Insurance News

  • NY Order and Guidance Affect COVID-19 Leave for Employees July 7, 2020
    New York Governor Andrew Cuomo has issued an order barring state COVID-19 leave for employees who travel to states on New York’s travel advisory. In addition, recent state guidance clarifies when health care workers under isolation or quarantine orders are eligible for leave under the New York law.
  • Colorado Passes Paid Sick Leave Law July 2, 2020
    The Colorado legislature has passed the Healthy Families and Workplaces Act (Act), requiring all Colorado employers to provide employees with different types of paid sick leave in different circumstances:
  • IRS Issues Guidance on Leave Donation Programs for COVID-19 June 30, 2020
    Employee leave donated to COVID-19 charities through employer-based programs will not be taxed as income of the donor employees, according to recent guidance by the IRS.
  • IRS Issues Proposed Regulations for Qualified Employee Transportation Fringe Benefits June 30, 2020
    The IRS has issued proposed regulations that provide guidance for employers determining the amount of nondeductible qualified fringe transportation expenses. The proposed rules also provide guidance for applying exceptions, and include definitions, special rules and methodologies.
  • DOL Issues Guidance on FFCRA Leave for Summer Camp Closures June 26, 2020
    The U.S. Department of Labor has issued Field Assistance Bulletin 2020-4, clarifying when employees may take paid leave under the Families First Coronavirus Response Act for the COVID-19-related closure of a summer camp, summer enrichment program or other summer program.
  • DOL Launches Employee Tool for Determining FFCRA Leave June 25, 2020
    The U.S. Department of Labor has created an online tool to help workers determine whether they qualify for paid leave under the Families First Coronavirus Response Act.
  • DOL Issues Five New Fair Labor Standards Act Opinion Letters June 25, 2020
    The New Letters Clarify Compliance Issues With the FLSA On June 25, 2020 the U.S. Department of Labor (DOL) published five new opinion letters. Opinion letters provide the DOL’s official position on how labor and employment standards apply in specific
  • Federal Agencies Release More FAQs on Coronavirus-related Changes for Health Plans June 25, 2020
    New FAQs Address a Variety of Health Coverage Issues Related to the COVID 19 Outbreak The Departments of Labor, Health and Human Services and the Treasury have provided answers to a second set of FAQs (FAQs Part 43) about health
  • President Trump Suspends Entry of Certain Foreign Workers June 25, 2020
    The Order Is Effective Between June 24 and December 31 On June 22, 2020, President Trump suspended the entry to the United States of certain foreign nationals holding specific working, nonimmigrant visas. The order becomes effective June 24, 2020 and
  • OSHA Issues Guidance for Reopening Nonessential Businesses June 22, 2020
    OSHA's Publication Includes Charts and Examples Help Implement Safety Principles On June 18, 2020, the Occupational Safety and Health Administration (OSHA) released guidance to help employers plan how to reopen nonessential businesses. The guidance also addresses issues employers should consider

GROUP INSURANCE FAQ’S

  • Optima Health Questions
  • Anthem and Aetna Questions
  • COBRA Questions

 

*OPTIMA FAQ’s

Do members need a referral to see specialists? No, they don’t. All of Optima’s plans (HMO, POS and PPO) are all considered Open Access. By definition, this means that they may go to any provider set within limits of their plan.

Can groups have more than one option? Yes! Optima is now allowing groups to have dual options all the way down to 2 lives.

What is the deadline to get my Small Group (2-50) enrolled with Optima? Optima still allows Small Group enrollment if paperwork is received by the 10th of the month coverage is effective in. Please note that the 10th doesn’t always fall on a business day, so please contact Elizabeth or Terry for the final date. Remind your groups that the paperwork will still require normal processing time so the later the group enrollment is submitted the group numbers, ID cards, etc. could also be delayed.

Do members have to select a PCP? If they are using a Doctor for their primary care, it is best for them to notify Optima who that provider is. If one is not selected, Optima will select one that is closest to their home zip code. Their PCP can be changed by simply making a request to do so.

What is the employer contribution for small group? There is no minimum employer contribution level in small group (2-50). Keep in mind for the small group self-funded (15-50) plans-on a monthly basis, the employer must contribute a minimum of 50 percent of the employee premium. It must be fair, equitable, and non-discriminatory toward any employee class.

*ANTHEM AND AETNA FAQ’s

Can you write a husband and wife group for health insurance with Anthem? No, due to ACA regulations. You have to have a 3rd employee. That 3rd employee can either enroll or have a valid waiver.

How about Aetna? No, due to ACA regulations, but if you have a 3rd employee, they can either enroll or waive.

Can a dual option contain an HMO plan and a PPO with Anthem and Aetna? Yes, it sure can.

Do you need a VEC report to install a new group with Anthem and Aetna? Yes. If you do not have one, please call us to discuss options depending on the carrier.

Can you terminate an employee the beginning of the month? No, they are terminated the end of the month. This is for both Anthem and Aetna.

How do you terminate a group with Anthem and Aetna? Please submit a request in writing on the group’s letterhead, with the group number and date of termination. Signed and dated by the decision maker of the group.

*COBRA FAQ’s

Which employers are subject to COBRA? Generally, the COBRA law applies to private sector employers that employed at least 20 or more employees on more than 50 percent of its typical business days in the previous calendar year. The law does not apply to churches.

How much does COBRA coverage cost the member? Normally the COBRA members will pay 100% of the premium. The group or third-party administrator may also charge an additional 2% administration fee.

When are COBRA premiums due? Plans must provide members at least 45 days after the COBRA election to make the initial premium payment. After that a plan must give at least a 30-day grace period for ongoing payments.

Do COBRA notices need to be sent to employees/spouses when they are first added to a plan? YES! The COBRA General Notice must be provided within the first 90 days of coverage. The purpose of this notice is to describe their COBRA rights.

How much does Glandon Resources charge employers for COBRA Administration service? Our fee is simply an annual fee of $16 per employee listed on the group’s most recent health bill. There are no monthly fees in addition to that.