open enrollment if they have a "life event". A life event would be: marriage, new baby, loss of coverage (generally by a spouse). If an employee loses prior insurance coverage then they could apply 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 its own "new hire waiting period" This is the period of time from when the employee is hired and when his/her coverage is effective. These periods 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 applications which waiting period they would have. It is important to submit the application forms to United HealthCare of Utah within 30 days of when the "new hire waiting period" is completed. If the application is received late then the employee must wait until the group open enrollment period. Open Enrollment: Each year on the renewal date, most groups will have an "open enrollment" period. This is when the renewal rates generally change and any employee who 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 prior coverage or not. 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 managed care organization or its affiliates for lower fees. By using a PPO the employee generally receives better benefits at lower costs. The provider "writes off" any amounts over the contracted fee. The employee is not respnsible to pay the difference. Also, all paperwork is handled through the provider and the managed care organization or its affiliate. It is highly recommended to use a PPO provider whenever possible. A NON-PPO, are providers who are not on the panel or "list". With NON-PPO plans you may receive care from a provider not on the list but your out-of-pocket charges are higher. You may also be required to submit the bills for reimbursment. Any charges that exceed the normal contracted fees would also be the responsibility of the employee. Pre Existing Conditions: With the recent change in the law, pre-existing conditions are generally covered with prior credible coverage. There are some exceptions. If any employee or dependent did not have prior coverange then he/she would have to wait the 12 month pre-existing condition time period. If an employee is a late entrant on the group plan then his/her PEC would be 18 months. It is very important to include a "certificate of credible coverage" for each employee 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. Waiving Coverage: If a new employee chooses to "waive" 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 he/she has a "life event". If he/she chooses not to be covered when hired, then he/she should sign a waiver form showing the coverage was offered to them. Keep this form in their employee file. . . |
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Copyright © Ryan P. Thorn Insurance Planning Inc. |
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