Insurance News

  • Virginia Legalizes Marijuana and Expands Employer Restrictions February 23, 2021
    The New Law Affects Background Checks for Job Applicants On Feb. 5, 2021, Virginia passed a new law (House Bill 2312) that legalizes recreational marijuana for adults ages 21 and older in the state. The new law also expands an
  • DOL Proposes New Effective Date for Independent Contractor Rule February 23, 2021
    The Delay Would Allow the Biden Administration Time to Evaluate the Rule Before It Becomes Effective On Friday, Feb. 5, 2021, the U.S. Department of Labor’s (DOL) Wage and Hour Division (WHD) proposed delaying the effective date for the Independent
  • CDC Provides Guidance on Consent and Disclosures for Workplace COVID-19 Testing February 23, 2021
    Informed Consent Requires Disclosure, Understanding and Free Choice The Centers for Disease Control and Prevention (CDC) has issued guidance on the elements of consent and disclosures necessary to support employee decision making when employers incorporate workplace COVID 19 testing.
  • Outbreak Period Expiration Approaching February 22, 2021
    Last year, federal agencies issued relief postponing various employee benefit plan deadlines during a defined “Outbreak Period” to help plans, participants and service providers impacted by the COVID-19 pandemic.
  • 9th Cir.: FMLA Leave Includes “Off” Time in Rotating Schedules February 19, 2021
    An employee working a “one week on, one week off” schedule who takes 12 workweeks of continuous federal Family and Medical Leave Act (FMLA) leave may be required to return to work 12 weeks later, a federal appeals court has held.
  • Additional COVID-19 Relief and Clarifying Guidance for Cafeteria Plans February 18, 2021
    On Feb. 18, 2021, the IRS released Notice 2021-15, which provides additional mid-year election change relief for Section 125 cafeteria plans for plan years ending in 2021.
  • Employers May Have to Provide Paid Military Leave, Court Says February 17, 2021
    Employees who take off work for military duty may be entitled to paid leave from their employers, according to a Feb. 3, 2021, federal appeals court decision.
  • DOL Issues Updated Model Employer CHIP Notice February 9, 2021
    The Department of Labor (DOL) has released a new model Employer CHIP Notice with information current as of Jan. 31, 2021.
  • New York Issues New Guidance on COVID-19 Leave February 3, 2021
    Employers who prohibit employees not in quarantine or isolation from coming to work for COVID-19 exposure reasons must pay them their regular rate, according to new guidance issued by the New York Department of Labor. The Jan. 20, 2021, guidance also states that employees may take leave for three periods of quarantine or isolation, among other points.
  • IRS Updates FAQs on Employer Tax Credits for FFCRA Leave February 2, 2021
    On Jan. 29, 2021, the IRS updated its frequently asked questions on tax credits available to employers for providing paid employee leave under the Families First Coronavirus Response Act.

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.