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Timely Topics for Group Benefits Administrators Issue 19
April 2007
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.

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.

At Initial Enrollment
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.
 
After Qualifying Events 
 
Dependents can also be added onto the employees plan within a limited time after qualifying events, generally 30-31 days.
  • Marriage
  • Registration of domestic partnership
  • 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.

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.
 
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.
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.
 
 
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?
Email me at cpaul@shargel.com.

 

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Shargel & Co. Insurance Services | 703 Market Street Suite 901 | San Francisco | CA | 94103

 
Timely Topics for Group Benefits Administrators Issue 17
January-February 2007
We've recently received several questions about COBRA and Cal-COBRA. Here's the basic information. It will help you determine which your law your company falls under and who is responsible for administration.
Topics:
  • Cecilia's Corner: Using Technology
  • Requirements Refresher
  • Cal-COBRA Information and Notifications
  • Federal COBRA Information and Notifications
  • Links to Forms
  • HIPAA Coverage
  • Special Note
  • Help us help you!
     
  • Requirements Refresher
    pill case images

    Paperwork, paperwork! Make sure you do all the necessary Cal-COBRA / COBRA paperwork for your departing employees. First, here's a refresher on the basics.

    The Consolidated Omnibus Budget Reconciliation Act of 1985 protects the rights of individuals who would otherwise lose group health coverage.

    It requires employers to provide the opportunity for covered employees and their eligible dependents to continue health coverage at group rates (plus an administrative percentage) after certain qualifying events, including termination of employment or reduction in working hours.

    Health coverage includes medical, dental and vision plans.
     

     
    Cal-COBRA Information and Notifications

    Groups with 2-19 employees during at least half of the previous calendar year are subject to Cal-COBRA law under the state of California.

    Cal-COBRA also applies to federal COBRA participants who have exhausted their coverage.

    Employer Responsibilities

    For Cal-COBRA, the employer must notify the health plan of the employees loss of group health care coverage eligibility within 30 days of termination of employment or reduction in hours. In some cases, an additional form is required. (See the forms section below.)

    Health Plan Responsibilities

    For small employers who fall under Cal-COBRA, the health plan acts as the administrator. The health plan notifies the subscriber of the availability of Cal-COBRA and handles the administration.

    Federal COBRA Information and Notifications

    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.

    HIPAA Coverage


    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.
     

    Special Note


    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.
     

    Help us help you!


    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...

    Happy New Year! Did you know you can take advantage of online tools to help you with benefits administration?

    Many carriers allow you to make employee changes online - to add, drop or change coverage, move people to COBRA or Cal-COBRA.

    Making changes online is secure and fast. It eliminates errors or omissions due to lost paperwork or faxes.

    If you have a benefits topic you'd like to see covered, let us know!

    We appreciate your business. If there's any way we can be of service call us at 415.543.8949

    or if you have a benefits question, email me at cpaul@shargel.com

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