Insurance News

  • DOL Provides Guidance on Small Employer Exemption to Coronavirus Paid Leave March 30, 2020
    New FAQs on the FFCRA Address Small Employer Exemption The U.S. Department of Labor (DOL) issued new FAQs that address the small employer exemption to certain paid leave requirements under the Families First Coronavirus Response Act (FFCRA).  Small
  • DOL Issues Guidance Documents on FFCRA March 27, 2020
    Guidance materials on the new Families First Coronavirus Response Act are now available for employers from the U.S. Department of Labor (DOL). Links to the materials, which explain how the law will be implemented and include required notices, can be found on a DOL webpage dedicated to COVID-19.
  • DOL: New Paid Leave Requirements Take Effect April 1 March 25, 2020
    Coronavirus Response Act Applies to Leaves Taken April – Dec. 2020 The paid leave provisions of the recently enacted Families First Coronavirus Response Act will go into effect April 1, 2020, according to Q&As released by the U.S. Department of
  • Congress Passes Coronavirus Aid Law March 18, 2020
    On March 18, 2020, President Trump signed into law a coronavirus relief bill, requiring employers to provide paid sick leave for reasons related to the pandemic, among other measures.
  • Health Plans Must Provide Free Coronavirus (COVID-19) Testing March 18, 2020
    Health Plans Must Cover COVID 19 Testing At No Charge On March 18, 2020, the U.S. Congress passed its second coronavirus relief measure – the Families First Coronavirus Response Act (Act). President Trump is expected to sign the bill into
  • House Approves Corrections to Coronavirus Relief Bill March 17, 2020
    On March 16, the U.S. House of Representatives passed technical corrections to the coronavirus relief bill, titled the Families First Coronavirus Response Act.
  • House of Representatives Passes Coronavirus Relief Bill March 16, 2020
    The U.S. House of Representatives passed the Families First Coronavirus Response Act on March 14, 2020, following negotiations with the White House. The U.S. Senate is expected to vote on the bill this week.
  • Deal Reached on Coronavirus Aid March 14, 2020
    The White House and U.S. House of Representatives have reached a deal that would involve several billion dollars in federal spending and provide free medical testing, paid leave, food assistance for poor families, and other aid for people affected by the coronavirus (COVID-19) outbreak.
  • CO Mandates Paid Employee Sick Days for COVID-19 Testing March 12, 2020
    Effective immediately, Colorado employers in seven industries must give employees up to four days of paid sick leave for testing coronavirus (COVID 19) testing.
  • California Labor Commissioner Issues Guidance on Coronavirus March 12, 2020
    The FAQs address issues such as leave for employees under quarantine or at risk of exposure, questioning employees about their travel to high-risk areas, and the effect of operational shutdowns on employee compensation.

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.