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Timely Topics for Group
Benefits Administrators |
Issue 19
April 2007
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Employees need help
understanding when they
can and cannot add
dependents onto their
benefits plans.
Missing dependents on
an application or not
knowing when coverage
ends can result in
employees' family
members not
having insurance when they
need it.
This month we've got
some reminders for you to
pass along to employees to
keep them covered.
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Timing is Everything |
 Dependents
become eligible for
benefits at key time
periods:
- When the employee
becomes eligible for
benefits after date of
hire.
- For a short time after
a "qualifying event" -
marriage, birth, adoption,
establishment of domestic
partnership, loss of other
group coverage
- At the annual open
enrollment period
Dependents become
ineligible as a result of
other events:
- divorce or legal
separation
- termination of
domestic partnership
- child turning age 19
if not a full-time student
- graduation for
children 19-24 (varies by
carrier)
- marriage of full-time
student
Dependents losing
coverage under the
employee's plan have
individual Cal-COBRA or
COBRA rights. |
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At Initial Enrollment
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Employees
can enroll
dependents-including
spouses, domestic partners
and dependent children-on
their original enrollment
application.
Employees need to fully
complete an application
for each insurance
carrier.
If employees are waiving
coverage for themselves
or their dependents,
they must compete a
waiver form.
Note on waiting
periods:
Most employers have a
waiting period of 30-90
days. Coverage generally
starts the first of the
month following
completion of the wait
period.
We recommend that new
employees complete their
benefits forms well
before their wait period
is over to ensure the
earliest possible
effective date.
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After Qualifying
Events |
Dependents
can also be added onto the
employees plan within a
limited time after
qualifying events,
generally 30-31 days.
-
Marriage
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Registration of domestic
partnership
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Birth or adoption of child
- Loss of
other group health
coverage
See your
administrator's guide for
the required forms. Some
carriers allow you to
process changes online. |
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At Open Enrollment / Plan
Renewal |
Employees
and dependents who waived
coverage or failed to
enroll after a qualifying
event can enroll in
coverage at the plan
renewal.
Enrollment forms must be
completed within the
open enrollment period.
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Prexisting
Conditions |
It's
important to note that PPO
plans may have
pre-existing condition
exclusion limitations and
exclusionary periods up to
six months.
If an employee or
dependent enrolls after
not having coverage, they
may be subject to these
exclusions.
Most dental plans have
exclusionary periods for
some major services.
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Help Us Help You! |
Thank you for being our
client. If you have a
benefits question you
would like us to help
you resolve, let me know
cpaul@shargel.com.
If there's a topic you
would like to see
covered in an Admin
Alert, send an email to
news@shargel.com.
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Cecilia's Corner: Put On
Your Referror's Hat |
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We know you're
busy wearing many
hats. We try to make
the benefits
administrator hat as
comfortable as
possible.
If you know of other
small businesses
that could benefit
from our services,
please feel free to
forward this
newsletter along.
Thank you!
Have a question?
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Carrier Links |

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Shargel & Co. Insurance Services | 703
Market Street Suite 901 | San
Francisco | CA | 94103
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Timely Topics for Group Benefits
Administrators |
Issue 17
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Federal COBRA Information and
Notifications |
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Groups with 20+ employees
during at least half of the previous
calendar year are subject to
federal COBRA law.
The 20-employee count includes
full-time employees plus each
part-time employee counted as a
fraction of hours worked per full-time
workday or pay period. (For example, a
part-time employee working 30 hours a
week where full-time is 40 hours would
count as 0.75 employees.)
Employer Responsibilities
For federal COBRA, the employer is
responsible for notifying the employee
of eligibility for COBRA and
subsequent Cal-COBRA, if applicable,
among other responsibilities.
We recommend using a third party
administrator for COBRA. Most insurers
have a reputable company that they
work with. CobraServ and Ceridian are
examples.
Using a third party adminstrator
ensures that all the necessary
notifications and paperwork are taken
care of.
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HIPAA Coverage |
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When advising an employee or dependent of
his/her rights to continue coverage under
COBRA or Cal-COBRA, employers must ensure
that the employee or dependent understands
that failure to elect COBRA/Cal-COBRA will
result in ineligibility for HIPAA
guaranteed issue coverage in the future.
HIPAA, the Health Insurance Portability
and Accountability Act of 1996, requires
that insurers guarantee issue to
individuals who have had significant (and
continuous) coverage in the small group
market immediately prior to applying for
individual coverage, regardless of health
or other factors.
Unless covered under another group
plan, to remain eligible for HIPAA plans,
the individual must fully exhaust their
COBRA/Cal-COBRA benefits.
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Special Note |
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The information here is presented as a
courtesy reminder for our clients of
employer COBRA and Cal-COBRA
responsibilities. It is not a
comprehensive summary of those
requirements, nor is it intended as legal
advice.
If you have additional questions,
please refer to the appropriate government
site, your legal advisor or human
resources consultant.
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Help us help you! |
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Help us serve you better! If you
run into a challenging benefits issue, let
us know! We'll work with you to find a
solution-and help others.
Thanks for being our client! We
appreciate your business.
We want to make your job easier. Call
us at 800.733.8692 or...
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