Column 65 Implementation for 100 Employee Group: Communication is key

Column 64:  Implementation for  100 Employee Group: Communication is key


You are an employer with 100 employees and you are trying to anticipate the process for open enrollment.  Ideally, you will be able to provide your employees with information more than 30 days prior to the effective date so that all are given ample time to evaluate the options and make a choice. 

You will want to provide a packet that includes a summary of the plan and the rates for coverage for the employee and any dependents they wish to enroll.  When you received your quote from the insurer, remember that it likely has a caveat that says if actual enrollment varies 10% from the projected enrollment, the carrier has the right to adjust rates. 

If yours is a "virgin" group, meaning that you have not had prior insurance, there is a very real possibility that the final enrollment could vary, so it would be good to have a caveat in your employee package.

Your enrollment packet should include a simple summary of the plan, but it also should include the SBC (Summary of Benefits & Coverage) as required by the ACA.  You may also provide this electronically to do the employees if you can prove that everyone will get it.  This could be a company email system.   You will want to have this in the event of an audit by the Department of Labor.

In my experience it is best to give no more than a week for folks to make a decision.  Like anything else, most people put it off until the deadline anyway. 

You and your broker can explore online enrollment options in advance of the enrollment to determine if this is appropriate for your workforce. This can be very efficient for groups that have internet access and multiple locations.  Otherwise, good old fashioned paper enrollments need to be processed.  I recommend that you maintain a copy of the enrollment or waiver form for every employee. 

Waiver forms are critical for the protection of both the employee and the employer.  If an employee waives coverage due to other qualifying coverage, and subsequently has an involuntary loss of that coverage, they are eligible to enroll on your group plan within 30 days of the event. Other group insurance such as VA (Veterans Coverage), Medicare, Medi-Cal and the like are qualified.  Individual coverage is not a qualified plan.

Note, that once you offer group insurance to your employees and the premium for the employee only coverage is less than 9.5% of the employee's W-2 income, the employee and/or family are no longer eligible for subsidized coverage under the Exchange.  The Exchange is known as Covered California in our state.

Processing time can take up to two weeks as the applications are "scrubbed" first at the Broker's office and then at the insurer's office.  Since this industry is so highly regulated, the T's must be crossed so while it may seem that the carrier is being "nitpicky", it is simply the reality of this business.

Most fully insured carriers will expect a binder check to be submitted with the master application and the individual apps.  The final premium will be readjusted after underwriting is complete and the group number is issued.

At that time a welcome kit should be sent to all employees providing customer service numbers, policy number and the like to be used until ID Cards are issued.  We encourage our clients' employees to set up online access with the carrier once ID cards are received. These sites provide claim status and excellent health care resources, including discounts for specialty services.  Often the employee can print duplicate ID cards at these sites as well.

Those groups with over 100 employees that already have group insurance are simply going through the same annual shopping and enrollment experience. But those that are "virgin" groups and are facing the "pay or play" decision would be wise to enlist the services of a qualified broker/consultant to be sure they are making the best choice for their individual situation.

Note: All information in this column is provided" to the best of my knowledge" subject to final regulation by the respective agencies.